Electronic Visit Verification General Stakeholder Meeting April 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. Meeting And specifically to: Purpose • Review EVV, the legislative mandate, and the scope of implementation • Discuss EVV Project Updates • Provide a platform to gather stakeholder feedback 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
Introductions Brief Overview of EVV Implementation Timeline Code of Regulation Rule Timeline Agenda Project Updates Sandata Call Center Report Department Data Analytics Open Forum
Overview of EVV
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.
TYPE OF SERVICE INDIVIDUAL DATE OF THE PERFORMED RECEIVING THE SERVICE What must 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, 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
Questions 16
EVV Implementation Timeline
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 – 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. DME
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 19
Code of Regulations Rule Medical Services Board Timeline Public Rule Review Feedback: 4/20 – 4/24 First Reading: 5/8/2020 Second Reading: 6/12/2020 Rule Effective: 7/30/2020 Mandate Effective: 8/3/2020 20
EVV Rule Resources Public Rule Review is an opportunity to offer input on • proposed rule prior to Medical Service Board Email EVV@state.co.us with feedback on EVV rule by 4/24 Public Rule Review: https://www.colorado.gov/pacific/hcpf/public-rule- review-meetings Medical Services Board: • • https://www.colorado.gov/pacific/hcpf/medical-services-board 21
Project Updates
Live-in Caregiver Update Department is finalizing live-in caregiver solution • System testing is currently underway • Estimated guidance release in late April • Live-in Caregiver Attestation Form finalized • Services permitted to utilize live-in caregiver • exemption 23
Live-in Caregivers Definition Live-in Caregiver means 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 the U.S. Department of Labor, Internal Revenue Service, or Department- approved extenuating circumstances. Documentation of live-in caregiver status must be collected and maintained by the Provider. 24
Live-in Caregivers Attestation Form • Department collaborated with the Member and Caregiver Subcommittee • Final draft posted on website for stakeholder review • Provide feedback by April 24, 2020 25
Live-in Caregiver Attestation Form https://www.colorado.gov /hcpf/electronic-visit- verification-stakeholder- workgroup 26
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 Exemption may utilize Home Health Allowed 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 27
Live-in Caregiver Exemption Billing Provider Responsibilities • Determine if the agency 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, once released 28
Alternate Location Functionality • Modification of EVV location as needed • Provider Choice systems must ensure correct locations • State EVV Solution requires Alternate Locations in the following situations: • Telephony (TVV) or Mobile App (MVV) with wrong location (before claim matching) • Correcting existing EVV (after claim matching) • Entering Manual Visit Records Alternate Location Fact sheet on website under Provider Resources https://www.colorado.gov/hcpf/electronic-visit-verification-resources
EVV User Testing BINGO! • Prepare for as many scenarios as possible before go-live. • Develop good habits and familiarity with the different access points and functionalities. • Become aware of resources and how they can be utilized best. • Help the Department catch potential system bugs in the system early-on to address them sooner. • Help the Department collect utilization data to more accurately develop reports. https://www.colorado.gov/hcpf/electronic-visit-verification-resources 30
DXC Payment Processing Schedule
EVV Visit Weekly Submission EVV data must be submitted by midnight on Thursday to be matched to a claim on the week’s Processing Date
Sandata Call Center Report
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