Electronic Visit Verification (EVV) is a system mandated at the federal level to digitally confirm and log details of service delivery. This includes critical information for specific Medicaid service visits such as the date, time, type of service provided, and the location where services were rendered.
Understanding EVV Mandates and Program Requirements
The implementation of EVV is driven by the 21st Century Cures Act (Section 12006), a federal law enacted in 2016. This act requires all states to adopt EVV for Medicaid-funded personal care services and home health care services that necessitate in-home visits. Failure to comply with the EVV mandate results in a reduction of federal Medicaid funding to the non-compliant state.
Key dates for EVV implementation include:
- January 1, 2021: Mandatory EVV implementation for Medicaid personal care services.
- January 1, 2024: Mandatory EVV implementation for Medicaid home health care services.
This federal mandate ensures better oversight and accountability in the provision of Medicaid services, aiming to reduce fraud and improve service quality.
Communication and Compliance for EVV
Effective communication and strict compliance are essential components of the EVV system. Healthcare agencies and providers must stay informed about EVV requirements and ensure their practices align with state and federal guidelines.
Payers, including HHSC and managed care organizations, routinely conduct EVV compliance reviews. These reviews are designed to verify that program providers, Financial Management Services Agencies (FMSAs), and Consumer Directed Services (CDS) employers are adhering to all EVV mandates and policies.
Resources for EVV Compliance
For detailed information on navigating compliance, refer to section 11000 EVV Compliance Reviews within the EVV Policy Handbook. This section provides job aids and comprehensive guidance on maintaining EVV compliance.
Consumer Directed Services (CDS) and EVV Options
The EVV Consumer Directed Services Option offers specific resources and information tailored to Consumer Directed Services within the EVV framework. This option provides flexibility and support for consumers who self-direct their care.
EVV Policies and Handbook
Comprehensive policies governing EVV are documented and regularly updated in the EVV Policy Handbook.
Accessing the Policy Handbook
The EVV Policy Handbook is a crucial resource for understanding the detailed regulations and guidelines.
Policy Handbook Revision Log
Stay up-to-date with the latest changes and updates to EVV policies through the Policy Handbook Revision Log, ensuring adherence to the most current standards.
Proprietary EVV Systems: An Alternative Approach
Program providers and FMSAs have the option to seek approval from HHSC to utilize a proprietary EVV system instead of a vendor-based system. This allows for customization and integration with existing systems, provided it meets all EVV requirements.
More information about implementing and getting approval for these systems can be found at EVV Proprietary Systems.
Utilizing EVV Reason Codes Effectively
When visit maintenance is required within the EVV system, it is critical for program providers, FMSAs, and CDS employers to select the most appropriate EVV Reason Code. This includes choosing the correct Reason Code Number, Reason Code Description, and providing necessary free text to clarify visit modifications.
EVV Reason Codes Resources
Several resources are available to assist with the correct use of reason codes:
EVV Reason Codes Quick Reference Guide
The EVV: When to Use Reason Codes Numbers and Descriptions Effective Oct. 1, 2023 (PDF) offers practical examples and guidelines for when to apply each Reason Code Number and when free text is needed.
EVV Reason Codes Crosswalk
For users transitioning between different versions of reason codes, the EVV Reason Codes Crosswalk (PDF) provides a comparison and mapping of codes across versions.
Historical EVV Reason Codes
For historical data and older records, resources on Historical EVV Reason Codes are also available.
Essential EVV Resources and Support
Navigating EVV can be complex, and numerous resources are available to provide support and guidance.
EVV Contact Guides
For specific inquiries and support needs, consult the Contact Guides which provide detailed contact information for various EVV-related questions.
Getting Started with EVV Guides
Specific guides are designed to help different stakeholders in getting started with EVV. These resources are tailored for program providers, FMSAs, and CDS employers to facilitate a smooth onboarding process.
EVV Best Practices
To optimize EVV implementation and usage, refer to the EVV Best Practices guides. These guides offer insights and recommendations for efficient and compliant EVV operations.
Form 1718: Responsibilities and Information
Form 1718 is utilized by MCO service coordinators to inform Medicaid recipients about their EVV compliance responsibilities, as mandated by TAC §Section 354.4011.
EVV Schedules and Requirements
The Program and Service Requirements for Schedules (PDF) document outlines the scheduling requirements and guidelines for different programs and services under EVV.
Statutes and Rules Governing EVV
For legal and regulatory details, refer to the Statutes and Rules that govern EVV implementation and operation.
EVV Service Bill Codes Table
The EVV Service Bill Codes Table provides a comprehensive list of current billing codes and detailed information for EVV-relevant services across Long-term Care, Acute Care, and Managed Care programs.
Program providers must ensure they are using the correct Healthcare Common Procedure Coding System (HCPCS) and modifier combinations to avoid transaction rejections and claim denials related to EVV visits.
Specific Service Guidelines: Personal Care and Home Health Care
Detailed guidelines and requirements are available for both Personal Care Services and Home Health Care Services to ensure EVV compliance in these specific areas.
EVV Training Resources
HHSC EVV Training Resources offers extensive training materials and support for providers and staff to effectively use the EVV system.
Managing Visit Maintenance with Unlock Requests
The EVV Visit Maintenance Unlock Request (VMUR) process allows program providers, FMSAs, and CDS employers to correct data elements on EVV visit transactions after the standard maintenance timeframe has expired.
To initiate a correction, users must follow specific instructions provided in the EVV Visit Maintenance Unlock Request spreadsheets. Crucially, all request emails must include a contact name, email address, and phone number to facilitate communication and prevent processing delays. Failure to send requests securely may lead to HIPAA violations, resulting in request denial by the payer.
VMUR Instructions and Templates
Access detailed VMUR Instructions and Templates to correctly complete and submit unlock requests.
VMUR Job Aids
Additional VMUR Job Aids are available to provide step-by-step assistance and best practices for managing visit maintenance unlock requests efficiently.
This comprehensive guide serves as your central reference for understanding and navigating Electronic Visit Verification. By utilizing the resources and guidelines provided, stakeholders can ensure compliance, optimize service delivery, and effectively manage EVV processes.
