Electronic Visit Verification Update

Electronic Visit Verification Update

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The Office of Long-Term Living (OLTL) released the following provider update on electronic visit verification (EVV).

How will Electronic Visit Verification (EVV) impact providers who serve participants in OLTL programs?
As a reminder, EVV is a technology solution which electronically verifies the delivery dates and times of home and community-based services to the individuals needing those services. EVV is intended to require submission of information that will help electronically validate services and prevent fraudulent claims.  Federal law (the 21st  Century Cures Act) requires all state Medicaid agencies implement an EVV solution to manage their personal care services by January 1, 2020, and home health care services by January 1, 2023. The Department of Human Services (DHS) is moving forward with a soft implementation in September of 2019 and DHS will continue to provide you with guidance and updates as we move through this process.  Updated information will be sent to you and will also be included on the DHS website.

Providers Serving Participants Enrolled in the OBRA Waiver or Act 150 Program
Providers serving participants in the OBRA waiver or Act 150 program must adhere to all timelines and guidance issued by DHS in order to comply with EVV requirements in the fee-for-service system. DHS is working with vendors (DXC and Sandata) to develop an EVV system that will integrate with PROMISe, our existing Medicaid Management Information System.  Providers with their own internal EVV system must work with DHS to ensure their EVV system can interface with the DHS EVV aggregator system. Providers without an EVV system may secure their own EVV solution; if they choose to do so, they must follow all guidance issued by DHS to ensure training and implementation requirements are completed in order to implement EVV by September 2019. DHS will issue additional implementation details as they become available.

Providers Serving Participants in an Active Community HealthChoices (CHC) Zone (Southwest or Southeast)
Providers serving participants who are already enrolled in one of the CHC Managed Care Organizations (MCOs) will have the option to use the MCO’s EVV system, HHAeXchange.  A CHC-participating provider with their own internal EVV system must work with each contracted MCO to ensure the provider’s system is able to send information to HHAeXchange. Providers should begin discussing training and system options with their contracted MCO(s) in order to implement EVV by September 2019.

Providers Serving Participants in the Phase 3 Region of CHC
Providers in Phase 3 of CHC, which includes Lehigh/Capital, Northeast, and Northwest Zones, must coordinate the use of EVV with MCOs when Phase 3 is implemented on January 1, 2020. This includes providers currently serving participants in Aging, Attendant Care, and Independence waivers. Providers who will be participating in CHC will have the option to use the MCO’s EVV system, HHAeXchange.  A CHC-participating provider with their own internal EVV system must work with each contracted MCO to ensure the provider’s system is able to send information to HHAeXchange. Providers currently serving participants in the Phase 3 region of CHC should begin discussing training and system options with the three MCOs to ensure that they will be able to use EVV when they transition to CHC on January 1, 2020.

Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.

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