Electronic Visit Verification General Stakeholder Meeting November - - PowerPoint PPT Presentation

Electronic Visit Verification

General Stakeholder Meeting

November 19, 2019

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Our Mission

Improving health care access and

• utcomes for the people we serve

while demonstrating sound stewardship of financial resources

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Welcome Stakeholders

• Restroom locations
• HCPF Introductions

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Meeting Purpose

The purpose of this meeting is to engage providers, members, and other stakeholders as the Department works to implement EVV for community based services

• ffered through both the State Plan and Waivers.

And specifically to:

• Review EVV, the legislative mandate, and the scope
• f implementation
• Discuss EVV project updates
• Provide a platform to gather stakeholder feedback

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Meeting Guidelines

We ask that you:

• Mind E-manners
• Identify yourself when speaking
• Share the air
• Listen for understanding
• Stay solution and scope focused

Agenda

Introductions Brief Overview of EVV Live-in Caregiver Definition Scope of EVV Program Claim Edit Follow-up Sandata Call Center Report Stakeholder Engagement Discussion

What is EVV?

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• Electronic Visit Verification (EVV) is a technology

solution which verifies information through mobile application, telephony, or web-based portal

• EVV is used to ensure that home or community-

based services are delivered to people needing those services by documenting the precise time service begins and ends

• Section 12006 of the 21st Century Cures Act

requires all state Medicaid agencies implement an EVV solution

• States that do not implement EVV will incur a

reduction of Federal funding

• The Department intends to implement EVV for all

Colorado required services in late summer 2020.

What must EVV Capture?

TYPE OF SERVICE PERFORMED INDIVIDUAL RECEIVING THE SERVICE DATE OF THE SERVICE LOCATION OF SERVICE DELIVERY INDIVIDUAL PROVIDING THE SERVICE TIME THE SERVICE BEGINS AND ENDS

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Which Types of Services Require EVV?

EVV Required

• Select Fee for Services (FFS) State Plan and HCBS Waiver

Services EVV Excepted

• Per Diem Services, Managed Care, Program for All-Inclusive

Care for the Elderly (PACE), and other Capitated Services

• Personal Care
• Pediatric Personal Care
• Home Health: RN, LPN, CNA, PT, OT, SLP
• Private Duty Nursing
• Hospice
• Homemaker
• Respite (provided in the home or community)
• Consumer Directed Attendant Support Services

(CDASS)

• In-Home Support Services (IHSS)
• Independent Living Skills Training (ILST)
• Life Skills Training
• Physical Therapy (provided in the home)
• Occupational Therapy (provided in the home)
• Speech Therapy (provided in the home)
• Behavioral Therapies (provided in the home or

community)

• Pediatric Behavioral Health
• Youth Day
• Durable Medical Equipment (select services)

Which Services Require EVV?*

*Subject to change

Behavioral Therapies Consumer Directed Attendant Support Services Consumer Directed Attendant Support Services – SLS Health Maintenance Durable Medical Equipment Home Health – Certified Nurse Aide Home Health – Nursing Home Health – Occupational Therapy Home Health – Physical Therapy Home Health – Speech/Language Therapy Homemaker Hospice - In Home Hospice - Inpatient Independent Living Skills Training and Life Skills Training In-Home Support Services Occupational Therapy Pediatric Behavioral Therapies Pediatric Personal Care Personal Care Physical Therapy Private Duty Nursing Respite and Youth Day Speech Therapy 11

Service Types Groupings

Service Location

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• The Department recognizes that EVV services

can happen in the home or in the community.

• It is essential that EVV does not disrupt this

flexibility of service location.

• Services that happen in a facility or professional

building are exempt from EVV. Unless noted

• therwise.

Questions

• r

Comments

Key Terminologies

Term Meaning State EVV Solution State EVV system available to providers at no cost Provider Choice System EVV system procured, purchased, and used by a provider Alternate Vendor Vendor who manages a provider choice system Data Aggregator Where provider choice systems will submit EVV data to the State Solution

State EVV Model: Hybrid

Colorado selected a vendor that will provide EVV solutions, while also allowing providers to use alternative/existing EVV systems, if they meet state specifications: ✓ Providers choosing to use an alternate vendor must ensure that their system is configured to Colorado EVV rules and requirements. ✓ Provider Choice Systems must connect to the Data Aggregator ✓ Self-paced aggregator training must be completed prior to connecting to the Data Aggregator

State EVV Solution Overview

Colorado EVV Technologies

Mobile Application Telephony Provider Web Portal (Santrax)

Mobile Application: MVV

• Mobile Visit Verification (MVV): A GPS enabled mobile application

downloaded on a smartphone or tablet

• “Bring your own device” method that works on iPhone and Android
• GPS Enabled
• Captures location when a caregiver clocks-in/clocks-out
• No continual location reporting
• Direct care workers log-in with unique Sandata ID or email address
• Available in English, Spanish, Somali, Russian, Chinese Mandarin, and

Arabic Egyptian

Rural Area Considerations

• State EVV Solution application will work in rural areas or

telephony can be used

• MVV will automatically switch to “Disconnected Mode” when

smartphone or tablet is not connected to a network

• EVV data will be saved for a later transmission when the

caregiver logs-in and network connectivity (cellular or wi-fi) is established

Telephony Visit Verification (TVV)

• Each provider ID has two toll-free, multi-language

numbers

• Both numbers are accessible 24 hours a day, 7 days a

week

• Non-GPS option
• Client phone is preferred for TVV
• Location captured through ANI technology
• Member identified by Sandata Client ID
• Direct care workers identified by Sandata ID

Provider Portal

• Used for visit maintenance and administrative tasks
• Limited capacity for manual entry of EVV data
• Used by providers who utilize State EVV Solution
• View and verify visits
• Address exceptions or errors
• State enforced manual entry threshold

Project Updates

• Good Faith Effort Exemption request was approved 9/18/19
• Additional time will be used to explore solutions to exempt live-in caregivers
• The State EVV Solution and Data Aggregator are now live and available for use
• The Department strongly encourages providers to use EVV during the Soft-Launch
• DME providers may begin using EVV in early 2020
• Colorado anticipated EVV mandate will be late summer 2020

DME

Colorado EVV Implementation Timeline

Early Adoption - Voluntary Soft Launch

• Began October

1st, 2019

Colorado Anticipated Mandate

• Summer 2020
• CCR Rule in

Effect

CMS Mandate

• January 1, 2021
• Pre-payment

claims review

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Good Faith Effort Request Approved

State exploring live-in caregiver solutions

A live-in caregiver is a caregiver who permanently or for an extended period of time resides in the same residence as the Medicaid member receiving services. Live-in caregiver status is determined by meeting requirements established by either the U.S. Department of Labor or Internal Revenue service. Verification of live-in caregiver status must be validated by the provider though an official Department form. The Department permits live-in caregiver establishment beyond the above definitions in limited circumstances, at Department discretion. Examples may include:

• Joint custody arrangements
• Children in Foster Care
• Members transitioning out of residential service

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Proposed Live-in Caregiver Definition

Note: Live-in caregiver status is established by the member/caregiver relationship. If a caregiver provides services to more than one member, the establishment of live-in status only pertains to relationships where documentation has been provided and approved.

EVV Project Scope

Program Size Since Go-Live

*Data pulled on 11/13/2019

SERVICE TYPE CLIENTS VISITS PROVIDERS BHSVC 10 15 1 HHBAS 2 8 2 HHNUR 4 4 2 HMKR 145 876 5 IHSS 3 3 2 OT 2 2 2 PEDBT 5 9 3 PRSNL 77 582 9 PT 12 13 2 RSPT 4 12 1 SLT 3 8 1 No Service 39 118 7 TOTAL 306 1650 37

Verified vs. Unverified Visits

SERVICE TYPE VERIFIED VISITS UNVERIFIED VISITS PERCENT VERIFIED BHSVC 15 0.0% HHBAS 8 0.0% HHNUR 4 0.0% HMKR 50 826 5.7% IHSS 3 0.0% OT 2 0.0% PEDBT 3 6 33.3% PRSNL 206 376 35.4% PT 13 0.0% RSPT 3 9 25.0% SLT 1 7 12.5% No Service 118 0.0% TOTAL 263 1387

Verified:

• Complete visit
• All data points collected
• Cures-compliant visit
• Can match to a claim line

Unverified:

• Incomplete visit
• One or more data points missing
• Not a Cures-compliant visit
• Cannot match to a claim line

Claim Edit Follow-up

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From Provider Newsletter:

Claim Edit Follow-up

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Questions

• r

Comments

Sandata Call Center Update

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Contact: Phone: 855-871-8780 or email Email: CO-HCPF-EVVProviderHelpdesk@etraconline.net

Calls Presented

33 Presented - calls that come into the call center (Dark Green) Answered - calls that were answered by a call center representative (Light Green) Abandoned - calls that were not answered by the call center (Gray)

% of Calls Answered in 60 Seconds

34 Percentage is the amount of calls that were answered in 60 seconds over all calls received.

% of Calls Captured

35 Percentage is the amount of calls that were answered from all calls presented.

Average Answer and Talk

36 Average time of call, in seconds. Average time to answer call, in seconds.

Call Minutes: 9.8 9.9 9.4 7.8 11.4 9.1 10.8 9.9 7.2 7.1

Electronic Visit Verification Roadmap 2019

Electronic Visit Verification Implementation Roadmap

2018-2020

Project Kickoff 2018

Develop and Finalize Training Plan

Develop Colorado Rules and Regulation Draft Collect Stakeholder Feedback

• n EVV CCR

User

Acceptance

Testing

State System and Aggregator Live

Collect Stakeholder Feedback

• n

Scheduler

Provider Welcome Letter Register for Training

Begin Soft Launch

Interface

Testing

Provider Training Call Center Available

Go Live Mandatory Use Summer* 2020

Release Technical Specifications for Provider Choice Systems

*Subject to change

• Began October 1, 2019 when the State EVV Solution and Data Aggregator went live.
• Providers may begin to collect EVV data and transmit to the Department.
• Optional participation until EVV is mandated, estimated late summer 2020.
• Opportunity to familiarize providers with EVV prior to claims integration. Claims will

continue to pay and EVV errors will appear on remittance advice.

• Opportunity for caregivers to practice EVV collection and for members to become

accustomed to EVV.

• Help the Department identify and develop supplemental training materials.

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Soft-Launch

Stakeholder Engagement Discussion

Stakeholder Meeting Updates

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Subcommittees

• Consumer Direction and Family Caregiver
• Training and Communications (Sunset November 2019)
• Systems (Sunset November 2019)
• Privacy (Sunset February 2019)

General EVV Stakeholder Meeting

• How would you like to use this time?

Questions

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Contact Information

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Lana Eggers EVV@state.co.us

Thank you!

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