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electronic visit verification

Many agencies and providers have successfully participated in the DHS Sandata EVV training. These providers are successfully using the DHS Sandata EVV system during the PA-DHS soft-launch period. As a reminder, the soft-launch period is scheduled to end Dec 31, 2019.

While Pennsylvania is seeking a Good Faith Effort Exemption (GFE) from the Centers for Medicare and Medicaid Services (CMS) to extend the soft launch period, it has not yet been approved. If your agency is one of the few that still needs to complete Sandata EVV training to get your DHS Sandata EVV credentials, it is not too late!

Online self-paced training is still available 24/7 and can be accessed here. To receive your agency credentials, at least one provider representative must complete training.

The first person in your agency who enrolled and completes training will receive an emailed Welcome Kit with your agency’s credentials.

Welcome Kits: Presently, Welcome Kits are distributed within two business days after the completion of training. Due to the holidays, any agency completing training on or after December 20, 2019, will not be guaranteed a Welcome Kit by January 1, 2020.

If your agency has competed training and did not receive a Welcome Kit, please contact PAC at 800-248-2152 or via email.

Questions?

For questions on whether a provider or services are included in the EVV mandate, contact Provider Enrollment:

  • ODP Provider Enrollment: 866-565-9435 or email
  • OLTL Provider Enrollment: 800-932-0939 option 1

For DHS Sandata EVV application questions, call 800-248-2152 or email. Submit EVV program questions here. For ALT-EVV Certification, call 855-705-2407 or email.

As a reminder, section 12006 of the 21st Century Cures Act requires all states to implement the use of EVV for Medicaid-funded personal care and home health care services. EVV must be implemented for personal care services by January 1, 2020, and for home health care services by January 1, 2023.

OLTL waiver services included in the initial implementation of EVV:

  • Personal Assistance Services (Agency and Participant-Directed Model)
  • Participant-Directed Community Supports
  • Respite (unlicensed settings only)

As part of the soft launch period, claims submitted to PROMISeTM for services subjected to EVV will be validated against EVV visits submitted through the Department of Human Services (DHS) Sandata system or DHS Aggregator. During claims processing in PROMISeTM, EVV validation against the DHS Aggregator will continue to be performed and EVV Error Service Codes (ESCs) will set without impacting claim payment. The ESCs for EVV will become active on December 13, 2019, for claims submissions with dates of service on or after November 1, 2019. Providers are expected to review when the EVV edit(s) set and actively make corrections either to the data stored in the DHS Aggregator or the claim itself to ensure errors do not repeat.

Please see this chart of EVV-specific ESCs for reference. If you have questions about EVV, please refer to the Frequently Asked Questions document on the DHS EVV website or contact the EVV Resource Account.

ODP Announcement 19-150 is to inform stakeholders that Pennsylvania will formally request a Good Faith Effort (GFE) Exemption from CMS to delay the implementation of the electronic visit verification (EVV) mandate. More time is needed in order to allow providers to fully prepare for EVV. ODP has heard from many providers who are using Alternate EVV systems and have been working with Sandata to certify their systems for integration with the DHS Aggregator. Since the time for certification is taking longer than originally projected, the Department is seeking an extension to allow additional time for these systems to go through the necessary testing with Sandata and become integrated to feed EVV data to the DHS Aggregator.

The Department is seeking a GFE to extend the soft launch period and to delay the denial of payments. The timeframe between system launch and the EVV mandate is referred to as the soft launch. The soft launch is an opportunity to:

  • Test and interface Alternate EVV systems
  • Familiarize providers with EVV prior to claims integration. Claims will continue to pay and EVV errors will appear on remittance advice.
  • Inform policy and system development
  • Help the Department identify and develop supplemental training materials
  • Facilitate EVV participation by caregivers and members

If approved by CMS, the GFE will allow the Department to extend the soft launch period and implement a tiered compliance structure before the denial of payments. EVV system implementation, training, and vendor interfacing will proceed on the current project schedule. Since the exemption has not yet been approved, providers are still required to begin using EVV by January 1, 2020. Provider participation will produce valuable data for system modification and policy development.

Please visit the DHS EVV website to view the ODP EVV technical guidance, public meeting notices, training resources, and Frequently Asked Questions (FAQs).

Office of Developmental Programs (ODP) Communication 19-020 is intended to provide current information to external stakeholders regarding the Electronic Visit Verification (EVV) Federal mandate established by the 21st Century Cures Act. This is also to request that you complete a DHS survey to help inform their EVV system development and implementation.

EVV is a technology solution which electronically verifies that home and community-based services are delivered to the individuals needing those services. EVV includes multiple technologies, such as telephonic, mobile, and web portal verification inputs. The 21st Century Cures Act requires that 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.

As a reminder, the EVV system must collect and verify:

  1. Type of service performed;
  2. Individual receiving the service;
  3. Individual providing the service;
  4. Date of the service;
  5. Location of service delivery; and
  6. Time the service begins and ends.

DHS is working with DXC and Sandata to develop an EVV system that will integrate with their existing Medicaid Management Information System (MMIS), PROMISe™. However, Pennsylvania is using an open EVV system model and providers may use their own EVV vendor/system, as long as it captures the six required items and is able to submit EVV data into the state’s system. Third party EVV systems will need to meet Sandata’s technical specifications and DHS’ Addendum, both of which will be made available once finalized. Providers serving participants covered under one of the Community HealthChoices Managed Care Organizations (CHC-MCOs) will be able to use the MCO’s EVV system, HHAeXchange. If a provider participating in CHC already has their own internal EVV system, they must work with the CHC-MCO to ensure their system is able to send information to HHAeXchange. For participant-directed programs in the Office of Long-Term Living (OLTL) waivers, the vendor fiscal agent Public Partnerships LLC (PPL) will be utilizing their EVV system, Time4Care, to satisfy EVV requirements.

DHS is developing the state EVV system with a full go-live date of August or September 2019, with a soft implementation of the system and outreach and training beginning this spring through the fall. DHS is also asking that you complete a quick survey to help inform EVV system development and implementation by March 8, 2019. You can access the survey directly at this link.

DHS will continue to provide you with guidance and updates as they move through this process. Updated information will be sent to you and will also be included on the DHS website. Questions or comments can be submitted to the EVV resource account email.

(From OLTL)

EVV Implementation Update

The 21st Century Cures Act requires implementation of electronic visit verification (EVV) by January 1, 2019 for personal care services (PCS).  On July 30, 2018, the President signed a law delaying penalties for implementation to January 1, 2020 for PCS.  The requirement for implementation of EVV for home health services by January 1, 2023 has not changed.

This delay will allow Pennsylvania an opportunity to extend implementation activities and training, to make sure that providers are fully ready for the implementation of EVV.  The tentative plan for Pennsylvania’s implementation of EVV is:

  • January 2019 – PA guidance will be distributed
  • Spring 2019 – provider training will be offered with phased-in system use
  • Summer 2019 – full implementation of system

As shared previously, we will utilize an open system for EVV.  This means that providers who already have an EVV system will be able to submit information to the state’s EVV vendor.  The Department of Human Services is using the existing PROMISe™ fiscal agent contract with DXC for EVV.

Providers who do not have their own EVV will be able to utilize the Department’s system for compliance.

For Office of Long-Term Living waivers, including Agency and Participant-Directed Services, PCS includes:

  • Personal Assistance Services
  • Respite (unlicensed settings only)

Additional information will be shared when it becomes available.  You may also look for information on our website at http://dhs.pa.gov/provider/billinginformation/electronicvisitverification/index.htm.  For further questions regarding EVV, please email RA-PWEVVNotice@pa.gov.

A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

Please share this email with other members of your organization as appropriate. Also, it is imperative that you notify the Office of Long-Term Living for changes that would affect your provider file, such as addresses and telephone numbers. Mail to/pay to addresses, email addresses, and phone numbers may be updated electronically through ePEAP, which can be accessed through the PROMISe™ provider portal. For any other provider file changes please notify the Bureau of Quality and Provider Management Enrollment and Certification Section at 1-800-932-0939 Option #1.

To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

NOTICE: This confidential message/attachment contains information intended for a specific individual(s) and purpose. Any inappropriate use, distribution or copying is strictly prohibited. If received in error, notify the sender and immediately delete the message.

This week, both the US Senate and US House introduced bipartisan legislation (HR 5912 in the House and S 2897 in the Senate) designed to delay implementation of the Electronic Visit Verification (EVV) provision of the 21st Century Cures Act and require public input from stakeholders. The bill was led by Senators Lisa Murkowski (R-AK) and Sherrod Brown (D-OH) and co-sponsored by a range of Democrats and Republicans in the Senate and House. The EVV delay bill gives states an additional year to implement EVV, having it take effect on January 1, 2020 instead of January 1, 2019.

In late 2016, Congress had ordered states to install EVV systems as a way of preventing fraud in Medicaid as part of the 21st Century Cures Act, but many challenges arose after the bill passed. This is partially due to CMS not releasing guidance on the EVV statute until May 2018, leaving states in the dark for a full 18 months following passage of the EVV law. Even despite CMS’ recent guidance, many concerns remain about which disability supports and services are required to comply with the rule. Additionally, because there has been little stakeholder input, questions abound about privacy, costs, and other aspects of compliance.

Please contact your legislators and ask them to support the EVV delay bill. The American Network of Community Options and Resources (ANCOR) has been instrumental in advocating for this legislation; RCPA is proud to be a member of ANCOR and appreciates their initiative on this issue.