Map the real job
Trace how staff identify, investigate, and resolve authorization-to-payment exceptions across the systems they already use.
Research program · design partners
Can administrative fractures interrupt authorized home care?
SubOps is validating a read-only evidence workflow for Medicaid home- and community-based services (HCBS): connect versioned authorization and policy rules to schedules, EVV, claims, remittance, and payroll—then surface source-linked exceptions for human review.
Proposed research — not a current SubOps product.
No HCBS adapter, healthcare dataset, clinical outcome, design partner, or operating healthcare compliance program exists in the application today. Initial discovery does not collect PHI.
Initial study
One narrow workflow, measured in shadow mode.
The first target is an independent Medicaid HCBS agency serving older adults with fragmented authorization, EVV, billing, remittance, and payroll review. The study will select one state and payer workflow before any prototype work.
Test a source-linked ledger
Evaluate whether versioned rules and event provenance can find true exceptions with calibrated abstention and deterministic money.
Measure operational value
Compare review time, false critical alerts, implementation burden, willingness to pay, and a separately reviewed care-continuity proxy.
Evidence behind the question
Enough evidence to investigate—not enough to claim a solution.
EVV is required infrastructure, not the whole workflow
CMS guidance establishes EVV requirements for covered personal-care and home-health services. Our question begins after those records exist: can a read-only evidence layer connect them to authorization, claims, remittance, and payroll without replacing EVV?
CMS MedicaidHCBS policy and administration vary materially
MACPAC documents the complexity and variation across Medicaid HCBS authorities. The first study will therefore select one state, payer workflow, EVV path, and service-code family instead of pretending the rules are nationally uniform.
MACPACWorkforce capacity is a care-continuity constraint
Published research found that the home-care workforce did not keep pace with HCBS participation. That supports studying authorized-but-unstaffed or delayed-service signals, but it does not prove this proposed system can improve care outcomes.
Health Affairs / PubMedExisting program data may be underused
A 2025 learning-health-systems analysis describes fragmented information sharing in Medicaid HCBS and identifies program data as a potential substrate for improving coordination, including for people with dementia. The commercial and scientific value still requires prospective validation.
Learning Health Systems / PMCBoundaries for the discovery phase
- No PHI or production exports during initial interviews.
- No EVV, scheduler, EMR, payroll, or agency-system replacement.
- No clinical recommendations, eligibility decisions, or autonomous claims.
- No caregiver scoring, geolocation surveillance, or worker ranking.
- No health, savings, recovery, or funding claims before measured evidence.
- Any later data study requires an approved lawful-data and security path.
Design-partner conversations
Help determine whether this should be built at all.
We want to speak with HCBS agency owners, operations and compliance leaders, billing teams, direct-care leaders, payer experts, and researchers. The first conversation is workflow discovery only.
Contact the research team