Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Evv Rollout Home Care topic
No spam. Unsubscribe anytime.
Home‑care providers tell committee EVV rollout and claims denials are threatening services
Summary
Home-care providers and industry consultants said Ohio's electronic visit verification (EVV) implementation and premature claims denials are causing payment delays, forcing some providers to drop Medicaid patients and threatening service continuity.
Home‑care providers told the Senate Medicaid subcommittee that Ohio's phased EVV (electronic visit verification) rollout, combined with new claims edits and denials, is producing payment disruptions that threaten provider viability and patient access.
Kimberly King, chief operating officer of Home Care Network and acting treasurer for the Ohio Council for Home Care and Hospice, described multiple operational pressures: licensing and re‑credentialing, a malfunctioning provider portal run by Gainwell, and the introduction of phase‑1 EVV edits in March that led many providers to see claims denials. King said one provider segment reported that only 1 in 13 providers was profitable on Medicaid business and that some providers are dropping Medicaid patients after denials began.
King asked the committee to consider EVV and claims denial language that would: delay or manage adjudication edits until systematic errors are addressed; require the department to enforce contractor obligations; and provide a plan and timeline to bring providers to compliance. Christie Pyles, an EVV consultant who has certified state EVV programs including Ohio's, told the panel that the federal 21st Century Cures Act (often cited in discussions of EVV) does not require claims denials as a condition of enhanced federal funding. She said CMS prefers edits but has not mandated claims denials, and she called Ohio's current denials premature while systemic issues persist.
Providers and consultants asked for a measured approach: fix system issues, audit Medicaid IDs, and phase in denials after providers have time to respond. No formal actions were taken during the hearing.
