Federal officials this week issued long-awaited guidelines to help states comply with an upcoming Medicaid requirement that service providers electronically check in when providing in-home care to people with disabilities.

But advocates say there still isn’t enough time for states to implement the program by January 2019, while grappling with concerns about privacy and costs. They are calling on Congress to extend the deadline, noting that states will lose federal funds if they don’t comply.

“This is happening too quickly and the stakes are so high,” said Esme Grewal, vice president for government relations at the American Network of Community Options and Resources, or ANCOR, a nonprofit trade association representing service providers.

The 21st Century CURES Act was enacted by Congress in December 2016 and included a provision for “electronic visit verification,” or EVV, in order to prevent fraud. The scope of who the program would apply to was unclear until Wednesday when the Centers for Medicare and Medicaid Services said the requirement excludes people living in group homes or other 24-hour facilities but does cover personal care and home health services provided in any other type of home.

“Just to implement what’s in the statute now in a way that is responsible, makes good use of taxpayer money and ultimately accomplishes the goal that is set out for EVV, which is combating fraud and waste, we don’t think there’s any way to do that by January,” said Dan Berland, director of federal policy for the National Association of State Directors of Developmental Disabilities Services.

In some states that have already started rollout, concerns have arisen about privacy and expense. In Ohio, which has been using military-grade cellphones with GPS monitoring capability, some clients have balked at carrying the device to facilitate visit verification wherever they receive services.

Berland said states are free to design a system that works best for them, but should take privacy concerns seriously.

“A person who has support to go be a part of their community doesn’t want to have that person checking in every 20 minutes to say, ‘Here’s where Joe went,'” Berland said. “The (attendant) needs to be able to be engaged with the person they’re supporting. If instead half their brain is focused on do I need to check in now on my phone or how do I use this software, it takes away from successful services.”

Alabama is requiring caregivers to purchase tablets. In one consultant’s report, a provider agency reported the cost of tablets at $68,000, which did not include data plans needed for homes without Internet access.

“These are not cheap systems to implement or maintain,” Grewal said.

A spokeswoman for CMS declined to comment, however in the new FAQ document, the agency addressed tracking of movement and said states do not need to “capture each location as the individual is moving throughout the community.”

CMS also said states have discretion in selecting EVV systems and that GPS is an option, but not a requirement.

“A common alternative to GPS is interactive voice response, which requires the caregiver to check in and out using a landline or cellular device located at the individual’s home,” the FAQ document said.

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