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

Electronic Visit Verification

General Stakeholder Meeting

January 21, 2020

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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 Provider Experience (guest) Billing and EVV Timeline Sandata Call Center Report Department Analytics Open Forum

Overview

• f EVV

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 12

Service Types Groupings

Service Location

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• EVV services happen in the home and in the

community.

• EVV does not disrupt this flexibility of service

location.

• Facility-based services are exempt from EVV

unless otherwise noted.

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 ✓ Training is required for State EVV Solution and Provider Choice EVV

State EVV Solution Technologies

Mobile Application Telephony Provider Web Portal

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

GoldStar Learning Options, Inc Guest Speakers: Rachael Porter and Katie Burpo

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Provider Experience

• Does EVV change the way providers bill?
• How will EVV impact claims processing?
• What is a claim edit?
• When will claims require EVV to pay?

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Billing and EVV

Caregiver provides service(s) using EVV Provider bills for services as normal

Billing and EVV

Step 1: Claim will process as usual, including verification against existing claim edits

Missing PAR Correct PAR

Billing and EVV

Step 2: Does this claim require an EVV Visit?

Code Billed on Line of Claim EVV Code List

Billing and EVV

Is this Code on the EVV List? Yes No No EOB 3054 EVV is not required

Does the claim have an EVV record?

No Yes Denial EOB 3054 – Missing EVV Paid No EOB 3054 EVV is required

Billing and EVV

Paid

Department Updates

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

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

• The State EVV Solution and Data Aggregator are now live and available for use
• Providers may begin to collect EVV data and transmit to the Department.
• Opportunity to familiarize providers with EVV prior to claims integration. Claims will

continue to pay and EVV errors will appear on Remittance Advice (EOB 3054).

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

accustomed to EVV.

• Help the Department identify and develop supplemental training materials.
• The Department strongly encourages providers to use EVV during the Soft-Launch

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Soft-Launch Review

• 9/18/19: Good Faith Effort Exemption request approved by CMS
• 10/1/2019: State EVV Solution and Data Aggregator went live
• 10/1/2019 – Summer 2020: Soft-Launch
• Summer 2020: Anticipated EVV mandate, Code of Regulation Rule passes
• Late 2020 or 1/1/2021: Prepayment claims review, claims will deny without

corresponding EVV

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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Colorado EVV Mandate Timeline

State exploring live-in caregiver solutions

Questions

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Colorado EVV Sandata Call Center Report

Sandata Call Center

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Phone 855-871-8780 Email CO-HCPF-EVVProviderHelpdesk@etraconline.net

Total Incoming Calls

Percent of Calls Captured

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Call Times: What To Expect

Wait Time for a Call Representative Time with a Call Representative 17.73 Seconds 10.22 Minutes

Questions

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Colorado EVV Department Analytics

Current Program Size

*Data pulled on 1/2/2020

SERVICE TYPE CLIENTS VISITS PROVIDERS BHSVC 19 97 3 HHBAS 6 59 5 HHNUR 24 301 4 HHOT 2 2 1 HHPT 8 16 1 HMKR 215 3132 13 HSPH 1 3 1 IHSS 36 302 11 LST 7 42 2 OT 13 38 5 PDRN 3 7 3 PEDBT 29 222 4 PEDPC 3 3 3 PRSNL 225 4904 16 PT 61 181 4 RSPT 14 63 4 SLT 14 50 4 No Service 137 897 14 Distinct Count 603 10319 47

Verified vs. Unverified Visits

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

SERVICE TYPEVERIFIED VISITS UNVERIFIED VISITS Percent Verified BHSVC 2 95 2.06% HHBAS 59 0.00% HHNUR 1 300 0.33% HHOT 2 100.00% HHPT 16 0.00% HMKR 205 2927 6.55% HSPH 3 0.00% IHSS 20 282 6.62% LST 3 39 7.14% OT 2 36 5.26% PDRN 7 0.00% PEDBT 23 199 10.36% PEDPC 3 0.00% PRSNL 557 4347 11.36% PT 3 178 1.66% RSPT 6 57 9.52% SLT 3 47 6.00% No Service 897 0.00% TOTAL 827 9492 8.01%

EVV Website: 2019 Activity

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January 478 July 1832 February 446 August 1861 March 637 September 1550 April 557 October 1519 May 1369 November 740 June 1184 December 672

Unique Views: 12,845

Questions

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Additional Updates

New FAQ on Website Provider Survey (due 1/24/2020) Alternate Vendor Update

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www.colorado.gov/hcpf/evv

Upcoming Stakeholder Meetings

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Consumer Direction and Family Caregiver Subcommittee

Next meeting: February 25, 2020

EVV General Stakeholder Meeting

Next meeting: February 18, 2020

Contact Information

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Lana Eggers EVV@state.co.us

Thank you!

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