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Independent Living News & Policy from the National Council on Independent Living

NCIL Position Opposing Electronic Visit Verification

The National Council on Independent Living Opposes Section 207 of H.R. 2646, Regarding Electronic Visit Verification.

As the nation’s oldest cross-disability, national grassroots organization run by and for people with disabilities, NCIL vehemently opposes the passage of § 207 of H.R. 2646, requiring electronic visit verification (EVV) for personal care and home health services under Medicaid. This requirement which appeared last minute in markup will only serve to harm people with disabilities and seniors, and is little more than a handout to EVV companies.

This EVV requirement, based on false stereotypes that disabled people and seniors are helpless and homebound, only serves to infantilize and discriminate against older and disabled Americans who require personal care and home health services. Furthermore, this requirement could result in the States being found as joint employers under the new Fair Labor Standards Act companionship rules, resulting in significant unfunded costs being imposed on the States. This requirement, which is harmful and burdensome to both individuals and the States, cannot pass into law.

Electronic Visit Verification Impedes the Rights of People with Disabilities and Seniors

EVV is based on the archaic and offensive idea that disabled people and seniors are unable to leave their homes. However, the majority of our nation’s laws that have been passed in the past 3 decades regarding people with disabilities are based on the presumption that people with disabilities are not only capable of living active lives in the community, but it is our right to do so. Receiving services to assist us to live independently in the community does not make us any less active in our communities, on the contrary, the services we receive are provided to us with the precise purpose of helping us to be more active in our communities. People with disabilities and seniors who receive services are students, employees, volunteers, athletes, artists, and voters. We speak many languages, we go many places, and participate in and add to the richness of our communities. Beyond our opposition to the EVV requirement on principle, we oppose this requirement because our lives are not congruent with EVV systems, which are essentially government tracking systems for Americans with disabilities and seniors: these systems that would require us to stay at home all day, and speak and understand one language, or be accused of fraud. 

For example:

  • The EVV systems that use geo-tracking effectively put people with disabilities and seniors on house arrest because their attendants will not be paid when the geo-tracking indicates that they have left the home. Not only does this hinder our ability to perform our daily activities, such as working, going to school, buying groceries, and socializing with friends, it also violates our rights to freedom of movement. All of the progress we’ve made in making our country more accessible under Americans with Disabilities Act is useless if we are restricted from leaving our homes.
  • Similarly, EVV systems that require attendants to check in from a home phone number multiple times per day also puts us under house arrest. Having our attendants check in from home phone numbers (that many of us no longer have in the 21st century) requires us to stay at home so the calls can be made. The very purpose of attendants is to help disabled people and seniors to live in the community. This purpose is defeated if we cannot leave our homes for fear of losing our services because our attendant does not call in at precisely 3:15pm.
  • The EVV systems that allow cell phones to operate as the point of contact, and call at random times intrude on our lives and privacy. These systems require the person with a disability or the senior to always have their cell phone on them, to never allow the battery to die, and to hand our phones over to our attendants to use for verification at random times. Essentially, this means that a 28 year old woman receiving services can never forget her phone when she’s running out the door to work, and can never let her cell phone battery die, because if she does, her attendant may be accused of fraud. This also means that when this 28 year old woman is on an important conference call for work, she may be forced to hand over her phone to her attendant to answer a verification call.
  • The EVV systems that require the voice recognition or speech recognition discriminate against Deaf and non-English speaking workers. A Deaf wheelchair user may prefer to use a Deaf person as their attendant in order to have effective communication; however, if their Deaf attendant cannot hear the instructions on the phone and/or voice their answers, the EVV system will presume fraud is occurring. Likewise, any non-English speaking attendants would also be subject to fraud accusations because of the EVV system.

Electronic Visit Verification is Not More Effective than Peer Review Systems

EVV systems often involve GPS tracking or telephone based systems for healthcare workers to call into a system to verify their shift. EVV is less effective than peer review systems that involve a common written timesheet which require sign-offs from multiple attendants and from the consumer to verify that an attendant has completed their shift. EVVs rely on the mistaken belief that electronic systems are more reliable or less able to be tricked than other forms of verification, when in fact phone numbers and other purely electronic systems are less secure than systems that require multiple sign-offs. In fact, in some States where EVV is required, consumer directed personal assistance (CDPA) services have been exempted because nature of CDPA services and the burden that EVV imposes on the disabled people who direct and receive CDPA services. By including this as a Federal mandate, Congress would deny States the ability to make the decision on whether CDPA, or other services, should be excluded from the EVV requirement.

States Could Be Found as Joint Employers, Imposing Significant Costs on the States

The EVV may impose significant liability on States in the form of joint employment. If EVV is mandated for all personal care and home health workers who provide services through Medicaid, the State may be found to be a joint employer of those workers under the FLSA. Under the new FLSA companionship rule, joint employers are required to pay overtime to personal care and home health workers. As a result, States are likely to encounter a significant financial liability for unpaid overtime costs. Where States are found to be a joint employer, States may be liable to pay overtime for any hours over 40 worked by the attendant through multiple agencies in the State. For example, if Joan works 40 hours for Max, a disabled man, through Loving Homecare, and 20 hours for Stella, an elderly woman, through Lifetime Independence, the State may be liable as a joint employer for the 20 hours of overtime that Joan worked, because the requirement to use a single EVV system for reporting tasks and checking in makes the State a joint employer of Joan.

Because the EVV requirement is unnecessary and harmful individuals with disabilities and seniors, NCIL opposes the EVV requirement.

Comments

  1. Travis Hoffman says:

    Is this supposed to be H.R.2446, not H.R.2646?

  2. This is sad because there is a large denial of the tax payer rights that are paying for services that are not able to be verified. We are at a time in our economic history that we cannot sustain fraud, waste and abuse. A reasonable view of EVV should evidence that there are many benefits to accountability and assurance of worker presence. This NCIL is not paying attention to the fact that paper time sheets are a system that supports significant fraud, waste and abuse at every level (for the worker and/or for the billing agency). Accountable electronic assurance of presence gives some assurance to the tax payer, the person getting service and the family caregivers who want to know… is someone there???

    • The idea that attendants commit a “significant amount of fraud” is abhorrent in its assumption that there are a significant percentage of attendants who are criminals, particularly in the Consumer Directed model, where attendants are usually family members, ex-spouses or close personal friends. You have justified NCIL’s opposition to EVV by your stereotypical establishment response.

    • @not necessary,
      I am Deaf, and two out of my 6 PCAs are Deaf as well. In addition, I live in an area with spotty cellular service. My phone only gets a signal in my back yard, and it records me as living two towns away. As a result, all of my entries would need me to confirm them through another system, such as the online timesheet system that I’m currently using. Care providers clock in and out, just like any other job. The attempts to make the process “easier and more accurate” will make things more complicated due to a voice control system that is inaccessible to myself and 1/3 of my PCAs, and it will only work outside of my house. My last PCA shows up at 10pm and leaves between 1:00-2:00am. I’m sound asleep by then, transferred to my bed, positioned comfortably, hooked to the ventilator and other devices. Then, she does a batch of laundry and tidied up. In order to clock out with the new system, she would need me to verify it…and go outside in order to get a signal.

      I understand your concerns regarding accountability, and that’s why my PCAs clock in and out on my own hard-wired computer. The EVV system will make the process less accurate and less accessible.

    • I am a tax payer and also a pca user and the idea that fraud is committed in the consumer controlled model has consistently been refuted as being a very small percentage of people who use the program to remain independent in the community. Get educated on the issue @not necessary!

    • I have no idea who “not necessary” is, or what knowledge he/she possesses, but that knowledge does not include living with a significant disability. In my state, our former governor claimed the personal care systems were “rampant with fraud as high as 25 percent”. Our legislators caved in and passed onerous regulations. Then, after the damage was done, they actually checked the “fraud” rate. It turned out that the actual fraud rate was .04!

    • belinda stradley says:

      December 2017
      EVV-CA-Subscribe@yahoogroups.com

      CALL TO ACTION!

      DISABILITY COMMUNITY AND ALLIES ACROSS THE UNITED STATES
      THERE IS AN URGENT NEED TO ACT TO PROTECT THE FREEDOM AND PRIVACY OF INDIVIDUALS WITH DISABILITIES AND THEIR CARE GIVERS

       A new federal law has been enacted that poses perhaps the most serious threat to the independence of people with disabilities in decades. The 21st Century CURES Act Section 12006 enacted December 2016 mandates that states implement electronic monitoring of people with disabilities receiving In-Home Support Services (IHSS) and their caregivers. This onerous law is being implemented across the country with a January 1, 2018 deadline, or states face cuts to their already strained Medicaid funding.

       ELECTRONIC VISIT VERIFICATION (EVV) is an electronic tool used by the state to monitor the location and activities of IHSS workers and individuals with disabilities who require help with daily activities to avoid institutionalization. This can include geo-tracking or GPS. EVV attacks the rights, privacy and freedom of movement for people with disabilities and their workers (who are often family members).

       As states implement EVV during 2017, there is an alarming trend toward states utilizing placement agency models, instead of the individual personal care provider model which predominates in CA. This trend shifts control away from consumers (and independent living) toward placement agency care (aka off-site nursing home care).

      CALL and WRITE YOUR SENATORS AND ASSEMBLY MEMBERS and tell them that you are OUTRAGED BY THIS ATTACK ON OUR CIVIL LIBERTIES AND PRIVACY! TELL YOUR REPRESENTATIVES TO TAKE A STAND WITH US AGAINST SURVEILLANCE of our movements IN OUR OWN HOMES!!

       EVV will funnel a give-away of hundreds of millions of dollars to private companies to surveil people who may already struggle with everyday living. These federal funds should instead be used to raise the pay of home care workers above minimum wage, or to ease the suffering of seniors and people with disabilities who are forced to live on SSI at $898 a month (including food and housing). This is not enough to afford even a studio apartment and avoid having to go into a nursing home. Tell your representatives not to waste this federal funding on EVV, but instead help us to be able to stay out of institutions, to not become homeless, and not have to live with chronic hunger.

       EVV undermines the civil rights that the disability community and our allies have fought so hard to establish over many decades. Now we are fighting again against this costly boondoggle to protect our rights to self determination, freedom of movement, independent living, and the ability to be active in our communities and to participate in civic life.
      ELECTRONIC VERIFICATION IS THE OPPOSITE OF INDEPENDENT LIVING AND CONSUMER CONTROL. Some states are starting to require that, to facilitate monitoring, people with disabilities must stay at home to receive In-Home Support Services.

       The National Council on Independent Living (NCIL), which opposes this law, reports that EVV systems basically place people with disabilities under house arrest because they’re constantly monitored when they’re with their personal care workers. “This requirement, which appeared last minute in a markup will only serve to harm people with disabilities and seniors and is little more than a handout to EVV companies.”

       This electronic surveillance mandate discriminates against seniors and people with disabilities who need to use home health services. It relies on prejudice and stereotypes that we are helpless and homebound. To the contrary, the civil rights laws passed in the last thirty years for people with disabilities mandate that we are have the civil right to equal participation in our communities. In-Home Support Services are intended to support us to be part of society, not to keep us prisoners at home so that we and our care workers can be monitored by the state.

       All of the progress we’ve made in making our country more accessible under the Americans with Disabilities Act is useless if our ability to leave our homes is undermined by EVV reporting requirements that put restrictions on our freedoms.
      WE WILL NOT LET OUR HOMES BE TURNED INTO OUT-CALL NURSING HOMES
      TELL YOUR LEGISLATORS TO DEFEND OUR CIVIL LIBERTIES
       The National Council on Independent Living reminds us that “People with disabilities and seniors who receive services are students, employees, volunteers, athletes, artists, consumers, and voters. We speak many languages; we go many places; we participate and add to the richness of our communities. Beyond our opposition to the EVV requirement on principle, we oppose this requirement because our lives are not congruent with EVV systems, which are essentially government tracking systems for Americans with disabilities and seniors.”

       EVV WILL CHANGE THE RELATIONSHIP BETWEEN PEOPLE WITH DISABILITIES AND CARE WORKERS. Independent living and consumer control of our lives means that we and our care givers work closely together. The individual with a disability trains and directs workers in achieving our daily living goals. With EVV, the state steps into the middle of this relationship, usurping the role of the employer with a disability. EVV forces workers to divert precious time with consumers to instead enter electronic data about very personal activities. Consumers can find this invasion of our privacy humiliating as it gives information about hygiene and bodily functions through electronic methods that are not secure from hacking.

       Turning this employer relationship on its head, EVV tells workers they are responsible to the government more than to the person with a disability, and that the disabled person may be less than competent. EVV portrays the person with a disability more like a patient in the medical model, and undermines the very essence of consumer-driven independent living. Loss of this consumer control will force many back into institutions.

       EVV will be more compatible with home care placement AGENCIES than with individual workers whose only priority is the consumer that hires them. This default to agency placement of workers in the home will undermine consumer control. Agency employees will follow agency rules instead of directions given by the consumer.

       EFFECT ON PROVIDERS – EVV imposes new stringent requirements on IHSS providers that didn’t exist before. Learning how to use EVV technology will be too big a challenge for many workers. Adding technology makes the job more difficult, and puts more pressure on their time when their pay will not be raised to match. The type and duration of services performed changes daily. Having to report every detail to the state is onerous and will turn away potential workers of which there’s a chronic shortage.

       Consumers face huge challenges recruiting and retaining quality homecare workers. There are never enough people willing to do the work for the low pay. EVV will only exacerbate the shortage of workers and make it more difficult for consumers to remain safely in their homes. At minimum wage, many workers live on the brink of homelessness, and they often face late pay checks from the state. EVV adds more hoops to jump through, and will discourage many who might consider this employment.

       Electronic Verification is NOT More Effective and is less secure against hacking than existing paper Peer Review Systems. A written timesheet with sign-offs from attendants and consumers effectively verifies that a shift has been completed, and also keeps the consumer’s confidential personal information safe from electronic hacking. So, why must be millions of dollars be squandered in a giveaway to high-tech organizations that would spy on us in our homes instead of providing care for us?!

       Missouri appears to exempt Consumer-Directed Personal Assistance (CDPA) services from EVV. What can we learn from their independent living consumer-based model?
      PRESERVE YOUR PRIVACY AND AUTONOMY

      ORGANIZE..NETWORK..ACT UP..SIT IN..LAY DOWN..FIGHT BACK!

      SAY NO TO TURNING OUR HOMES INTO OUT-CALL NURSING HOMES

      JOIN THE EVV DISCUSSION AT EVV-CA-Subscribe@yahoogroups.com

    • Ellyn Kearney says:

      Not Necessary, can’t imagine who you are speaking for – lol – but to imagine such a dystopian universe as to say that EVV is the only way to provide “assurance” that the work is actually being done and that “fraud, waste and abuse” are the sole concern of paper processes are naive at best. You obviously belong to the rarefied group that is wealthy enough to know you will never need assistance in this life. Praying God gets hold of you in a meaningful way!

  3. Would be nice to have info here about how we can act to oppose this bill. Can someone post a link to the bill itself? This page does not appear to provide a link to finding out who your reps are in congress. Maybe add that 🙂

  4. Alicia Hopkins says:

    EVV also puts consumers and providers who are victims of violent crimes or domestic violence at risk if system were ever hacked.

  5. I am an employed Educator and am also a graduate student. I am Deaf and I hire Deaf Personal Care Attendants. I use a wheelchair for mobility and have significant health issues, including noninvasive ventilation and parenteral nutrition and hydration. Despite these limitations, I am a productive member of society, pay taxes, and pay premiums for three sources of health insurance. (Private indemnity plan, Medicare A/B/D, and a Medicaid supplement that only covers hearing aids every 5 years and PCA services for 48 hours/week. I live an an area with spotty cell phone coverage. While it has improved over the years, I still cannot get cell service inside my house. In order to make a call, I need to go into my back yard. How will this work, if my PCA has helped me transfer into my bed…and then needs me to go outside to verify her hours?

    The current system allows my PCAs to sign in and out online under their own names. They can do this right from my home computer. I receive a report listing everyone’s hours and have the ability to correct errors. I compare the arrival and departure times to my master schedule and contact the PCA to check on any discrepancies, such as forgetting to log in/out or an error when reporting dates or times.

    I am NOT home bound when I have PCA assistance. Losing this critical service would force me to quit my job, quit grad school, and spend my days “living off the system” while forcing my adult children and husband to become my full time caregivers. I am extremely disheartened that the federal government is making plans to cut the services that force me to give up my well-paying job while simultaneously discussing the implementation of mandatory employment for other individuals receiving Medicaid. Why would the GOP refuse my right to work?

    By the way, my job as an Adult Basic Educator for Deaf adults involves assisting individuals who want to obtain Hogh School equivalency certificates in order to enter tech training programs or community college. My forced resignation would undoubtedly have a negative effect on the individuals to whom I provide English literacy and numeracy instruction. Losing my job is likely to negatively impact the individuals who I am assisting a transition from government assistance to self-sufficiency through education and trade skills acquisition.

    This does not make sense. What is the purported goal of English literacy, high school equivalency certification, and job training programs? I thought this administration pledged support for retaining displaced workers, including work suitable for d/Deaf and hard of hearing adults.

  6. To make a broad statement on the prevalence of IHSS fraud is one reason why EVV is a bad idea. Community and family providers help recipients to stay in their homes and be productive members of society via work, school, volunteering, community involvement, etc. To force home phone check in, which most households no longer have, would leave providers at the mercy of cellphone coverage and costs. There would be many cases of fraud that would be initiated with no real foundation. What about if a recipient has a bowel movement accident or a GI accidental removal, does the provider now have to call to check in for each task before they can attend to their recipient? This can set a dangerous precedence. How is monitoring and keeping seniors/disabled individuals home bound legal? What of our personal freedoms? Sure we want fraud to be eliminated but not at the cost of our basic rights.

  7. Ardys De Lu says:

    This is ridiculous! Plus its undemocratic. Seems as if its a way to eliminate IHSS.

  8. I totally agree that so many of the clients and aides look to freedom they go to appts they stop they are allowed on bus trips if needed to see their Dr with their aide if they don’t get back in time what happens ? in bad weather many times if the aide is running late and let’s agency know and pt they can stay and make time up again government is taking common sense out of real care ……the real theft is government not these programs everyone needs to think this will bevthevusual government mess that makes no sense

    • Reynolds says:

      I agree with Rose, and let’s not forget the IHSS pays the Aide nothing while their client is at the Doctors office ( even if the client is in a wheelchair.)

  9. Catherine Gray says:

    I am both a Medicaid provider and advocate for a Medicaid member and unequivocally against the EVV system mandate. If Seema Veerma is so concerned about fraud, she should look at Trump’s golf trips and jet planes, pharmacy manufacturing and hospital outrageous rates! Furthermore, it’s dehumanizing and degrading to falsely presume that just because people use government programs, we are worthless frauds! This is another decisive tactic for the GOP Reuplicans to further spread their hate for our poor, elderly, and disabled!

  10. ellie_h says:

    Perhaps EVV would allow Medicaid member providers to be paid for the amount of work they are actually doing? Maybe the false narrative of “fraud” was simply a rhetoric to get it passed, but the system will actually reveal the amount of time care providers dedicate to their job, who I’m sure overwhelmingly subsidize the system with unpaid overtime. CO is working to remove the geotracking and other contentious components of the program, and hopefully take the above thoughts into account, and make the EVV system work for the people, not the gov. Don’t attack me for this perspective, just trying to see how this system could be altered be positive, since it will be implemented nationally.

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