Revision 18-0; Effective November 1, 2018

 

 

1100 Program Introduction

Revision 18-0; Effective November 1, 2018

 

In 2011, the legislature recommended the use of Electronic Visit Verification (EVV) for various long-term care services and as a result, the Texas Health and Human Services Commission (HHSC) formerly known as the Department of Aging and Disability Services (DADS) initiated an EVV pilot program in certain regions across the state. In 2013, the legislature expanded their direction for HHSC to implement a statewide EVV program to include personal assistance services in the managed care programs, personal care services in acute care fee-for-service and community first choice. The HHSC EVV program became operational statewide in June 1, 2015.

This EVV Provider Policy Handbook (EVVPPH) provides EVV utilization standards and policy requirements for provider agencies who are contracted with HHSC and Managed Care Organizations (MCOs) to adhere to. Provider agencies are responsible for complying with all requirements pertaining to EVV in this handbook in addition to program requirements. While the EVVPPH has common requirements across HHSC and the MCOs, each of these entities may have other requirements for provider agencies according to their individual contracts. Provider agencies should contact their appropriate contracted entity with any questions on EVV requirements. The following contracted entities administer the EVV program:

 

Fee-for-Service (FFS)
HHSC

 

Managed Care Organizations (MCOs)
Aetna Better Health Cook Children's Health Plan
Amerigroup Driscoll Children's Health Plan
Blue Cross Blue Shield Molina
Children's Medical Center Health Plan Superior Health Plan
Cigna-Health Spring Texas Children's Health Plan
Community First Health United Health Group

 

1200 Program Overview

Revision 18-0; Effective November 1, 2018

 

EVV is a computer-based system that electronically verifies the occurrence of authorized personal attendant service visits by electronically documenting the precise time a service delivery visit begins and ends. The EVV program was implemented to replace paper-based attendant timesheets, which are difficult to monitor and regulate, with an electronic, verifiable clock-in and clock-out system.

In Texas, EVV is required for certain Medicaid funded home and community-based services provided through HHSC and MCOs. Texas Medicaid and Healthcare Partnership (TMHP), the Texas Medicaid claims administrator, and MCOs use electronic visit data from the EVV system, called an EVV visit transaction, during the Medicaid claims adjudication process to verify people who receive Medicaid receive services authorized for their care and to aid in the prevention of fraud, waste, and abuse. HHSC rules require the MCOs and TMHP to verify the existence of an EVV visit transaction prior to paying a claim for reimbursement. Claims not supported by an EVV transaction may be denied or subject to recoupment.

 

1300 Governing Rules

Revision 18-0; Effective November 1, 2018

 

EVV state and federal statutes and rules include:

A. Texas Government Code §531.024172
B. Human Resource Code, Section 161.086
C. Section 12006 of the 21st Century Cures Act (Cures Act)
D. TAC, Title, 1 Part 15, Chapter 354, Subchapter A, Division 11, Rule §354.1177(d)
E. TAC, Title 40, Part 1, Chapter 49, Subchapter C
F. TAC, Title, 40 Part 1, Chapter 68