COLUMBUS, Ohio – The Ohio Department of Medicaid (ODM) has confirmed it will begin phasing in Electronic Visit Verification (EVV) requirements next year. The announcement aligns with recommendations from the Audit in the Public Interest of EVV released Tuesday by Auditor of State Keith Faber. The full audit report is available online at ohioauditor.gov.
The EVV system, mandated by the 2016 federal 21st Century Cures Act, requires states to use electronic verification for Medicaid-funded personal care and home health services that involve in-home visits. The system aims to ensure Medicaid payments for services rendered are electronically verified.
Audit Findings
The audit reviewed data from January 1, 2022, to December 31, 2022, assessing whether Medicaid payments for in-home services were supported by electronic verification. Key findings included:
- 56% of services lacked EVV verification: More than half of covered in-home services were not processed through the EVV system.
- 37 of 100 providers did not submit EVV data: Auditors found many providers were not using the system at all.
- $1.1 billion in unmatched claims: Out of $2 billion in total claims, $1.1 billion could not be matched to an EVV entry.
Ohio was one of 34 states that had not yet required EVV compliance during the review period, which auditors identified as a factor contributing to the low usage rate.
Auditor Recommendations
To address these issues, auditors recommended that the Ohio Department of Medicaid:
- Increase communications with providers about the importance of using EVV for covered services.
- Require EVV compliance as a condition of payment for Medicaid-reimbursed services.
- Develop an electronic scorecard to track and share provider compliance with EVV requirements.
The findings and recommendations are expected to guide ODM as it begins phasing in EVV requirements in 2024.