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Electronic Visit Verification (EVV) Proprietary Systems Workgroup
3rd Meeting
November 12, 2019
Steve Abshier
HHSC EVV Operations
2
Housekeeping and Introductions (1 of 3)
• GoToWebinar Etiquette
• All participants will remain muted
• Questions or comments may be submitted using the Question feature
3
Housekeeping and Introductions (2 of 3)
• If you’re planning on using your phone for audio, it’s important that you follow the instructions that came with your invite.
• You may have audio issues if you don’t input the audio PIN after joining the webinar.
4
Housekeeping and Introductions (3 of 3)
Roll Call
• Did everyone sign in that is here in person?
• We will have a log of all attendees on the phone from the meeting registration.
• Introduction of panel
• It was difficult to find the best spot for a break in todays presentation, but we will take a break somewhere in the window between 10 and 10:30.
5
Purpose of Workgroup
• Consult with Medicaid program providers to implement an open model EVV system.
• Obtain feedback on proposed processes.
• Use program provider experiences and feedback to improve or enhance where possible.
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Meeting Rules and Expectations
• All documents, concepts, and materials presented in this workgroup are considered informal drafts unless otherwise documented.
• Discussions must remain on topic.
• On-topic feedback will be collected, but HHSC will not provide a formal response to each comment.
• This workgroup will not make final decisions.
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Meeting Rules and Expectations (cont.)
• Participation in the workgroup is not required to seek HHSC approval of your proprietary system.
• The proprietary system option is not an opportunity for software vendors to contract with the State of Texas.
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Workgroup Membership (1 of 2)
Software vendor participation
• May only attend if invited by a provider.
• Providers are only allowed two slots and may use one slot for their software vendor, at their discretion.
• Provider must attend with software vendor.
• The proprietary system option is not an opportunity for software vendors to contract with the State of Texas.
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Workgroup Membership (2 of 2)
As a member of the workgroup, your role is to:
• Provide constructive feedback on proposed documents and processes.
• Share experiences that should be considered while developing the proprietary system option.
• Review materials in advance of meetings when possible and provide written feedback.
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Workgroup Member Role
• Review documents ahead of next meeting.
• Provide feedback in writing to HHSC EVV mailbox (preferred):
• Use email subject: Proprietary workgroup feedback – [organization name].
• Provide the actual rule number that you are commenting on
• Provide feedback at the next meeting.
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Recap from last meeting
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Recap from last meeting (1 of 2)
• We appreciate the participation and feedback
• Reminder, if you provide written comments to PS Business Rules, please identify the actual rule number that you are referencing.
• Example: if you want to comment on the Mobile Method Consent rule under the category Electronic Verification Methods, that would be rule EVM-8P**
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Recap from last meeting (2 of 2)
• Two Questions that HHSC took back last meeting
• POL-06 - What if a PSO’s Software Vendor goes out of business and does not give the PSO 120 days notice?
• TAC-16 – FMSA questioned whether the recoupment for Fraud, Waste and Abuse would be all payroll or just FMSA Fees.
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Trish BurkettTechnology Program Manager
HHSC EVV
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Business Rules
• The HHSC EVV Business Rules for Proprietary Systems describe the business outcome expected from the EVV system.
• These rules will not provide detailed design specifications about how the EVV system must operate.
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User Onboarding
• System User Profile Set-Up and Data Elements Validation
• Create a unique profile for each user.
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PAO-30P
**‘EVV System’ must allow the following relationships, at a minimum:
• An ‘Enrolled, Contracted, or Subcontracted Provider’ (or ‘FMSA’) can be
associated with multiple ‘Members’.
• An ‘Enrolled, Contracted, or Subcontracted Provider’ (or ‘FMSA’) can be
associated with multiple ‘Service Attendants’.
• An ‘Enrolled or Contracted Provider’ (or ‘FMSA’) can be associated with
multiple ‘Subcontracted Providers’.
• A ‘Contracted or Subcontracted Provider’ (or ‘FMSA’) can be associated
with multiple ‘CDS Employers’.
• A ‘CDS Employer’ can be associated with multiple ‘Members’.
• A ‘CDS Employer’ can be a ‘Member’.
• A ‘CDS Employer’ can be associated with multiple ‘Service Attendants’.
Note: If the PSO does not serve any CDS employers, the references to CDS employer and FMSA do not apply.
User Onboarding (cont.)
• Service Attendant Profile Set-Up and Data Elements Validation
• Create a unique profile for each service attendant.
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PAO-32P
**
‘EVV System’ must allow the following relationships, at a minimum:
• A ‘Service Attendant’ can be associated with multiple ‘CDS
Employers’.
• A ‘Service Attendant’ can be associated with both ‘Enrolled,
Contracted, or Subcontracted Providers’ (or ‘FMSAs’) and ‘CDS
Employers’.
• A ‘Service Attendant’ can be associated with multiple
‘Members’.
User Onboarding (cont.)
• Member Profile and Data Elements Validation
• Create a unique profile for each member, validated using EVV Aggregator data.
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PAO-33P
**
‘EVV System’ must allow the following relationships, at a
minimum:
• A ‘Member’ can be associated with only one ‘CDS Employer’.
• A ‘Member’ can be associated with both ‘Enrolled, Contracted,
or Subcontracted Providers’ (or ‘FMSAs’) and a ‘CDS
Employer’.
• A ‘Member’ can be associated with multiple ‘Service
Attendants’.
User Onboarding (cont.)
• EVV System Training
• Provide ongoing training to all users in the access to, and use of, the system.
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PAO-21P ** ‘Proprietary System Operator’ must provide ongoing system
training, as needed, to HHSC and ‘MCO’ staff. The training
must include access to, and use of, the system where full
system functionality is demonstrated.
User Onboarding (cont.)
• Pending Rule Addition
• Rules will be added to take advantage of the EVV Master Provider Web Service to set up, validate and maintain distinct business unit and system user profiles for the Program Provider or FMSA.
• Details of this service to be provided later in this presentation.
• HHSC is not soliciting input on these new rules from the Proprietary Systems Workgroup.
21
User Onboarding (cont.)
• Pending Rule Addition (1 of 4)
• This is an update to an existing rule.
22
PAO-3P ‘EVV System’ must create a unique profile for each distinct
business unit the ‘Program Provider’ or ‘FMSA’ will use to submit
‘EVV Visit Transactions’ to the ‘EVV Aggregator’. This includes
distinct profiles for each type of ‘System User’ in each business unit.
User Onboarding (cont.)
• Pending Rule Addition (2 of 4)
23
PAO-4P ‘EVV System’ may electronically document identification
information data elements for each distinct business unit through
the EVV Master Provider web service described in Appendix
New.
User Onboarding (cont.)
• Pending Rule Addition (3 of 4)
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PAO-5P ‘EVV System’ must validate identification data entered by
‘System User’ against the ‘EVV Aggregator’ using the EVV
Master Provider web service. An error must be communicated
to the ‘System User’ for any required data elements that do not
match, and creation of the distinct business unit profile must not
occur until the errors are corrected. See Appendix New for
details on EVV Master Provider web service.
User Onboarding (cont.)
• Pending Rule Addition (4 of 4)
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PAO-6P ‘EVV System must allow ‘System Users’ with appropriate security
access to initiate business unit profile updates. All ‘System
User’-initiated updates must be validated against the EVV
Aggregator as described in PAO-5P.
User Onboarding (cont.)
• Any questions for other rules in these sub-sections?
• System User Profile Set-Up and Data Elements Validation
• Service Attendant Profile Set-Up and Data Elements Validation
• Member Profile and Data Elements Validation
• EVV System Training
26
Establishing Service
There are no Rules open for comment in this section.
• Any questions in sub-sections:
• Prior Authorizations/Service Authorizations
• Request, receive and store Fee For Service authorizations
• Manually enter authorizations
• Use authorizations to validate visit transactions.
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Establishing Service (cont.)
There are no Rules open for comment in this section.
• Any questions in sub-sections:
• Schedules
• Set up and maintain schedules for pending visits
• Required for some programs, optional for others
• Always optional for CDS employers regardless of program rules
• Document services that were delivered, but not scheduled.
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Electronic Verification Methods
There are no rules open for comment in these subsections.
• Any questions?
• Home Landline
• Includes verification that the phone number on the visit transaction is the member’s home landline.
• Alternative Methods/Devices
• Must be approved by HHSC prior to use by the PSO; must be associated to the member.
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Electronic Verification Methods (cont.)
• Mobile Method
• Mobile methods must be provided by the PSO; must be associated to the member; must capture longitude and latitude only at clock-in and clock-out.
• Mobile Method Rules for Comment (1 of 4)
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EVM-8P ** ‘Proprietary System Operator’ must receive consent from a
‘Service Attendant’ when a personal cell phone is used for
clock-in/clock-out through EVV.
Electronic Verification Methods (cont.)
• Mobile Method Rules for Comment (2 of 4)
31
EVM-12P ** ‘EVV System’ must not require significant data usage through
cellular network for the mobile methods when the cost
associated with that data use is the responsibility of the
‘Service Attendant’.
Electronic Verification Methods (cont.)
• Mobile Method Rules for Comment (3 of 4)
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EVM-17P ** The mobile method must allow multiple users to use the
same device but must require logon credentials unique to
each person/user.
Electronic Verification Methods (cont.)
• Mobile Method Rules for Comment (4 of 4)
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EVM-18P ** The mobile method provided by the ‘Proprietary System
Operator’ must allow the user to download, set up and begin
using the mobile method without hands on interaction by the
‘Proprietary System Operator’ or ‘System User’.
Glossary
• Defines terms as used in this document.
• Identified in single quotes throughout the document.
• Questions about the glossary?
34
Sam DanielTechnology Solution Architect
TMHP EVV
35
Appendices
Appendix A – HHSC EVV Reason Codes
• Valid reason codes, to be used during visit maintenance in the Proprietary System according to HHSC EVV Policy.
• Questions about this appendix?
Appendix B – EVV Service Bill Codes Table
• Valid Healthcare Common Procedure Coding System (HCPCS) codes to identify all current EVV services.
• Questions about this appendix?
36
Appendices (cont.)
Appendix C – EVV Visit Transaction File
• File used to communicate visit transaction data from the EVV system to the Data Aggregator.
• Questions about this appendix?
37
Appendices (cont.)
Appendix D – x12 270/271
• The 270 Transaction Set is used to transmit Health Care Eligibility Benefit Inquiries from health care providers, insurers, clearinghouses and other health care adjudication processors.
• The 270 Transaction Set can be used to make an inquiry about the Medicaid eligibility of an individual.
• The 271 Transaction Set is the appropriate response mechanism for Health Care Eligibility Benefit Inquiries
• This standard transaction is used by the EVV system to validate the member’s identifying information and determine Medicaid eligibility from Texas Medicaid data.
• Questions about this appendix?38
Appendices (cont.)
Appendix E – EVV Prior Authorization File
• This file is used by the EVV System to obtain Fee for Service prior authorization data from the Data Aggregator.
• Managed Care authorizations are not currently provided through this interface.
• Questions about this appendix?
Appendix F – EVV Standard Reports
• Descriptions of the reports that must be provided by the EVV system.
• Questions about this appendix?39
Appendices (cont.)
Appendix G – Mobile Method Community Locations
• Valid community location codes, per HHSC EVV policy, to be used when the visit occurs outside the member’s home.
• Questions about this appendix?
Appendix H – Texas-EVV Specific Terms
• Texas-specific terms identified in HHSC EVV Policy to be used in the EVV system User Interface.
• Questions about this appendix?
40
Appendices (cont.)
Appendix I – Payer Plan Code Web Service
• Web service used by the EVV system to verify payer and plan code used in the service delivery transaction.
• Note: This layout will be provided and feedback requested for a future PSO Workgroup meeting.
• Payer of Long Term Care Fee for Service is ‘LTC’
• Payer of Acute Care Fee for Service is ‘HHSC’
• Payer of Managed Care is determined by the Managed Care Organization (MCO) enrollment of the individual receiving services at the time of that service delivery.
• Questions about this appendix?41
Appendices (cont.)
Appendix J – EVV Visit Data Layout Edits Crosswalk
• Note: This layout will be provided and feedback requested for a future PSO Workgroup meeting.
• Describes the data elements in the visit data file exchanged between the EVV system and the EVV Aggregator.
• Also describes the edits performed at the EVV Aggregator upon receipt of the file containing EVV visit transactions.
• Questions about this appendix?
42
Appendices (cont.)
Appendix New – EVV Master Provider Web Service
• Web service used by the EVV system to set up, validate and maintain distinct business unit and system user profiles for the Program Provider or FMSA.
• This new appendix will be inserted between existing appendices C and D in the next update to the draft rules.
• Web Service referenced in additional rules PAO-3P, PAO-4P, PAO-5P and PAO-6P since the document was distributed to the workgroup.
• Questions about this new appendix?
43
Questions
• Questions from the room
• Questions from GoToWebinar chat
44
Action Items
Action Item Review
45
Resources
HHSC
• New Page for Proprietary Systems on the HHSC Website: You will also receive this link via email after the meeting.
• https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/evv-proprietary-systems
• Continue to check this page for updates to:
• Project developments.
• Timelines.
• Workgroup presentations and materials.46
Resources
HHSC
• Website: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/electronic-visit-verification
• Email: [email protected]
• Sign up to get HHSC EVV notices: https://public.govdelivery.com/accounts/TXHHSC/subscriber/new?topic_id=TXHHSC_247
TMHP
• Website:http://www.tmhp.com/Pages/EVV/EVV_Home.aspx
• Email: [email protected]
