Electronic Visit Verification General Stakeholder Meeting November 19, 2019 1
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2
Welcome Stakeholders • Restroom locations • HCPF Introductions
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 Purpose of implementation • Discuss EVV project updates • Provide a platform to gather stakeholder feedback 4
We ask that you: • Mind E-manners Meeting • Identify yourself when speaking Guidelines • Share the air • Listen for understanding • Stay solution and scope focused 5
Introductions Brief Overview of EVV Live-in Caregiver Definition Agenda Scope of EVV Program Claim Edit Follow-up Sandata Call Center Report Stakeholder Engagement Discussion
• Electronic Visit Verification (EVV) is a technology 7 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 EVV? 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 TYPE OF SERVICE INDIVIDUAL DATE OF THE PERFORMED RECEIVING THE SERVICE SERVICE EVV Capture? LOCATION OF INDIVIDUAL TIME THE SERVICE SERVICE DELIVERY PROVIDING THE BEGINS AND ENDS SERVICE
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 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) • • *Subject to change
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 - In Home Hospice - Inpatient Physical Therapy Therapy Therapy Independent Living Skills Training In-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
12 • The Department recognizes that EVV services can happen in the home or in the community. Service • It is essential that EVV does not disrupt this flexibility of service location. Location • Services that happen in a facility or professional building are exempt from EVV. Unless noted otherwise.
Questions or 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
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 State EVV configured to Colorado EVV rules and requirements. Model: Hybrid ✓ 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
Colorado EVV Implementation Timeline 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
Good Faith Effort Request Approved Early Colorado CMS Adoption - Anticipated Mandate Voluntary Mandate • January 1, 2021 Soft Launch • Summer 2020 • Pre-payment • CCR Rule in • Began October claims review Effect 1 st , 2019 State exploring live-in caregiver solutions 24
Proposed Live-in Caregiver Definition 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 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. 25
EVV Project Scope
SERVICE TYPE CLIENTS VISITS PROVIDERS BHSVC 10 15 1 HHBAS 2 8 2 HHNUR 4 4 2 Program HMKR 145 876 5 IHSS 3 3 2 Size Since OT 2 2 2 PEDBT 5 9 3 Go-Live PRSNL 77 582 9 PT 12 13 2 RSPT 4 12 1 SLT 3 8 1 No Service 39 118 7 *Data pulled on 11/13/2019 TOTAL 306 1650 37
SERVICE TYPE VERIFIED VISITS UNVERIFIED VISITS PERCENT VERIFIED Verified vs. BHSVC 15 0.0% HHBAS 8 0.0% Unverified HHNUR 4 0.0% HMKR 50 826 5.7% Visits IHSS 3 0.0% OT 2 0.0% Verified : • Complete visit PEDBT 3 6 33.3% • All data points collected PRSNL 206 376 35.4% • Cures-compliant visit • Can match to a claim line PT 13 0.0% RSPT 3 9 25.0% Unverified : • Incomplete visit SLT 1 7 12.5% • One or more data points missing No Service 118 0.0% • Not a Cures-compliant visit TOTAL 263 1387 • Cannot match to a claim line
Claim Edit Follow-up From Provider Newsletter : 29
Claim Edit Follow-up 30
Questions or Comments
Sandata Call Center Update Contact: Phone: 855-871-8780 or email Email: CO-HCPF-EVVProviderHelpdesk@etraconline.net 32
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