COLUMBUS, Ohio — Ohio is spending millions on new technology to log the visits of home-health workers and personal-care aides who make it possible for people with disabilities and other medical conditions to live and work in their communities.

But the first rollout of the state’s new “electronic visit-verification” system, part of a federal push to reduce Medicaid fraud, has drawn a firestorm of complaints about glitches, a lack of training and what many consumers see as a violation of their privacy.

The system uses repurposed, military-grade cellphones with GPS monitoring capability — devices that are supposed to stay with the Medicaid client whenever and wherever they receive services.

Melissa Day, 39, received her device last month and promptly put it in the garage. Some angry consumers have encased the devices in bubble wrap, advocates say, or even stowed them outside in doghouses.

“I’m very active,” said Day, who was paralyzed in a diving accident as a teenager. “For my job, I travel all over the state. For them to know where I am every moment of the day is completely ridiculous.”

Day and several others have refused to use the devices, instead opting for an alternative call-in method that requires voice verification. That can be cumbersome, too, Day said. But she prefers it to the GPS device, which also has a microphone and cameras on the back and front that state officials say are not operational.

“Basically, every time you log in or log out, it records the location,” said Rajai Saleh, who receives nine hours of services a day. “Now, if you’re in your home or within 1,000 feet (of your home), you don’t have to do anything extra. But if it’s an unknown location that’s not associated with the consumer, it’ll show up as an exception.”

Saleh also started using the call-in method due to privacy concerns and because of the hassle that frequently documenting new locations such as restaurants would create for her and her case manager.

“There’s this idea that people with disabilities just stay home all the time, and that’s not the case,” Saleh said. “It kind of feels like they haven’t thought this through.”

Ohio Medicaid officials say the electronic visit-verification system, launched on Jan. 8, complies with a requirement in the 21st Century Cures Act. States must have some type of electronic visit-verification system for personal-care services by January 2019 and for home-health services by January 2023 or face a reduction in Medicaid funding.

Ohio awarded a seven-year, $66.5 million contract to New York-based Sandata Technologies to administer its system.

Kim Kelly, an advocate and parent of an adult son with disabilities, said many families felt blindsided by the new requirements. “We got a letter in the mail three weeks before it went live” and received little to no training, she said.

The state is first issuing visit-verification devices to approximately 22,000 Ohioans covered under the home-care waiver and Medicaid state plan. Those on managed-care plans and other waivers, including people served by the Ohio Department of Developmental Disabilities, are to follow.

“When all is said and done, we’re thinking it’s roughly 90,000 people,” said Jim Tassie, assistant director of the Ohio Department of Medicaid.

The state has heard consumers’ concerns and worked to address them, Tassie said. Officials say the GPS is not on all the time; it transmits data to Medicaid only when pinged.

“The one thing to remember is that place of service has always been required on claims,” Tassie said. “At the end of the day, we need to know where these services are being provided. It’s not a means to try and track anyone.”

Medicaid fraud is a serious issue in Ohio and throughout the nation, and Tassie said falsified home-care time sheets are a relatively common way to defraud the system. According to the Ohio attorney general’s office, the Medicaid Fraud Control Unit recovered more than $38 million last year in restitution and penalties.

While Medicaid is right to want to prevent fraud, implementing a burdensome system could wind up putting services at risk, said Michael Kirkman, executive director of Disability Rights Ohio. The state already faces a shortage of care providers, and advocates worry that imposing more reporting requirements and potential penalties on a low-wage workforce will lead more to leave the field.

Pay is not yet being withheld for errors and improperly logged shifts, but it could be starting in July.

“Ohio got so far out over its skis,” said Kirkman, whose agency asked the state to hold off on the rollout. “They are the only state in the country that’s using GPS, and one of four that’s rolled it out early.”

Texas, for example, allows for verification through home landlines, a phone app or a time-clock device, according to Disability Rights Ohio.

Keeping dependable care providers is difficult enough, said Adam Helbling, an author and speaker who was paralyzed in an auto accident. He relies on aides to help him at home and on the road.

“Many of these home-health providers are making $10 an hour,” he said. “Treat them better; don’t give them more things to work around. I can just see more and more quitting. We need help.”

© 2018 The Columbus Dispatch
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