Effective April 1, 2016, the Texas Health and Human Services Commission (HHSC), Texas Department of Aging and Disability Services (DADS) and the managed care organizations (MCOs) will enforce electronic visit verification (EVV) compliance. Regardless of your implementation date for the use of an EVV system — DataLogic/Vesta or MEDsys — all Medicaid providers required to use the EVV system will have their EVV visits reviewed for 90% compliance.

  • Provider agencies must adhere to the requirements of the Texas Health and Human Services (HHSC) Electronic Visit Verification (EVV) Initiative Provider Compliance Plan.
  • Provider agencies that deliver services for which EVV is required must select and use an HHSC-approved EVV vendor.
  • The provider agency must ensure that all required data elements, as determined by HHSC, are uploaded or entered into the EVV system completely and accurately within 60 days of the date of service.
  • Provider agencies must complete any and all required visit maintenance in EVV within 60 days of the day on which the service was delivered. Provider agencies cannot perform visit maintenance more than 60 days after the date of service.
  • Provider agencies must achieve and maintain an HHSC EVV Initiative Provider Compliance Plan score of at least 90% per review period. Reason codes must be used each time a change is made to an EVV visit record in the EVV System.
  • Provider agencies must use the reason code that most accurately explains why a change was made to a visit record in the EVV System.
  • Use of preferred reason codes:
  • The managed care organizations (MCOs) HHSC and the Texas Department of Aging and Disability Services (DADS) will review reason code use by their contracted provider agencies to ensure that preferred reason codes are not misused.
  • If HHSC, DADS or the appropriate MCO determines that a provider agency has misused preferred reason codes, the provider agency HHSC EVV Initiative Provider Compliance Plan score may be negatively impacted, and the provider agency may be subject to the assessment of liquidated damages, imposition of contract actions, implementation of the corrective action plan process, and/or referral for a fraud, waste, and abuse investigation.
  • Use of Non-preferred Reason Codes:
  • Will lower the provider agency HHSC EVV Initiative Provider Compliance Plan score.

There is only one compliance plan for providers. Failure to achieve and maintain an HHSC EVV Provider Compliance Plan Score of at least 90% per review period may result in the assessment of liquidated damages, the imposition of contract actions (including contract termination), and/or the corrective action plan process.

HHSC

Click the appropriate payor below to view their specific course of action for not meeting the 90% EVV compliance per review period.

DADS

MCOs