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Home‑care providers and vendors tell Senate panel EVV rollout and claim denials threaten services
Summary
Home‑care operators and an EVV consultant told the Medicaid subcommittee that the state's Electronic Visit Verification rollout and premature claims denials are causing payment delays, revenue losses and provider exits, and asked lawmakers for technical fixes and a delay of denials until system problems are resolved.
Providers and a national consultant warned the Senate Medicaid subcommittee that Ohio's Electronic Visit Verification (EVV) implementation has produced system errors, surprise claims denials and payment interruptions that are jeopardizing home‑ and community‑based services.
Kimberly King, acting COO of Home Care Network and acting treasurer of the Ohio Council for Home Care and Hospice, told the panel that a provider survey from her organization found more than 260,000 visits and 5,800 patients affected and that only about 1 in 13 providers was profitable on Medicaid business. She said EVV "phase 1 edits" went live in March and many providers are receiving denials they cannot correct quickly.
"When you add the pressures of electronic visit verification edits to the already problematic Medicaid system, providers are dropping Medicaid patients right after phase 1," King said. "My company is blanked a week with no notice — people have to keep lines of credit for payroll."
Christie Pyles, an EVV implementation consultant who has certified multiple state EVV programs, told the committee that the federal 21st Century Cures Act does not mandate automatic claims denials for EVV noncompliance and that Ohio has prematurely implemented denials while systemic issues remain unresolved.
"If you read the Cures Act, there is no claims denial language," Pyles said. "CMS prefers it, but it's not a condition for enhanced federal funding. To say that Ohio must deny claims right now because of the Cures Act is inaccurate."
Witnesses recommended delaying claims denials, directing the Department of Medicaid to audit provider IDs and contract compliance, and implementing an EVV transition plan that addresses training gaps, inaccurate provider data and production‑only changes from the state's vendor, GainWell. Committee members asked for written remediation plans and offered to receive provider lists and examples of specific denial patterns.
No formal action was taken during the hearing. The subcommittee recorded multiple requests for legislative language to require better project management and a pause or staged approach to claims denial until fixes are in place.
