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Electronic Visit Verification General Stakeholder Meeting
May 19, 2020
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Our Mission
Improving health care access and outcomes 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 Departmentworks to implement EVV for community based servicesoffered through both the State Plan and Waivers.
And specifically to:
• Review EVV, the legislative mandate, and the scope of 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 focused5
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 of 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 of 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
INDIVIDUAL RECEIVING THE
SERVICE
DATE OF THE SERVICE
LOCATION OF SERVICE DELIVERY
INDIVIDUAL PROVIDING THE
SERVICE
TIME 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?*
*Subject to change10
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
TherapyHome Health –
Physical TherapyHome Health –
Speech/Language Therapy
Homemaker Hospice - In Home Hospice - Inpatient
Independent Living Skills Training
and Life Skills Training
In-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 Implementation 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 Implementation 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
Second 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 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.
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Live-in Caregivers Definition
EVV Type of Service Live-in Caregiver
Behavioral Therapies Allowed Consumer Directed Attendant Support Services (CDASS) AllowedDurable Medical Equipment Ineligible Home Health AllowedHomemaker 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 [email protected] 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 rules27
Live-in Caregiver ExemptionBilling Provider Responsibilities
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Live-in Caregiver Billing Instructions • 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 Inbox Questions
Project Updates
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EVV Inbox
DXC (Billing)
Help Desk
Phone: 1-844-235-2387
EVV Help Desk
Phone: 1-855-871-8780
Email: COCustomerCare
@sandata.com
Provider Choice
Interface
Phone: 1-844-289-4246
Email: COAltEVV
@sandata.com
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EVV Support Pathways
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EVV Support PathwaysPathway Method Purpose Prepare Before
ContactingExpected Initial Response Time
EVV Help Desk
1-855-871-8780
Using State EVV Solution, interfacing Provider Choice Systems, Sandata 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 [email protected]
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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Total Incoming 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
Expected Percent
72.73%
Cumulative Percent
11.74%
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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 ExceptionsLocation Required
21.66%
Unmatched Client ID/Phone20.44%
Visits Without Any Calls20.17%
Visits Without Out Calls14.25%
Missing Service12.55%
Unkown Employees5.72%
Visits Without In Calls5.21%
Visit exceptions are error flags thrown on a visit that is
missing one or more required points of data.
Questions
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Thank you!
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