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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!

  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.

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