Electronic Visit Verification General Stakeholder Meeting May 19, - - PowerPoint PPT Presentation

Electronic Visit Verification

General Stakeholder Meeting

May 19, 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

• HCPF Introductions
• House Keeping

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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

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Agenda

Introductions Brief Overview of EVV Implementation Timeline Code of Regulation Update Live-in Caregiver Exemption Support Resources Overview Sandata Call Center Report Department Data Analytics Open Forum

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Overview

• f EVV

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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
• f Federal funding
• The Department will implement and mandate EVV for all

Colorado required services on August 3, 2020.

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What must EVV Capture?

TYPE OF SERVICE

PERFORMED

I NDI VI DUAL RECEI VI NG THE

SERVICE

DATE OF THE

SERVICE

LOCATI ON OF

SERVICE DELIVERY

I NDI VI DUAL PROVI DI NG THE

SERVICE

TI ME THE SERVICE

BEGINS AND ENDS

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• 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?*

* Subj e j ect t o change

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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 - I n Home Hospice - I npatient I ndependent Living Skills Training and Life Skills Training I n-Home Support Services Occupational Therapy Pediatric Behavioral Therapies Pediatric Personal Care Personal Care Physical Therapy Private Duty Nursing Respite and Youth Day Speech Therapy

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Service Types Groupings

Service Location

• 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.

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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

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State EVV Solution Technologies

Mobile Application Telephony Provider Web Portal

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Questions

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EVV I mplementation Timeline

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• 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 – 8/2/2020: Soft-Launch.
• 8/3/2020: EVV mandate, providers must use EVV.
• 1/1/2021: Prepayment claims review, claims will deny without corresponding

EVV.

Colorado EVV I mplementation Timeline

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• 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

• The EVV rule completed initial read on May 8, 2020
• The Department is updating the rule to accommodate stakeholder feedback

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Medical Services Board Update

First Reading: 5/ 8/ 2020 S econd Reading: 6/ 12/ 2020 Mandate Effective: 8/ 3/ 2020

Live-in Caregiver Exemption

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• Process for Live-in Caregiver Exemption finalized
• Live-in Caregiver Attestation Form finalized
• Memo Series Released: HCPF OM 20-051
• Services eligible for Live-in Caregiver Exemption finalized

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Live-in Caregiver Exemption

Live-in Caregiver means a caregiver who permanent ly or f or an ext ended period of t ime resides in t he same residence as t he Medicaid member receiving services. Live-in caregiver st at us is det ermined by meet ing requirement s est ablished by t he U.S . Depart ment of Labor, Int ernal Revenue S ervice, or Depart ment - approved ext enuat ing circumst ances. Document at ion of live-in caregiver st at us must be collect ed and maint ained by t he Provider.

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Live-in Caregivers Definition

EVV Type of Service Live-in Caregiver Behavioral Therapies Allowed Consumer Directed Attendant Support Services (CDASS) Allowed Durable Medical Equipment Ineligible Home Health Allowed Homemaker Allowed Hospice Allowed Independent Living Skills Training (ILST) and Life Skills Training (LST) Allowed In-Home Support Services (IHSS) Allowed Occupational Therapy Ineligible Pediatric Behavioral Therapies Ineligible Pediatric Personal Care Allowed Personal Care Allowed Physical Therapy Ineligible Private Duty Nursing Allowed Respite and Youth Day Allowed Speech Therapy Ineligible

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Services Permitted to Utilize Live-in Exemption

• EVV services appropriate

for Live-in Caregiver Exemption may utilize exemption, at provider discretion.

• EVV services that require

uninterrupted delivery are ineligible for live-in caregiver exemption.

1) Member and Caregiver decide if they would like to apply for the Live-in Caregiver Exemption from EVV. 2) Member or Caregiver review service list eligible for Exemption. 3) Member or Caregiver outreach Provider Agency or FMS Vendor to determine if an Exemption is permitted by the Provider Agency or FMS vendor. 4) If eligible, Member and/or Caregiver fill out Live-in Caregiver Attestation Form and collect supporting documentation. 5) Email EVV@state.co.us if Extenuating Circumstance Determination is necessary. 6) Supply completed form and supporting documentation to Provider Agency or FMS Vendor.

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Live-in Caregiver Process

7) Provider Agency reviews, attests to accuracy of information, and approves – OR – FMS Vendor reviews that required documentation is present and confirms receipt. 8) Once Exemption paperwork is submitted and approved, the Caregiver no longer needs to complete EVV when providing services to the specific Member. 9) Provider Agencies or FMS Vendors bill according to Exemption policy. 10) Provider Agency or FMS Vendor maintain exemption records and ensure they are updated annually. Records may be audited by the Department at without notice. 11) If at any time the Member and Caregiver no longer meet requirements of the Exemption, EVV must be collected.

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Live-in Caregiver Process Cont.

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Live-in Caregiver Attestation From

Online Review

Questions & Answers

• Determine if Provider Agency or FMS Vendor

will utilize the Live-in Caregiver Exemption from EVV

• Maintain Live-in Caregiver records
• Live-in Caregiver Attestation Form
• Supporting documentation
• Follow live-in caregiver billing rules

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Live-in Caregiver Exemption

Billing Provider Responsibilities

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Live-in Caregiver Billing I nstructions

• Claims billed using the CMS 1500 billing methodology:
• Place of Service 99 must be designated for all lines where a Live-in Caregiver

has delivered the service.

• Claims billed using the UB-04 billing methodology:
• Condition Code 23 must be designated for all lines where a Live-in Caregiver

has delivered the service.

• Each claim line must appropriately indicate if the service was provided by a Live-in

Caregiver.

• If the same service is provided by both a Live-in Caregiver and a non-Live-in

Caregiver, the units billed to each should be billed on separate claim lines and indicated correctly.

• What evidence documents should be used for a minor?
• Who signs under “Member or Authorized Representative”?
• What are the differences between Part A and Part B?
• What if I use Place of Service 99 for a different purpose?

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Live-in Caregiver Exemption

I nbox Questions

Project Updates

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EVV I nbox

EVV@state.co.us

DXC (Billing) Help Desk

Phone: 1-844-235-2387

EVV Help Desk

Phone: 1-855-871-8780 Email: COCustomerCare @sandata.com

Provider Choice I nterface

Phone: 1-844-289-4246 Email: COAltEVV @sandata.com

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EVV Support Pathways

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EVV Support Pathways

Pathway Method Purpose Prepare Before Contacting Expected Initial Response Time EVV Help Desk 1-855-871-8780 COCustomerCare @ sandata.com Using S tate EVV S

• lution,

interfacing Provider Choice S ystems, S andata trainings, EVV accounts Nothing needed Phone: As soon as connected Email: within two business days DXC (Billing) Help Desk 1-844-235-2387 Provider billing or claims processing questions Nothing needed As soon as connected EVV Inbox EVV@ state.co.us

• Dept. approval of Live-in

Caregiver exemption, Policy and Program answers, Escalations from other support methods Live-in Caregiver Documentation for review, Help Desk documentation (Call number, who you talked to, etc.) Within a week

Sandata Call Center Report

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Sandata Call Center

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Phone

855-871-8780

Email

COCustomerCare@ Sandata.com

May-20

Total I ncoming Calls

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Percent of Calls Captured

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Call Times: What To Expect

Wait Time for a Call Representative Time With a Call Representative 20.89 Seconds 10.58 Minutes

EVV Department Analytics

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Oct 1, 19 Nov 1, 19 Dec 1, 19 Jan 1, 20 Feb 1, 20 Mar 1, 20 Apr 1, 20 May 1, 20 Jun 1, 20 Jul 1, 20 Aug 1, 20 Day of Claim Paid Date 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% Perc

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Expected and Cumulative Percent of Providers Who Utilized an EVV System

Cumulative Percent 11.74% Expected Percent 72.73%

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Most Common Visit Exceptions

Location Required 21.66% Unmatched Client ID/ Phone 20.44% Visits Without Any Calls 20.17% Visits Without Out Calls 14.25% Missing S ervice 12.55% Unkown Employees 5.72% Visits Without In Calls 5.21%

Visit exceptions are error flags thrown on a visit that is missing one or more required points of data.

Questions

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Contact I nformation

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Lana Eggers EVV@ state.co.us www.colorado.gov/ hcpf/ evv

Thank you!

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