Electronic Visit Verification General Stakeholder Meeting January 21, 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 • 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 Provider Experience (guest) Billing and EVV Agenda Timeline Sandata Call Center Report Department Analytics Open Forum
Overview of EVV
• Electronic Visit Verification (EVV) is a technology 8 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 10
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 12
13 • 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.
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
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
Provider Experience GoldStar Learning Options, Inc Guest Speakers: Rachael Porter and Katie Burpo 17
Billing and EVV • 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? 18
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 Yes No Is this Code on the EVV List? EVV is required Does the claim have Yes No an EVV record? Paid No EOB 3054 Denial Paid EVV is not required EOB 3054 – Missing EVV No EOB 3054
Department Updates
Project Develop Kickoff Develop and User Collect Colorado Finalize Stakeholder 2018 Rules and Acceptance Feedback Training Regulation Testing on EVV CCR Plan Draft Electronic Visit State System Verification and Aggregator Implementation Release Collect Live Technical Provider Register Stakeholder Specifications Roadmap Welcome for Feedback for Provider on Letter Training Choice Scheduler Systems 2018-2020 Interface Provider Testing Go Live Training Soft Mandatory Call Center Use Launch Available Summer* 2020 *Subject to change
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 25
Colorado EVV Implementation 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 – 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 Mandate Timeline 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 27
Questions 28
Colorado EVV Sandata Call Center Report
Sandata Call Center Phone 855-871-8780 Email CO-HCPF-EVVProviderHelpdesk@etraconline.net 30
Total Incoming Calls
Percent of Calls Captured
Call Times: What To Expect Wait Time for a Call Representative Time with a Call Representative 17.73 Seconds 10.22 Minutes 33
Questions 34
Colorado EVV Department Analytics
SERVICE TYPE CLIENTS VISITS PROVIDERS BHSVC 19 97 3 HHBAS 6 59 5 HHNUR 24 301 4 HHOT 2 2 1 Current HHPT 8 16 1 HMKR 215 3132 13 Program HSPH 1 3 1 IHSS 36 302 11 LST 7 42 2 Size 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 *Data pulled on 1/2/2020 Distinct Count 603 10319 47
UNVERIFIED SERVICE TYPEVERIFIED VISITS VISITS Percent Verified Verified vs. BHSVC 2 95 2.06% HHBAS 0 59 0.00% Unverified HHNUR 1 300 0.33% HHOT 2 0 100.00% HHPT 0 16 0.00% Visits HMKR 205 2927 6.55% HSPH 0 3 0.00% IHSS 20 282 6.62% Verified : LST 3 39 7.14% • Complete visit OT 2 36 5.26% • All data points collected PDRN 0 7 0.00% • Cures-compliant visit PEDBT 23 199 10.36% • Can match to a claim line PEDPC 0 3 0.00% PRSNL 557 4347 11.36% Unverified : PT 3 178 1.66% • Incomplete visit RSPT 6 57 9.52% • One or more data points missing SLT 3 47 6.00% • Not a Cures-compliant visit No Service 0 897 0.00% • Cannot match to a claim line TOTAL 827 9492 8.01%
EVV Website: 2019 Activity 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 38
Questions 39
Additional Updates New FAQ on Website Provider Survey (due 1/24/2020) Alternate Vendor Update www.colorado.gov/hcpf/evv 40
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