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

Electronic Visit Verification General Stakeholder Meeting May 19, 2020 1

Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2

WELCOME Stakeholders • HCPF Introductions • House Keeping 3

The purpose of this meeting is to engage providers, members, and other stakeholders as the Department works to implement EVV for community based services offered through both the State Plan and Waivers. And specifically to: Meeting • Review EVV , the legislative mandate, and the scope of implementation Purpose • Discuss EVV Project Updates • Provide a platform to gather stakeholder feedback 4 4

We ask that you: • Mind E-manners • Identify yourself when speaking Meeting Guidelines • Share the air • Listen for understanding • Stay solution and scope focused 5 5

Introductions Brief Overview of EVV Implementation Timeline Code of Regulation Update Agenda Live-in Caregiver Exemption Support Resources Overview Sandata Call Center Report Department Data Analytics Open Forum 6

Overview of EVV 7

8 • 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 What is • Section 12006 of the 21st Century Cures Act requires all EVV? state Medicaid agencies implement an EVV solution • States that do not implement EVV will incur a reduction of Federal funding • The Department will implement and mandate EVV for all Colorado required services on August 3, 2020. 8

TYPE OF SERVICE I NDI VI DUAL DATE OF THE RECEI VI NG THE PERFORMED SERVICE SERVICE What must EVV Capture? LOCATI ON OF I NDI VI DUAL TI ME THE SERVICE PROVI DI NG THE SERVICE DELIVERY BEGINS AND ENDS SERVICE 9

Which Services Require EVV?* • • Personal Care Independent Living Skills Training (ILST) • • Pediatric Personal Care Life Skills Training • • Home Health: RN, LPN, CNA, PT, OT, SLP Physical Therapy (provided in the home) • • Private Duty Nursing Occupational Therapy (provided in the home) • • Hospice Speech Therapy (provided in the home) • • Homemaker Behavioral Therapies (provided in the home or community) • Respite (provided in the home or community) • Pediatric Behavioral Health • Consumer Directed Attendant Support Services • (CDASS) Youth Day • • In-Home Support Services (IHSS) Durable Medical Equipment (select services) * Subj e j ect t o change 10

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

• EVV services happen in the home and in the community. Service • EVV does not disrupt this flexibility of service location. Location • Facility-based services are exempt from EVV unless otherwise noted. 12

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 State EVV vendor must ensure that their system is configured to Colorado EVV rules and Model: requirements. Hybrid  Provider Choice Systems must connect to the Data Aggregator  Training is required for State EVV Solution and Provider Choice EVV 13

State EVV Solution Technologies Mobile Application Telephony Provider Web Portal 14

Questions 15

EVV I mplementation Timeline 16

Colorado EVV I mplementation Timeline • 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. 17

Soft-Launch Review • 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 18

Medical Services Board Update • The EVV rule completed initial read on May 8, 2020 • The Department is updating the rule to accommodate stakeholder feedback First Reading: 5/ 8/ 2020 S econd Reading: 6/ 12/ 2020 Mandate Effective: 8/ 3/ 2020 19

Live-in Caregiver Exemption 20

Live-in Caregiver Exemption • 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 21

Live-in Caregivers Definition 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. 22

Services Permitted to Utilize Live-in Exemption Live-in EVV Type of Service Caregiver Behavioral Therapies Allowed • EVV services appropriate Consumer Directed Attendant Support Services (CDASS) Allowed for Live-in Caregiver Durable Medical Equipment Ineligible Home Health Allowed Exemption may utilize Homemaker Allowed exemption, at provider Hospice Allowed discretion. Independent Living Skills Training (ILST) and Life Skills Training Allowed (LST) In-Home Support Services (IHSS) Allowed • EVV services that require Occupational Therapy Ineligible uninterrupted delivery are Pediatric Behavioral Therapies Ineligible ineligible for live-in Pediatric Personal Care Allowed Personal Care Allowed caregiver exemption. Physical Therapy Ineligible Private Duty Nursing Allowed Respite and Youth Day Allowed Speech Therapy Ineligible 23

Live-in Caregiver Process 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. 24

Live-in Caregiver Process Cont. 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. 25

Live-in Caregiver Attestation From Online Review Questions & Answers 26

Live-in Caregiver Exemption Billing Provider Responsibilities • 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 27