While the August 8th, 2019 CMCS Informational Bulletin below states it is not a federal requirement to use EVV for live-in caregivers, it also grants the states the latitude to use EVV to capture the visits on an hourly basis if they so choose.
Hawaii has chosen to include the use of EVV for live-in caregivers as this curbs and prevents fraud, waste and abuse.
CMS Guidance: "Do EVV requirements apply if the individual receiving personal care or home health care lives with the caregiver providing the service?
No, EVV requirements do not apply when the caregiver providing the service and the beneficiary live together. PCS or HHCS rendered by an individual living in the residence does not constitute an “in-home visit”. However, states are encouraged to apply appropriate oversight to services provided in these circumstances to curb fraud, waste and abuse. Additionally, states may choose to implement EVV in these instances, particularly when using discrete units of reimbursement, such as on an hourly basis."
If you are receiving in home assistance through a personal care assistant (Attendant Care, Personal Assistance Level I and II, Respite, DDD services) or skilled/certified care (Private Duty Nursing, Skilled nursing, PT, OT, ST, HHA) you are required to use EVV to track the time the provider(s) is in your home.
If you provide any of the above listed services you will need to use EVV. Your claims are sent to Medicaid for payment (known as fee-for-service).
In order to provide these services and be reimbursed by Med-QUEST, you will be required to use an EVV system. If you do not use an EVV system, claims submitted outside of this system will be denied.
No, EVV doesn’t require you to get a home landline phone. If you don’t have a home landline or you don’t want your personal attendant to use your home landline, a small alternative device will be ordered and placed in your home by a provider agency representative for your personal attendant to use to clock in and out.
EVV is a system under which service visits are electronically verified with respect to:
Congress passed a federal law in December 2016 requiring State Medicaid programs to implement an EVV system for some home and community-based services. The law is commonly referred to as the 21st Century CURES Act. The provisions of the CURES Act that address EVV can be found at section 12006 of the H.R. 34 (114th Congress) (2015-2016).
The statewide implementation of EVV will include Agency and Self-Direction/Consumer-Directed servics for:
When a visit is scheduled using the Sandata solution, the Service Code Description will automatically appear on the mobile application. The provider agency office worker will have the ability to modify/correct services delivered before billing takes place.
Implementation will be jointly led by Med-QUEST and the state’s selected EVV vendor Sandata.
Step 1: If you are delivering Home Care or Home Health services, obtain your Dept. of Health license.
Step 2: Register with Med-QUEST as a Medicaid Provider to obtain your 6 digit number.
Step 3: Send an email to [email protected] with the above information
No, you should not need additional staff to manage EVV. It is very important that you make sure that both your caregiver staff and office staff are fully trained and compliant with EVV, which will ensure a smooth and successful EVV implementation for your agency.
Yes, and the provider agency will need to work with Sandata directly to add the other services. Send your request to the Sandata [email protected]
Yes, Sandata can be used to capture other services outside of EVV. Yes, and the provider agency will need to work with Sandata directly to add the other services. Send your request to [email protected]
The Provider Agency will be scheduling appointments with the members / participants.
The Provider Agency will be scheduling appointments with the members / participants.
The use of Sandata for all EVV services are 100% to all provider agencies. There is no charge, setup fee, monthly fee, etc. for the use of Sandata Scheduling, Visits, or Billing. However, there are additional services available to the provider agency at a fee. Contact the Sandata Sales Manager for details.
No, caregivers will have multiple opportunities for training in October through December 2020.
No, each provider will have a different ID number.
Caregivers/Direct Care Workers/Employees
Using the task list in Sandata EVV is not required. If the tasks are sent from the health plan’s as defined by the Service Coordinator, they will automatically appear in the Sandata mobile app.
If a worker is providing multiple services on the same day the worker would need to clock in for the first service at the time it is being performed and clock out of the first service. The worker would then clock in for the second service and clock out of the second service.
If a worker is employed by two agencies and is scheduled to work consecutively, the worker would need to clock in with the first agency, perform their duties, and clock out with the first agency. The worker would then clock in with the second agency, perform their duties, and clock out with the second agency.
Mobile devices will be provided to the agency and they will distribute to their workers. Each worker will be able to receive a mobile device.
There is not a time limit but should be uploaded at least once a week. If the Sandata mobile app is used the data automatically uploads when the worker reaches an area with cell coverage or Wi-Fi connectivity.
The procedure for visit recording will be covered in the Sandata training.
As a last resort, manual visit reporting can be used BUT a fob MUST be used at the visit. Manual reporting is discouraged because it does not take advantage of the authorization and scheduling processes. Manual reporting also requires provider agency staff to type in the visit data into the Sandata website for storage. Manual visits are flagged for CMS reporting.
No. All visit data will need to be stored in the Sandata system before claims will be paid.
If using a 3rd party EVV solution, that system will make the determination. If using the Sandata mobile app, it will capture where a visit takes place by using the Location Services on the smartphone/tablet. Sandata will record the location and compare it to the address on file for the member. A member can have up to 4 addresses.
That is okay. Using Sandata, the visit will be recorded but someone in the provider agency may need to review the visits.
Using the Sandata system, the location is recorded at check-in and check-out and compared to the member’s addresses.
Yes. The location is captured at both check-in and check-out.
EVV is free. Med-QUEST is paying for the EVV system, including EVV system implementation, provider agency EVV training, and ongoing recurring EVV fees.
Yes. There is no cost for health plans, provider agencies, self-directed members, Medicaid members, or caregivers.
The Sandata Sales Manager can provide the cost.
Med-QUEST has contracted with Sandata Technologies LLC for the EVV system. However, provider agencies can use an alternate EVV vendor at their own costs.
Yes. However, the EVV visit data is required to be integrated into the Med-QUEST EVV system. Should you choose to use your current EVV system any cost associated with this integration will be the responsibility of the provider.
While some EMR systems have added EVV functionality, an EMR system is not the same as an EVV system. You will need to contact your EMR vendor to find out if they are 21st Century CURES Act compliant in gathering EVV data.
It is suggested to use the free EVV system provided by the state until your EMR system passes testing with Sandata.
There is no state requirement for the EVV data to be synchronized with an EMR.
Alternate EVV Vendors
Sandata will provide a Technical Specification document for your agency's Alternate EVV vendor to upload visit data. The Tech Spec explains the process and specifications on how to upload the visit data.
Yes, EVV validation just checks to make sure there are matching visits in an Approved/Verified/Process status. The regular claims process will stop duplicate billing.
The Visit Status in Sandata changes to "Processed" when a claim was submitted to the payer, the payer then checked Sandata for matching visits and it passed.
There are many reasons why a claim could deny that have nothing to do with EVV. e.g. the claim contained the wrong NPI, the claim did not have the correct service code, the claim did not have the correct DOS, the claim did not have the correct member's Medicaid ID, etc. CHECK THE 835 REMARKS.
From the claim line, the payer takes the NPI/Provider ID, Date of Service start, Date of Service end, quantity, service code for the member and checks Sandata to see if there are visit units in an Approved/Verified/Processed status equal to or greater than the quantity on the claim line.
It is up to each Provider Agency if a they choose to use the free Sandata billing module. However, the Sandata billing software can only be used if the visit was captured using the Sandata’s solution.
The tasks will not show on billing or cause a claim to deny.
Sandata offers a free billing module for provider agencies that use the Sandata EVV solution. Doing so reduces errors due to automation.
No, the EVV validation usually occurs the same day the claim is processed by the payer.
Yes, if no matching visits are found. Starting 10/1/21, payment will not be made by the Health Plans/DDD if there is no visit data that matches in Sandata .
A: Yes, all the information can be downloaded from this website and through the Sandata website login once your agency receives training. Instructions will be provided in training.
A: Yes, Sandata has a reporting module for each provider to access and generate reports
Sandata has implemented a task list that will be fed by the Health Plans. However, not all health plans will be sending task information when EVV goes live in October. The provider agencies can add task information for the member's services if not given from the health plan.
Med-QUEST is rollout out EVV on October 5th when the provider agencies start their training. You will start seeing caregivers use their smart devices to capture visit information. You will also be able to confirm or deny services.
Sandata EVV training will start October and be available through Decmber. The Soft Launch Period for EVV will be from 10/5/2020-12/29/2020. EVV mandatory usage will begin on 12/30/2020.
A small alternative device is an HCSB-approved device provided by the EVV vendor that displays a numeric code used to document the time services begin and end. Small alternative devices are provided at no charge to the provider agency or member by the EVV vendor.
The provider agency should order a small alternative device if:
Department of Human Services Med-QUEST Division
P.O. Box 700190