The 21st Century Cures Act, Section 12006 (Cures Act) is a federal law requiring Electronic Visit Verification for all Medicaid personal care services. HHSC already requires EVV for about 90 percent of personal care services.
Texas Must Implement Cures Act EVV Requirements by Jan. 1, 2021
HHSC understands that program providers, financial management services agencies, and consumer directed services employers are focusing on COVID-19 and its impacts on their members and employees and has relaxed deadlines where possible. However, federal law does not allow any further delays to implement the Cures Act EVV requirement for Medicaid personal care services. If HHSC does not implement by Jan. 1, 2021, Texas will lose federal dollars for state Medicaid programs.
Texas EVV requirements do not exempt live-in caregivers. Texas HHSC determines when EVV is required based on the services an individual receives, regardless of who delivers the service. EVV is required for all programs and services listed in the section below, regardless of who is delivering the service.
Programs, Services and Service Delivery Options Affected by the Cures Act
See pages 1-2 for the Programs, Services and Service Delivery Options Required to Use EVV (PDF) and affected by the Cures Act.
Cures Act EVV Expansion
This year, HHSC will implement the federal EVV requirement for all remaining Medicaid personal care services in programs and service delivery options not currently required to use EVV by state law in the Cures Act EVV Expansion.
Program providers, FMSAs, and CDS employers can refer to the document below to confirm if they are subject to Cures Act EVV requirements and included in the expansion.
Note: If you are included in the expansion, HHSC is referring to you as a Cures Act program provider and FMSA. When you see communications published by HHSC, Texas Medicaid & Healthcare Partnership, and managed care organizations with “Cures Act EVV” in the title you will know that the information is important and applies to you. HHSC encourages Cures Act program providers and FMSAs to sign up to receive EVV updates by email and continue to check this page for updates.
Cures Act EVV Expansion Timeline
There are several important dates and milestones that Cures Act program providers and FMSAs must meet throughout 2020. For more information, refer to each section of the timeline below.
Note: Dates are subject to change. Additional dates and milestones will be added below once known.
By May 1, 2020: Select an EVV System and Begin the Onboarding Process
Cures Act program providers and FMSAs must select an EVV vendor system or select to use their EVV proprietary system and begin the onboarding process. Read more about the deadline for selecting an EVV system.
July 1 – Dec. 31, 2020: EVV Practice Period
Between July 1, 2020 – Dec. 31, 2020, program providers and FMSAs can participate in the practice period and learn more about using the EVV system, EVV Portal, and EVV claims matching. CDS employers can participate to learn more about using the EVV system. During the practice period, EVV claims will not be denied for a mismatch.
- If an EVV vendor system is selected, the practice period can begin as soon as the EVV Provider Onboarding Process is complete.
- If an EVV proprietary system is selected the practice period can begin anytime, once the system is capable.
EVV system practice activities include:
- Identifying appropriate clock in/clock out methods when delivering services.
- Providing training on clock in/clock out methods.
- Reviewing EVV visit transactions to confirm all data elements are correct.
- Performing visit maintenance to correct any data elements, such as missing clock in or clock out times.
- Reviewing reports.
EVV Portal and claims matching practice activities include:
- Confirming EVV visit transactions are accepted in the EVV Portal prior to billing.
- After submitting an EVV claim, checking claims matching results to confirm the line items on the claim match the accepted EVV visit transactions.
- Reviewing reports.
By July 1, 2020: Begin Submitting All Managed Care EVV Claims to TMHP
This information only applies to STAR Health, STAR Kids, STAR+PLUS, and STAR+PLUS MMP program providers and FMSAs submitting claims for EVV-required services directly to their managed care organization (MCO). This information does not apply to the CLASS, DBMD, HCBS-AMH, HCS, TxHmL, and YES Waiver programs as they will continue to follow their current process for submitting EVV claims.
By July 1, 2020, HHSC strongly recommends submitting managed care EVV claims to TMHP to take full advantage of EVV claims matching during the practice period. Claims matching results for managed care EVV claims are only received when they are submitted to TMHP. After the claims matching process occurs, the claim is forwarded to the appropriate MCO for processing and payment.
Beginning Oct 1, 2020 all managed care EVV claims:
- Must be submitted to TMHP; and
- Will be denied or rejected when submitted directly to an MCO.
By Dec. 31, 2020: Complete Required Training
Program providers, FMSAs, and CDS employers must complete the following EVV training requirements:
- EVV System Training before using the EVV system, and then annually.
- Clock In/Clock Out Methods Training before using the EVV system.
- EVV Policy Training by Dec. 31, 2020, and then annually.
- EVV Portal Training by Dec. 31, 2020, and then annually. CDS employers do not have to complete EVV Portal training.
See the Cures Act EVV Required Training Checklist (PDF) for more information.
Jan. 1, 2021: EVV Claims Matching with Denials
Beginning Jan. 1, 2021:
- All service visits for an EVV-required service must be captured in the EVV system.
- Claims without a matching EVV visit transaction accepted into the EVV Portal will be denied for payment.
See the HHSC EVV Claims Matching Policy (PDF) for more information.
Email EVV policy questions to Electronic_Visit_Verification@hhsc.state.tx.us.
Email EVV vendor and EVV Portal questions to evv@TMHP.com.
See the EVV Contact Information Guide (PDF) for more topics and points of contact for EVV-related questions and issues.