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Electronic Visit Verification(EVV)Provider Stakeholder MeetingPresented byHHSC EVV OperationsFall 2017SHP 20184373A
Objectives This meeting is for providers who arerequired to use an HHSC approvedEVV system and are contracted with: HHSC/Department of Aging andDisability Services (DADS); or Management Care Organizations(MCOs) This material reflects a collaborationbetween HHSC, Texas MedicaidHealthcare & Partnership (TMHP),and MCOs1/11/20182
Objective It 1/11/2018is intended to provide an update of:EVV – Cures ActEVV - Senate Bill 894Individual/Member CommunicationMCO AuthorizationsEVV PilotsEVV Compliance ScoresMost Commonly EVV RecoupmentsMost Commonly EVV Denials3
Objective It is intended to introduce new EVVpolices and changes relating to: EVV Provider Manual Unlocking Visit MaintenanceProcess New Small Alternative DeviceOrder Process1/11/20184
Objective It is intended to provide a review of:EVV Reason CodesReason Code Free TextEVV Reports It is intended to allow provideragencies an opportunity to askquestions.1/11/20185
ScheduleSection IWelcome/Introductions/Provider FeedbackSection IIEVV Updates EVV – Cures Act EVV - Senate Bill 894 Individual/Member Communication MCO Authorizations EVV Pilots EVV Compliance Scores Most Commonly EVV Recoupments Most Commonly EVV Denials1/11/20186
ScheduleSection IIINew and Revised EVV PolicesEVV Provider ManualUnlocking Visit MaintenanceNew SAD ordering processSection IVEVV Review EVV Reason Codes Reason Code Free Text EVV ReportsSection VQuestions and Answers1/11/20187
Section IWelcomeIntroductionProvider Feedback1/11/20188
Section IIEVV Updates1/11/20189
21st CenturyCures Act Section 12006. Electronic VisitVerification System Required forPersonal Care Services and HomeHealth Care Services under Medicaid HHSC is currently discussingrequirements HHSC is waiting on additionalclarification from CMS1/11/201810
Senate Bill (SB) 894 HHSC is working on meeting all ofthe requirements in Section531.024172 Electronic VisitVerification System of SB 894 As the requirements are reviewedand finalized, the requirements willbe posted on the HHSC EVV andMCO websites1/11/201811
Senate Bill (SB) 894The following requirements are currentlybeing reviewed:(c) Inform Medicaid recipients whoreceive services required to use EVV;(d)(2)(A) the information required to bereported by health care providers isstandardized across managed careorganizations that contract with thecommission to provide health careservices to Medicaid recipients and acrosscommissions programs;1/11/201812
Senate Bill (SB) 894The following requirements are currentlybeing reviewed:(e)(1) Consider the administrative burdenplaced on health care providers to complywith standards; and(h) create a stakeholder work groupcomprised of representatives of affectedhealth care providers, MCOs, and Medicaidrecipients and periodically solicit from thatwork group input regarding the ongoingoperation of the electronic visit verification13system under this section.
Individual/MemberCommunicationEVV Enrollment Flyer HHSC and the MCOs have developedan EVV Information Flyer that will beincluded in all enrollment packets The EVV Flyer is intended to provideeducation to the individual/memberon EVV requirements The EVV Flyer informs the individual/member EVV is required by the State1/11/201814
Individual/MemberCommunicationEVV Rights and Responsibility Form MCO services coordinators (SC) andHHSC (DADS) case managers (CM)will provide each individual/memberreceiving EVV required services anEVV Rights and Responsibility Format initial face to face meeting The SC and the CM will verballyreview the form and have theindividual/member sign the form1/11/201815
Individual/MemberCommunicationEVV Rights and Responsibility Form The SC or CM will keep a copy of thesigned form and leave a copy for theindividual/member A new form will be sign annuallyThe estimated effective date EVVEnrollment Flyer and the EVV Rights andResponsibilities Form is March 2018.1/11/201816
MCO EVVAuthorizationAll MCOs will send an electronicauthorization file of active members toeach EVV vendor daily.1/11/201817
MCO EVVAuthorization Providers will still be required toenter the required data elements inthe EVV system Providers will be able to see what theMCO sent to the EVV vendor andwhat the provider entered into theEVV system1/11/201818
MCO EVVAuthorization The number of data elementsproviders entered will be reducedbeginning in March 2018. This date is subject to change. The data elements providers wouldbe required to enter will be publishedon the HHSC EVV and MCO websites.1/11/201819
GPS Mobile App Pilot The GPS Mobile Application (App)captures the geolocation coordinates(longitude and latitude) of where theattendant clocks-ins and clocks-outs Currently under pilot testing withDataLogic only The attendant must have a smart phonewith GPS capabilities and volunteer touse it for EVV No reimbursement for using phone
GPS Mobile AppPilot The attendant downloads the VestaMobile app on their smart phone anduses the app to clock-in and out bypressing the clock in/out button The GPS App estimated data usage isless than two megabytes (MB) permonth and does not use minutes fromcell phone plan There is no PHI stored on the mobileapp1/11/201821
GPS Mobile AppPilotSome restrictions: Smart Phone cannot be “jailbroken” or “Rooted”; Must have Apple iOS, or GoogleAndroid platform on smart phone;and Attendant cannot live in the sameresidential complex as theindividual/member receivingservices.1/11/201822
GPS Mobile AppPilotGPS Pilot Participation If you would like to be part of theEVV GPS Pilot and your EVV Vendoris DataLogic, please contactDataLogic.1/11/201823
Visit MaintenanceReduction Pilot Pilot Objectives: To reduce visit maintenance Increase auto-verified visits Provide more flexibility Pilot includes HHSC and MCOs payors1/11/201824
Visit MaintenanceReduction PilotDataLogic: As of Aug. 2017, 31 provider agenciesparticipating Average percent of increased autoverified visits is 17%MEDsys: As of Aug. 2017, 71 provider agenciesparticipating Average percent of increased autoverified visits is 8%1/11/201825
Visit MaintenanceReduction PilotThere are four (4) solutions used inthe visit maintenance reductionpilot. Call Matching Window for AutoVerification; Expanded Time Option for AutoVerification; Optional Alert Feature – AuthorizedHours Close to Being Reached; and Automatic Downward AdjustmentOption.1/11/201826
Visit MaintenanceReduction PilotOption 1 - Call Matching Window for AutoVerificationCurrent Rule: If the EVV clock-in iswithin 2 hours of the start of a scheduledvisit or 2 hours after a scheduled visit, andno other exceptions exist, the calls willauto-verify. Otherwise visit maintenance isrequired.Proposed Solution: If the EVV clock-inand clock-out is between 12:00am through11:59pm, on the same date of a scheduledvisit, and no other exceptions exist, thecalls will auto-verify.1/11/201827
Visit MaintenanceReduction PilotOption 2 – Expanded Time Option forAuto-VerificationCurrent Rule: If the rounded EVVpay hours equals the scheduledhours, and no other exceptions exist,the calls will auto-verify. Otherwisevisit maintenance is required.1/11/201828
Visit MaintenanceReduction PilotOption 2 – Expanded Time Option forAuto-VerificationProposed Solution: Providers have the option to select theExpanded Time Option which willextend the auto-verified timeframe by0.25 rounded hours. For providers that choose this option,if the rounded EVV pay hours are equalto the scheduled hours plus or minus0.25 rounded hours (plus or minus 22minutes), and no other exceptionsexist, the calls will auto-verify and logthe actual rounded EVV payhours. Otherwise, visit maintenance isrequired.1/11/201829
Visit MaintenanceReduction PilotOption 3 – Optional Alert Feature –Authorized Hours Close to Being ReachedCurrent Feature: No Alert is present inEVV systems to inform provider thatAuthorized Hours are close to beingreached.Proposed Feature: Each EVV vendorwill provide an optional "alert".The alert will notify the provider when theindividual/members authorized hours areclose to being reached for the week.1/11/201830
Visit MaintenanceReduction PilotOption 4 – Automatic Downward AdjustmentOption: The provider has an additional option tochoose the Automatic DownwardAdjustment Option. If checked, the rounded EVV pay hours willautomatically be downward adjusted to theoriginal scheduled hours, in order toprevent issues with EVV pay hoursexceeding the authorized levels for theindividual/member. If left unchecked, the auto-verified visit willinclude the additional .25 hours in theactual rounded EVV pay hours.1/11/201831
Visit MaintenanceReduction PilotExample #1: Schedule 8am - 12pm; 4 hours The Provider has Expanded Time Optionchecked The Provider has the Automatic DownwardAdjustment Option checked Attendant called in anytime between 12:00am - 11:59 pm The actual hours worked is 4 hours and 22minutes The call will AUTO-VERIFY at 4 EVVrounded pay hours (automaticallydownward adjusted to Scheduled Hoursinstead of 4.25 hours)1/11/201832
Visit MaintenanceReduction PilotExample #2: Scheduled 1pm - 3pm; 2 hours The Provider has the Expanded TimeOption checked The Provider has Automatic DownwardAdjustment Option unchecked Attendant called in anytime between 12:00am - 11:59 pm The actual hours worked is 2 hours and 11minutes The call will AUTO-VERIFY at 2.25 EVVrounded pay hours1/11/201833
Visit MaintenanceReduction PilotExample #3: Scheduled 1pm - 3pm; 2 hours The Provider has the Expanded TimeOption checked The Provider has Automatic DownwardAdjustment Option unchecked Attendant called in between 12:00 am 11:59 pm The actual hours worked is 1 hour and 40minutes The call will AUTO-VERFIY at 1.75 EVVrounded pay hours1/11/201834
Visit MaintenanceReduction PilotWant to Participate? If you consent to participate, yourentire agency (all branches) will beset-up to test the pilot solutions After your consent form is receivedby HHSC and the EVV vendor, yourEVV Vendor will reach out to you toprovide training on the pilot solutions You can choose what pilot optionsyou would like to test1/11/201835
Visit MaintenanceReduction PilotHow to sign up for VM Pilot? Please contact your EVV vendor ifyou are interested in participating inthe Visit Maintenance ReductionPilot. You must sign the HHSC VisitMaintenance Reduction Pilot consentform before starting1/11/201836
EVV ComplianceScoresHHSC (DADS) EVV Compliance ScoresQuarter 1*DataLogic: 65 out of 1208 contractswere below 90%.MEDsys: 83 out of 864 contracts werebelow 90%.* Quarter 1 April, May, June, 20171/11/201837
EVV Compliance ScoresMCOs EVV Compliance Scores Quarter 1 Aetna Amerigroup Blue Cross/BlueShield Children’s MedicalCenter CIGNA Community FirstHealth1/11/2018 Cook Children’sDriscollMolinaTexas Children’sSuperiorUnited38
Most Common Reasons for EVVRecoupments Fee-for-ServiceHHSC/DADSRegion1/102/93Reason for EVV Recoupment No free text documentation for RC 900, 905, 910 & 305Billing over weekly authorized unitsUse RC 305 for everything with no free text when required Failure to document the appropriate information in the free textfield on required reason codes Visit Maintenance completed after billingUnable to pull the EVV Visit LogUsing other reports such as Client Visit Log and Payroll reports toverify services renderedFailure to document the appropriate information in the free textfield on required reason codes 3/4 5/768111/11/2018 Unable to pull the EVV Visit LogFailure to document the appropriate information in the free textfield on required reason codesOverbilling-suspect the contractor is using the schedule insteadof actual EVV Visit timeNo free text on required reason codesFailure to document the appropriate information in the free textfield on required reason codesFailure to use correct free text or not using free text at allFailure to document the appropriate information in the free textfield on required reason codes39
Most Common Reasons forEVV Recoupments - MCOsEach MCO will provide an update onRecoupments. If the MCO is not present, theinformation will be available on their website. Aetna Amerigroup Blue Cross/BlueShield Children’s MedicalCenter CIGNA1/11/2018 Community FirstHealth Cook Children’s Driscoll Molina Texas Children’s Superior United40
Most Common Reasons forEVV Denials - MCOsEach MCO will provide an update onRecoupments. If the MCO is not present, theinformation will be available on their website. Aetna Amerigroup Blue Cross/BlueShield Children’s MedicalCenter CIGNA1/11/2018 Community FirstHealth Cook Children’s Driscoll Molina Texas Children’s Superior United41
Section IIINew and Revised EVV Policiesand Requirements1/11/201842
EVV ProviderManual The EVV Provider Manual: Includes all EVV policies andrequirements; Available electronically on the HHSEVV website; and Each MCO will have the sameinformation in the EVV Provider oneach MCO website.Tentative Published date is: Jan. 1, 20181/11/201843
EVV Provider Manual Appeal Process Data Elements Cell Phones EVV Forms HHS or MCOComplaints Fraud/Waste andAbuse EVV Compliance GPS Consumer DirectedServices How does EVVwork Contract Monitoringand EVV Introduction to EVV1/11/2018 Landlines44
EVV Provider Manual New Contracts/Grace Period EVV Billing Codes Program Definitions Small AlternativeDevice Program andservices required touse EVV Unlocking VisitMaintenanceProcess Reason Codes Visit Maintenance EVV Reports1/11/201845
Unlocking VisitMaintenanceWhat does this mean?Providers who recognize a correction isneeded to a data element past 60calendar days from the visit mayrequest visit maintenance unlocked.1/11/201846
Unlocking VisitMaintenanceHow do I know a correction isneeded? If you unable to pull an EVV visit log; Check the Mismatch Payor Reportfrom the MEDsys EVV system; or Check the Failed to Export Reportfrom the DataLogic EVV system.*For questions with these reports please reach outto your vendor1/11/201847
Unlocking VisitMaintenanceWhat is NOT allowed for corrections? Actual Visit Date Actual Time In Actual Time Out Visits prior to Apr. 1, 2016If a request is made during the time of acontract monitoring review your requestwill NOT be accepted.1/11/201848
Unlocking VisitMaintenanceHow do I request visit maintenancebe unlocked? Contact your payor associated withthe request via email asking to havevisit maintenance unlocked. Your payor will send you aspreadsheet that must be completelyfilled out and emailed back in asecure email. Unsecure email requests will not beprocessed and may result in a HIPAAviolation.1/11/201849
Unlocking VisitMaintenanceHow is a decision made? Approvals are at the payor’sdiscretion. Payors will determine their decisionon a case-by-case basis. Supporting documentation isrequired per request and will bereviewed by the payor. Payors may request additionalinformation if needed.1/11/201850
Unlocking VisitMaintenanceWhat happens once the decisionhas been made?Approved Requests: Your payor will send you an emailwith approval; and Your vendor will reach out to youwith further instruction.Denied Requests: Your payor will send you an emailexplaining the reason your requestwas denied.1/11/201851
Unlocking VisitMaintenancePlease Note: Data element(s) corrections will notimpact prior or current recoupments,denials, appeals, and contract actionas a result of the provider agencyentering an incorrect dataelement(s). Prior and current recoupments,denials, appeals, and contract actionwill remain.1/11/201852
Unlocking VisitMaintenanceSend unlocking visit maintenancerequests to: HHSC/TMHP electronic visit verification@hhsc.state.tx.us Cook Children’s Health Plan CCHPEVV@cookchildrens.org Children’s Medical Center Health Plan cmchpevv@childrens.com Driscoll Health Plan evvquestions@dchstx.org1/11/201853
Unlocking VisitMaintenanceSend unlocking visit maintenancerequests to: Superior Health Plan shp evv@centene.com Texas Children’s Health Plan EVVGroup@tchp.us (email updated 1-8-18) Community First Heal Plan cfhpevv@cfhp.com Aetna evvmailbox@aetna.com Blue Cross Blue Shield 1/11/2018bcbstx evv questions@bcbstx.com54
Unlocking VisitMaintenanceSend unlocking visit maintenancerequests to: Cigna Healthcare providerrelationscentral@healthspring.com Molina mhtxevv@molinahealthcare.com United uhc evv@uhc.com Amerigroup TXEVVSupport@amerigroup.com1/11/201855
New Small AlternativeDevice Order Process Each EVV vendor is currentlydeveloping an electronic requestprocess to order SADs directly fromthe EVV system This electronic request process willeliminate the SAD paper form Individuals’ and members’ signatureare no longer required to order a SAD More information and effective datewill be posted on the HHSC EVV andMCOs websites1/11/201856
Section IVReviewEVV Reason CodesEVV Free Text RequirementsEVV Reports1/11/201857
Reason CodesUpdate: Effective July 1, 2017, Reason Code305 free text now only requires theprovider agency to document themissing time in and/or out, the EVVsystem did not capture. Failure to document the missing timein and/or out in the free textcomment field may result in claimdenial, recoupment or contract action.1/11/201858
Reason CodesUpdate: Example: The attendant used theSAD to clock-in at 9am. The SADmalfunctioned at clock-out,12:00pm, so attendant did notreceive the values from device. The EVV visit screen shows the 9amclock-in but missing clock-out. TheEVV required free text is actualclock-out time of 12:00pm.1/11/201859
Reason CodeFree TextSeven (7) reason codes require freetext entry in the comment field.1.Reason Code 130 – Disaster orEmergency Must document the nature of thedisaster or emergency and actualtime in and/or time out1/11/201860
Reason CodeFree TextSeven (7) reason codes require freetext entry in the comment field.2.Reason Code 305 –Malfunctioning Small AlternativeDevice and/or Invalid SmallAlternative Device Value –Verified Services Were Delivered Must document the missing actualtime1/11/201861
Reason CodeFree Text3.Reason Code 310 – MobileApplication Problems Must document the nature of theproblem and actual time in andtime out4. Reason Code 900 – AttendantFailed to Call In – VerifiedServices Were Delivered Must document actual time in1/11/201862
Reason CodeFree Text5. Reason Code 905 – Attendant Failed toCall Out – Verified Services WereDelivered Must document actual time out6. Reason Code 910 – Attendant Failed toCall In and Out – Verified Services WereDelivered Must document actual time in and timeout7. Reason Code 999 – Other 1/11/2018Must enter free text in the comments fieldto explain the use of this reason code.
Reason CodeScenarios1/11/201864
Scenario 1An attendant worked from 9:00 a.m. to1:00 p.m. but did not use the tokendevice that was already installed in thehome to clock in and out.A.RC 900- Attendant or assigned stafffailed to call inB.RC 905- Attendant or assigned stafffailed to call outC.RC 910- Attendant or assigned stafffailed to call in and outD.RC 205- Small Alternative DevicePending Installation1/11/201865
Scenario 2An attendant shows up to an individual/member’s home and immediately sees theyhave fallen.Instead of making the individual/memberwait for help so the attendant can call intothe EVV system what reason code is themost appropriate to use for the missingclock-in time?A. RC 130- Disaster or EmergencyB. RC 405 Phone unavailable- VerifiedServices were deliveredC. RC 500- In-Home Respite ServicesD. RC 999- Other66
Scenario 3An attendant is scheduled
GPS Mobile App Pilot The attendant downloads the Vesta Mobile app on their smart phone and uses the app to clock-in and out by pressing the clock in/out button The GPS App estimated data usage is less than two megabytes (MB) per month and does not use minutes from cell phone plan There is no P
