Open model EVV

CMS’s 2018 informational bulletin on EVV sorts state designs into five models: provider choice, managed care plan choice, a system the state builds and runs itself, one state-contracted vendor that everyone must use, and the open vendor model. It calls the open model a hybrid. The state contracts with at least one EVV vendor or runs its own system, and providers and plans that already own EVV technology may keep it. Because every system still has to serve the Cures Act aim of preventing fraud, waste and abuse, CMS expected states to require some integration between them, and it noted that some open-model states keep a list of preferred vendors¹.

An open model works only with one place where all the data lands. CMS describes states building an aggregation solution, specifying the data each outside system must report and receiving standardized visit records from all of them¹. Indiana and Wisconsin follow that pattern: each offers Sandata as the state system and accepts alternate systems that export to the Sandata aggregator^2,3. Wisconsin adds steps before an alternate system goes live: a certification and setup process, a signed attestation and aggregator portal training³.

The choice is an agency decision with billing consequences. In Wisconsin the state system spares the agency the cost of buying one, while an alternate system’s implementation, training and interface costs are the agency’s own³. An outside system can tie EVV to scheduling and payroll, but when its export fails, it is that agency’s claims that stall. Before choosing, read the state’s certification steps, confirm that its claim edits read from the aggregator, and test a full billing cycle.