EVV (Electronic Visit Verification) Updates

by | Dec 5, 2024

December 5th, 2024

Reminder – Compliance Review Grace Period Ends Dec. 31, 2024

The compliance reviews grace period for EVV Usage and EVV Landline Phone Verification reviews for, personal care services and home health care services, will end on Dec. 31, 2024. Beginning Jan. 1, 2025, program providers, financial management service agencies (FMSAs) and Consumer Directed Services (CDS) employers, that do not fully comply with the EVV usage and landline review requirements will be subject to enforcement actions.

October 30th, 2024

Don’t Forget Your Annual EVV Training Requirement!

Just a reminder that even though providers are required to do an initial training to implement EVV services, there is also an annual training requirement.
See information below: Here is the link to the training requirement checklist
EVV Training Requirements Checklist:
https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/evv/evv-required-training-checklist.pdf

HHSC has stated the following: Program providers, FMSAs, CDS employers, or any staff who performs EVV system operations (such as visit maintenance) must complete required EVV training initially before using the EVV system, and then annually after that.

Note: Service providers and CDS employees are not required to take clock in and clock out methods training annually after they’re trained initially. However, if a service provider or CDS employee switches the clock in and clock out method they’re using, they may need some refresher training on how to use another method. In addition, if a program provider or FMSA transfers from one EVV system to another, then the program provider is required to train the service provider on the new EVV system’s clock in and clock out method(s), and the CDS employer is required to provide training to the CDS employee on the new EVV system’s clock in and clock out method(s). We will clarify that in the Training Checklist the next time we update it.

The EVV Training Policy is located in the EVV Policy Handbook in sections 4200–4250.

October 2nd, 2024

Compliance Review Grace Period Ends Dec. 31st, 2024!

The compliance reviews grace period for EVV Usage and EVV Landline Phone Verification reviews for, personal care services and home health care services, will end on Dec. 31, 2024.

Beginning January 1, 2025, program providers, financial management service agencies (FMSAs) and Consumer Directed Services (CDS) employers, that do not fully comply with the EVV usage and landline review requirements will be subject to enforcement actions.

Payers conduct EVV compliance reviews to make sure program providers, FMSAs and CDS employers are in compliance with EVV requirements and policies.

Payers will conduct reviews and initiate contract or enforcement action if the program providers, FMSAs or CDS employers do not meet any of the following EVV compliance requirements:

  • Usage Reviews
    • Meet and maintain the minimum EVV Usage Score of 80%.
    • Ensure staff is properly trained and consistently using EVV to record visits.
  • Landline Reviews
    • Payers will review landline reports generated from the EVV systems to determine compliance with the EVV Landline requirements.
    • Program providers and FMSAs must ensure the phone number entered in the EVV system is a valid landline for members and CDS employers who have chosen to use a landline for clocking in and clocking out.

Next Steps

Program Providers, FMSAs, and CDS employers are encouraged to review their EVV Usage Reports monthly to ensure compliance with EVV requirements.

  • Program providers and FMSAs can generate EVV Usage reports from the TMHP EVV Portal.
  • Option 1 and Option 2 CDS employers can generate EVV Usage reports directly from their EVV system.
  • Option 3 CDS employers must request a copy of their EVV Usage report from their FMSA.

Resources

Review section 11000 of the EVV Policy Handbook for more information about EVV Compliance Reviews.

Contact HHSC EVV Operations for questions.

September 12th, 2024

How to bill for HHCS delivered in-home versus out-of-home. 

Refer to the EVV Home Health Care Services Bill Codes Table (PDF) on the HHSC EVV webpage to ensure you’re using the appropriate Healthcare Common Procedure Coding System (HCPCS) and Modifiers before submitting the EVV claim.

Billing Combinations for HHCS

HHSC created new Long-Term Care billing combinations to submit claims for EVV and non-EVV service delivery locations.

**Services that begin or end in a member’s OHFH setting will require an EVV visit match.
**Services provided out-of-home in the Community or in Other Residential Type settings will not require an EVV visit match.

HHSC has published training resources for program providers and FMSAs to prevent EVV claim mismatches when submitting EVV claims for HCS and TxHmL services:

June 19th, 2024

FYI- there are also additional modifiers for EVV-required services (such as TG for Specialized Nursing and UC for CDS Nursing).

Useful EVV tool: 

April 1, 2024, provides additional HCPCS and modifier combinations. 
EVV Home Health Care Services Bill Codes Table (texas.gov)

June 7th, 2024

Reminder: 

Please Use Appropriate Modifiers To Be Reimbursed Properly For Nursing & Other Specific Therapies That Occur In (OFH) In-Home Services!

Updates LTC HCS and TxHmL Bill Code Crosswalks for EVV Home Health Care Services 

Please Note The In-Home Billable Activities for Nursing & Specific Therapies in Own Family Home (OFH) EVV Crosswalk Changes

Electronic Visit Verification (EVV) claims matching for home health care services (HHCS)  began Jan. 1, 2024.

EVV claims with dates of service of Jan. 1, 2024, and after that do not have an EVV visit match will be denied.

HHSC created new Long-Term Care billing combinations to submit claims for EVV and non-EVV service delivery locations.

  • Existing HHCS billing combinations have new descriptions for EVV services in the member’s own home/family home (OHFH).
  • New out-of-home services use the existing billing combinations with the KX modifier.
  • New in-home or other residential-type settings use the existing billing combinations with the HQ modifier.

Services that begin or end in a member’s OHFH setting will require an EVV visit match. Services provided out-of-home in the community or in other residential-type settings will not require an EVV visit match.

Home and Community-based Services (HCS) and Texas Home Living (TxHmL) EVV claims require the Texas EVV Attendant ID for in-home EVV services. Reference the document, HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (PDF) for information related to the Texas EVV Attendant ID.

Agency Services Affected 

• Nursing Services provided in the member’s own home/family home (RN; LVN; Specialized RN; Specialized LVN)

• Occupational Therapy provided in the home

• Physical Therapy provided in the home

“Own home/family home” does not include Host Home/Companion Care or Supervised Living/Residential Support Services (3/4-bed home).

CDS  (Only Nursing Affected)

Crosswalk changes

Place of Service: 12 (the group home or host home)

HCPCS:

~  T1002 (RN)

~  T1003 (LVN)

Modifier: HQ

Place of Service: 11, ,49, 99, etc. (applies to ALL persons regardless of their place of residence)

HCPCS:

~  T1002 (RN)

~  T1003 (LVN)

Modifier: KX

Place of Service: 12 (OHFH). REQUIRES EVV

HCPCS:

~  T1002 (RN)

~  T1003 (LVN)

Modifier: no modifier

Resources:

For questions about the EVV HHCS bill codes, modifiers or HHCS required to use EVV (PDF), email HHSC EVV Operations.

 

May 25th, 2024

EVV Proprietary Systems

Last updated on 
Short Recap below, for more info go to:  EVV Proprietary Systems (HHSC page)

An Electronic Visit Verification (EVV) proprietary system is an HHSC-approved system that a program provider or financial management services agency (FMSA) may decide to use instead of the state-provided EVV vendor system and:

  • Is purchased or developed by a program provider or an FMSA.
  • Is used to exchange EVV data with the EVV Aggregator.
  • Complies with HHSC EVV Policy as it relates to EVV proprietary systems.
  • Complies with HHSC EVV Business Rules for proprietary systems.
  • Complies with the requirements of Texas Government Code Section 531.024172 or its successors.

An EVV Proprietary System Operator (PSO) is a program provider or FMSA that is approved to operate an EVV proprietary system.

Refer to the EVV Policy Handbook, including Section 5000, for more information.

 

EVV PSO Onboarding Process

Step 1: Submit a Request Form

Program providers and FMSAs must complete, sign, and submit the EVV Proprietary System Request Form located in the EVV Portal to start the PSO onboarding process.

Note: EVV Portal access is required to submit a request form. Refer to the Accessing the EVV Portal for Program Providers and FMSAs job aid for more information. Request forms that are emailed to HHSC or TMHP will not be accepted.

When the request form is successfully submitted, program providers and FMSAs will receive a confirmation number (Request Form ID) and a confirmation date and time (Request Form Submission Date and Time).

Note: The submission of a request form does not guarantee an assignment to a PSO Operational Readiness Review (ORR) session. TMHP will review the submitted request forms and PSO ORR session requirements and notify program providers and FMSAs of their assignment status.

EVV ORR Sessions

The following PSO Onboarding Process Overview and Timeline documents outline the steps and required timeframes for a program provider or FMSA to onboard their proprietary system in the Texas EVV operating environment managed by HHSC and TMHP.

PSO Onboarding Standard Process Overview and Timeline

PSO Onboarding Expedited Process Overview and Timeline

Here is the high-level schedule for the 2024 PSO Onboarding:

Session Planning Meeting Date ORR Start Date Session Approval Date
2024-1: Expedited Feb. 5, 2024 Feb. 19, 2024 Mar. 8, 2024
2024-2: Expedited Apr. 29, 2024 May 6, 2024 Jun. 3, 2024
2024-3: Standard May 20, 2024 Jun. 3, 2024 Jul. 18, 2024
2024-4: Expedited Aug. 12, 2024 Aug. 19, 2024 Sept. 24, 2024
2024-5: Standard Sept. 2, 2024 Sept. 16, 2024 Oct. 30, 2024

 

Note: Please note that TMHP has a limited number of slots based on the available capacity and the schedule is subject to change.

A program provider or FMSA must have a developed and compliant proprietary system that meets all HHSC requirements by the ORR begin date.

Visit the PSO Business Rules to learn more about the compliance standards for proprietary systems in the Texas Medicaid EVV Program.

TMHP Contacts

LTC Help Desk:
800-626-4117
(Option 4)

TMHP Contact Center:

May 2nd, 2024

Alternative Devices Notice
Please see links to handouts below:
One provides an update on EVV focusing on the claims matching bypass, compliance review grace periods and geo-perimeter expansion.  The other handout pertains to the phasing out of alternative devices for service providers and CDS employees to clock in and clock out.  The phase out schedule begins January 1, 2025 and ends January 1, 2028.
In late April, HHSC issued a notice explaining its plan to phase out alternative devices and is asking for stakeholder feedback.  Comments are due by 5:00 p.m.on May 15, 2024  and are to be sent to:  evv@hhs.texas.gov

January 7th, 2024

Clarification Landline Vs. Mobile

EVV Program providers and financial management services agencies (FMSAs) must enter and maintain correct information in the EVV system for their service providers or Consumer Directed Services (CDS) employees.

Program providers and FMSAs must not enter an unallowable landline phone type into the EVV system as the member’s home phone landline.

An unallowable landline phone type is a cellular phone or cellular-enabled device, such as a tablet or a smart watch.   A phone used to clock in or clock out through the landline method must be a landline phone, and not a cellular phone or device.  Cellular phones, tablets, smart watches, and laptops come under “mobile devices” and should be entered as such..

TMHP Published EVV Known Issues and Resolutions, Vol. 2

January 1st, 2024

HHSC has revised the Electronic Visit Verification (EVV) rules in Texas Administrative Code (TAC), Title 1, Chapter 354, Subchapter O. The new TAC rules are effective Jan. 1, 2024.

The new EVV TAC rules:

  • Add the home health care services required by the 21st Century Cures Act, 1903(l) of the Social Security Act (42 U.S.C. §1396b(l)).
  • Add the current policies regarding training, visit maintenance, and requests by program providers and FMSAs to become Proprietary System Operators (PSOs).
  • Add definitions related to the addition of the new TAC rules.
  • Reorganize the structure of the existing EVV-required personal care services list for clarity.

Email questions to HHSC EVV.

December 31st, 2023

HHSC NOTICE: 

HHSC Electronic Visit Verification (EVV) is reaching out to you with time-sensitive information. Also noted in the TMHP news webpage:

December 6th, 2023

Discontinuation of EVV Free Text Reviews

Effective Aug. 1, 2023, the Texas Health and Human Services Commission (HHSC) and managed care organizations (MCO) will no longer conduct EVV compliance reviews for required free text.

HHSC no longer requires the documentation of any missing clock in and clock out in the free text field for dates of service on and after Aug. 1. The EVV system now requires missing time not electronically captured to be entered in the Bill Time In and Bill Time Out fields.

New reason codes effective Oct. 1, 2023 (PDF),  require program providers, financial management services agencies (FMSAs) and Consumer Directed Services (CDS) employers to enter free text only when using the following two reason codes:

  • Reason Code 210I — Emergency
  • Reason Code 600 — Other

Email questions to HHSC EVV Operations.

 

November 11th, 2023

Prepare for EVV Cures Act Home Health Care Services Implementation

HHSC will require Electronic Visit Verification (EVV) for Medicaid home health care services (HHCS) beginning Jan. 1, 2024, as listed in the Home Health Care Services required to use EVV (PDF). The 21st Century Cures Act is the federal law that requires states to implement EVV.

HHCS Claims for EVV Required Services Must be Submitted to TMHP Starting Dec. 1

  • Program providers and financial management services agencies (FMSAs) must submit all HHCS EVV claims to Texas Medicaid & Healthcare Partnership (TMHP) using TexMedConnect, or through Electronic Data Interchange (EDI) using a Compass 21 (C21) Submitter ID starting with dates of service on or after Dec. 1, 2023.
  • Managed care organizations (MCOs) will reject any HHCS managed care claims with EVV services and dates of service on or after Dec. 1, 2023, back to the program provider and FMSA, directing them to submit the claim to TMHP for EVV claims matching.

Register for TexMedConnect

  • To access TexMedConnect through the TMHP website you must already have an account. If you don’t have an account, set one up using the information provided in the TMHP Website Security Provider Training Manual.
  • Program providers and FMSAs that need help setting up C21 or CMS Submitter IDs should contact the EDI Help Desk at 888-863-3638, Option 4, or visit the TexMedConnect webpage for additional information.

Request EVV Portal Access

  • To access the EVV Portal, program providers and FMSAs must have a TMHP User Account.
  • Program providers and FMSA staff must contact their TMHP Provider Administrator to request EVV Portal access.
  • For full instructions, review the EVV Portal job aids on the EVV Learning Management System (LMS).

Complete Onboarding and EVV Portal Training by Dec. 31

Program providers and FMSAs must complete the following before Dec. 31, to avoid impacts to EVV claims payment:

  • Onboard with the state-funded EVV vendor system, HHAeXchange by submitting the HHAeXchange Provider Onboarding Form.
  • Complete the TMHP Learning Management System (LMS) to complete annual EVV Portal training requirements.

Visit the TMHP EVV Training webpage for more information.

EVV Home Health Care Services Practice Period: Oct. 1 – Dec. 31

The practice period allows program providers and FMSAs, to practice using the EVV system, using the EVV Portal and submitting EVV claims before the Jan. 1, 2024, implementation date. EVV claims will be paid by the payers (HHSC or MCO) even if the EVV visit transactions do not match the EVV claims.

  • Consumer Directed Services (CDS) employers can practice using the EVV system selected by their FMSA.
  • Service providers and CDS employees can practice clocking in and clocking out using their program provider’s or FMSA’s selected EVV system, and the visit data will be transmitted to the EVV Aggregator.

EVV Claims Matching with Denials

Effective Jan. 1, 2024, and after, when an HHCS EVV claim is submitted without a matching EVV visit transaction, the EVV claim will be denied. This applies to all program providers and FMSAs required to use an EVV system. Program providers and FMSAs will be able to view EVV claim match results in the EVV Portal.

Resources:

October 16th, 2023

IMPORTANT NOTICE: EVV Data Access & Conversion

For program providers transitioning to the new state-funded EVV vendor, HHAeXchange:

All visits in the EVV Aggregator will continue to be available and accessible for program providers. One year of historically accepted visits will be available in HHAeXchange as part of data conversion. This will be based on the data available in the EVV Aggregator.

For visit dates within the 95-day visit maintenance window, program providers should refer to the EVV Portal and perform visit maintenance in their legacy vendor system.

*If you rely on specific fields from EVV systems, DataLogic/Vesta and FirstData/AuthentiCare, this data may not be available after they are migrated to HHAeXchange.

Data Conversion

The following data will be transferred from your current EVV systems (AuthentiCare or Vesta) and uploaded to the new HHAeXchange system:

  • Five years of profile data
    • Direct service provider information
    • Member information
    • CDS employer information
    • Service authorization information
  • One year of accepted visit information (from the EVV Aggregator)

Data Availability

EVV visit data for dates of service Sept. 1, 2019, to present is available in the EVV Portal. Program providers or FMSAs needing access to data prior to Sept. 1, 2019, can email HHSC EVV Operations.

Program providers and FMSAs are encouraged to download and archive data in your current EVV systems that is not being converted as outlined above. For program providers and FMSAs that use the EVV systems or the paid for versions of AuthentiCare or Vesta to store or maintain non-EVV visit data, you should take steps now to maintain your non-EVV visit data. Access to the state provided AuthentiCare and Vesta systems will end on Dec. 22, 2023.

Once the data has been reviewed, users should contact HHAeXchange for any issues or concerns with their data.

Email HHAeXchange or call 833-430-1307.

August 20th, 2023

 EVV Alternative Device Policy For New State EVV Vendor

HHSC has updated the alternative device policy notice posted on July 17.

In addition to allocating free alternative devices to 7.5% of the program providers or Financial Management Services Agencies (FMSAs) census (rounded to the nearest whole number), HHSC is allowing the purchase of additional alternative devices for qualifying members.

This policy applies to program providers and FMSAs who will use the new State EVV vendor, HHAeXchange.

Additional information will be forthcoming about the processes for providers and FMSAs to order alternative devices.

Email questions to HHSC EVV Operations.

August 19th, 2023

Hurry Before It’s Too Late!   EVV Onboard with HHAeXchange by Aug. 31

Begin the onboarding process with the new Electronic Visit Verification (EVV) vendor HHAeXchange.

Current Users

Program providers and financial management services agencies (FMSAs) who are transitioning to HHAeXchange, and are not in the proprietary system onboarding process, must submit the HHAeXchange Provider Onboarding Form by Aug. 31.

Application programming interfaces (APIs) can be used to exchange data between third-party software systems, such as payroll systems, electronic health records systems, and the HHAeXchange Portal (the new EVV vendor system).

Program provider and financial management services agencies, who want to integrate their third-party software systems with HHAeXchange, can refer to the specifications listed in the HHAeXchange Web Service API Guide (PDF).

APIs available to integrate with HHAeXchange include:

  • Service Provider (Create, Update, Search, Get)
  • Member (Create, Update, Search, Get)
  • Schedule (Create, Update, Search, Get)
  • Visit (Search, Get)
  • Authorization (Create, Update)

To begin the integration process, submit a ticket through the HHAeXchange Client Support Portal.

Contact HHAeXchange for provider onboarding form questions.

June 13, 2023

Next Steps and Timeline for Transition to New Electronic Visit Verification State Vendor System

HHSC has posted the next steps and timeline to transition to the new, single and state-funded Electronic Visit Verification vendor system, the HHAeXchange Portal.

As stated in the EVV notice posted on May 5, users of the current EVV vendor systems (DataLogic/Vesta or First Data/AuthentiCare) must transition to HHAeXchange or receive approval as an EVV Proprietary System Operator by Oct. 1, 2023.

The following topics are listed in the notice, “Next Steps and Timeline for Transition to HHAeXchange” (PDF):

  • EVV requirement
  • Transition to HHAeXchange by Oct. 1, 2023
  • Proprietary systems
  • HHAeXchange Information Sessions
  • HHAeXchange Provider Onboarding Form
  • EVV Policy updates
  • HHAeXchange System Training
  • Access to the HHAeXchange Portal
  • Contact information and other resources

*Training begins in August and access to the portal begins in September of 2023 for HHAeXchange.

HHSC has created a brief version of the notice that was posted on May 5 about the transition and changes related to the new, single and state-funded Electronic Visit Verification vendor system, HHAeXchange.

Program providers and financial management services agencies may provide the brief notice to their members, services providers and Consumer Directed Services employers. The brief notice is available in English (PDF) and Spanish (PDF).

HHSC will continue to post communications and resources throughout the transition.

Email questions to HHSC EVV Operations.

June 10th, 2023

https://www.hhs.texas.gov/provider-news/2023/06/01/registration-available-hhsc-evv-policy-training-webinars-program-providers-fmsas-cds-employers

Registration Available for HHSC EVV Policy Training Webinars for Program Providers, FMSAs and CDS Employers
June 1, 2023

HHSC is hosting Electronic Visit Verification policy training webinars for program providers, financial management services agencies and Consumer Directed Services employers to complete the EVV policy training requirement. EVV policy training provides training on the EVV Policy Handbook.

Webinar agendas are included in the registration links below.

Webinar Registration

Program providers, FMSAs and CDS employers can also complete the EVV policy training requirement on the HHS Learning Portal.

The EVV Required Training Checklists (PDF) will help track completed EVV trainings.

Register for EVV GovDelivery to receive EVV notices by email, such as training updates and future webinar registrations.

Email questions to HHSC EVV Operations.

June 2nd, 2023

EVV Resources Updates

HHSC has updated three Electronic Visit Verification resources that are located on the EVV webpage:

  • EVV Training Requirements Checklists
  • Getting Started with EVV
  • Program and Service Requirements for Schedules

EVV Training Requirements Checklists

The EVV Required Training Checklists (PDF) is a resource for those required to use EVV due to all previous and upcoming EVV implementations (personal care services and home health care services). This resource was updated with the following:

  • Aligns with EVV Policy Handbook revisions
  • Lists training course names
  • Describes required trainings
  • Defines EVV Portal users, EVV system users and billing staff
  • Includes link to sign up for GovDelivery
  • Has interactive (fillable form) features to help document completed trainings

Getting Started with EVV

Getting Started with EVV is a guide that lists steps and resources to start using EVV. HHSC has created a single-page guide for each of the following stakeholders:

Program and Service Requirements for Schedules

The document, Program and Service Requirements for Schedules (PDF), is a resource that describes requirements related to using schedules in the EVV system. HHSC added managed care organization programs to the document.

Email EVV Operations for questions.

May 13th, 2023

Reminder:  EVV Claims Matching for HCS and TxHmL Will Begin for Dates of Service Starting May 1, 2023

This is a reminder that Electronic Visit Verification claims matching for Home and Community-based Services and Texas Home Living will begin on May 1, 2023. EVV claims with dates of service of May 1, 2023, and after that do not have an EVV visit match will deny.

For more information about billing updates for HCS and TxHmL, including resources to help avoid future payment denials or recoupments, reference the notice located on the EVV web page, “EVV Claims Matching for HCS and TxHmL Will Begin for Dates of Service Starting May 1, 2023”.

Email EVV Operations for questions.

April 3rd, 2023

Session 4 ORR Schedules Added to TMHP EVV Proprietary Systems Web Page

HHSC created the Session 4 Operational Readiness Review, which is a special abbreviated Electronic Visit Verification Proprietary System Operator onboarding path that supports additional PSO ORRs. This additional path allows program providers and financial management services agencies to onboard with a previously approved proprietary system or a proprietary system that is participating in the Session 3 Standard Path ORR.

The Texas Medicaid and Healthcare Partnership has updated the EVV ORR section of the EVV Proprietary Systems web page to include ORR schedules, requirements and information about the Session 4 ORR.

Email the TMHP EVV PSO inbox for questions.

January 12th, 2023

Electronic Visit Verification (EVV) for Individualized Skills and Socialization (ISS) IL-2023-03 alert letter

Electronic Visit Verification (EVV) for Individualized Skills and Socialization
Program providers must ensure EVV is used when delivering in-home individualized skills and socialization in an own home/family home (OHFH) setting. For dates of services on and after March 1, 2023,

HHSC will deny or recoup a claim for in-home individualized skills and socialization in the own home/family home setting without a matching EVV visit record. For more information about EVV claims matching, refer to the EVV notice, “EVV Claims Matching for HCS and TxHmL Starts March 1, 2023”.
Program providers must input the Texas EVV Attendant ID for in-home EVV individualized skills and socialization OHFH claims.

Email TMHP EVV Operations for questions or refer to the document, HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (PDF), for more information to help avoid EVV claim mismatches.

to the LTC Billing Crosswalk for more information about Staff ID requirements.

By January 13, 2023, HHSC will update the EVV Personal Care Services Bill Codes Table, located on the HHSC EVV web page, to include the specific Individualized Skills and Socialization billing codes which require EVV. Sign up for EVV GovDelivery to receive updates by email.

For EVV-related contact information, reference the EVV Contact Information Guide for Program Providers and FMSAs (PDF).

To read more, please click on link below, for Information Letter 2023-03 related to ISS automatic service authorizations and EVV

IL-2023-03

January 2nd, 2023

EVV Vendor Systems Will Display Individualized Skills and Socialization Services Starting 1/1/2023 Before New Authorizations Are Available

This notice is for Home and Community-based Services program providers, Texas Home Living program providers and financial management services agencies required to use Electronic Visit Verification.

As shared in the EVV notice published on Oct. 26, Individualized Skills and Socialization bill codes will replace day habilitation bill codes; therefore, the EVV vendor systems will display 1/1/23 as the effective date for these new services; however, HHSC has extended the date when the new authorizations for Individualized Skills and Socialization services will be available, which is the week of 1/9/23.

Program providers and FMSAs required to use EVV must continue to use EVV.

HHSC will continue posting related updates.

As a reminder, EVV claims matching for HCS and TxHmL starts March 1, 2023. EVV Operations will be posting the updated bill codes, including helpful information to avoid future payment denials or recoupments, following the publication of other HHSC materials.

For other EVV questions, email the EVV Operations inbox.

For questions about Individualized Skills and Socialization services, email the Long-Term Services and Supports Policy inbox.

December 17th, 2022

EVV Training Updates

This notice from HHSC lists Electronic Visit Verification training updates for program providers, financial management services agencies and Consumer Directed Services employers required to use EVV.

Resources from the following training webinars are now available in the HHS Learning Portal by selecting EVV Policy Training – Webinar Recordings FY23:

  • Español – EVV Compliance for CDS Employers (PDF) – Aug. 25 non-required training webinar
  • Annual EVV Policy Training for Program Providers and FMSAs – Sept. 30 and Oct. 27 webinars

If new to EVV and need to complete the EVV policy training requirement, complete one of the applicable computer-based training courses located in the HHS Learning Portal:

An account is required to access the training webinar resources and CBTs, including to obtain a certificate of completion. Note that a “non-required training” does not include a completion certificate because it is considered optional training. Reference the EVV HHS Learning Portal Guide (PDF) for instructions.

For more information on EVV training requirements, reference section 4200 from the EVV Policy Handbook.

Sign up for GovDelivery to receive EVV updates, such as training updates, by email.

Email EVV Operations for questions.

2023 EVV Operational Readiness Review Session & Business Rules for Proprietary Systems Version 3.0

EVV Operations has posted the following notice: Notice of 2023 EVV Operational Readiness Review Sessions and EVV Business Rules for Proprietary Systems Version 3.0 (PDF).

This notice is to inform program providers and financial management services agencies about the publication of the 2023 Operational Readiness Review Sessions, as well as the new EVV Business Rules for Proprietary Systems Version 3.0.

EVV Guidance on Program and Service Requirements for Schedules

HHSC has published the document, Program and Service Requirements for Schedules (PDF), under the Resources section on the Electronic Visit Verification web page. This document describes HHSC requirements related to using schedules in the EVV system.

Email HHSC EVV Operations for questions.

December 1st, 2022

Reminder for STAR+PLUS, STAR Kids and STAR Health: New EVV Bill Codes and Modifier Combinations Effective Dec. 1

As a reminder, starting Dec. 1, new Electronic Visit Verification personal care services Healthcare Common Procedure Coding System and modifier combinations will be effective for:

  • STAR+PLUS
  • STAR Kids
  • STAR Health

Refer to HHSC’s Oct. 31 notice for more information.

Contact your managed care organization for questions about these updates. Refer to the last page of the EVV contact guide (PDF) for MCO contact information.

December 1st, 2022

HCS and TxHmL Updates

The effective dates were updated for HCS and TxHmL services.

Refer to the bill codes table’s revision history dated Dec. 1, 2022, for more information.

For questions, email EVV Operations.

October 16th, 2022

Potential Electronic Visit Verification Changes Coming in 2023

The purpose of this notice is to inform stakeholders that HHSC’s contract for the current Electronic Visit Verification vendor systems (AuthentiCare and Vesta EVV) is scheduled to expire on Aug. 31, 2023.

On April 26, 2022, HHSC posted a competitive solicitation on the Electronic State Business Daily for EVV System Management Services. Contractor responsibilities will include:

  • Providing and managing a single EVV vendor system
  • Review and approval of provider-operated EVV proprietary systems  If you have an outside vendor (proprietary vendor), these will be reviewed as well.
  • Coordinating EVV system integration with the EVV aggregator
  • Providing operational and technical support for the functions listed above

Notification of contract award is anticipated in March 2023.

HHSC, at its sole discretion, may publish updates about the anticipated award date to the Procurement Forecast on the HHS Procurement Opportunities web page. Respondents are responsible for periodically checking the ESBD and the HHSC Procurement Forecast web page for updates.

HHSC must maintain the confidentiality and integrity of the procurement process; therefore, no additional information is available at this time. HHSC will provide more information in future announcements.

Email questions about this solicitation to Andrick Reese.

September 25th, 2022

EVV Updates for HCS and TxHmL Program Providers and FMSAs

HHSC and the Texas Medicaid and Healthcare Partnership posted helpful information for Home and Community-based Services program providers, Texas Home Living program providers and financial management services agencies required to use Electronic Visit Verification.

HHSC Notice

This notice is to help program providers and FMSAs that are receiving EVV mismatches for Day Habilitation services.

Refer to the Sept. 15 notice for information on billing requirements, such as which Day Habilitation bill codes to use.

TMHP Notice

This notice provides information about EVV requirements for In-Home Day Habilitation and about EVV claims matching starting Nov. 1 for HCS and TxHmL.

Refer to the Sept. 19 notice for more information and resources.

Email EVV Operations for questions.

September 25th, 2022

EVV Claims Matching Refresher for HCS and TxHmL

Electronic Visit Verification claims matching for Home and Community-based Services and Texas Home Living will begin for dates of service starting Nov. 1.

To help prepare, the Texas Medicaid and Healthcare Partnership will host a refresher webinar on Oct. 13, for:

  • HCS program providers
  • TxHmL program providers
  • Financial management services agencies

Refer to TMHP’s Sept. 15 notice for more information and to registerl

Click here for more information

September 18th, 2022

EVV Compliance Job Aids Updated

The Electronic Visit Verification Compliance Job Aids have been updated. They are in the compliance section on the EVV web page.

The job aids were simplified and provide updated information about the following EVV Compliance standards:

  • EVV Usage Scores and reviews
  • Required free text reviews
  • Landline phone verification reviews

August 31st, 2022

Annual EVV Policy Webinars for Program Providers & FMSAs

To view information about the upcoming webinars (September 30th and October 27th) and how to register go to:  https://www.tmhp.com/news/2022-08-30-annual-evv-policy-training-webinars-program-providers-and-fmsas
Both of the above-referenced webinars will cover the same information.  Information about the annual EVV policy webinars for CDS employers will be posted soon.

July 28th, 2022

EVV Portal and Training Updates

Texas Medicaid and Healthcare Partnership updated the Electronic Visit Verification Portal and related training materials on July 14.

Refer to the EVV Portal and Training Updates notice on TMHP’s EVV webpage for more information.

Email questions to TMHP.

July 5th, 2022

EVV Claims for HCS and TxHmL Will Deny for Dates of Service Starting Sept. 1

HHSC has extended the start date when Electronic Visit Verification claims for Home and Community-based Services and Texas Home Living will deny for no matching EVV visit. This will begin for the dates of service of Sept. 1, 2022, and after.

The extension gives HCS and TxHmL program providers and financial management services agencies more time to improve their claims matching. Texas Medicaid and Healthcare Partnership will provide more outreach and training on this topic. Trainings will be announced at a future date.

Refer to the HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (PDF) for technical guidance.

HCS and TxHmL EVV claims must continue to be submitted through the Client Assignment and Registration System or TMHP.

  • Submit EVV claims to CARE for dates of service before May 1, 2022.
  • Submit EVV claims to TMHP for dates of service of May 1, 2022, and after.

Program providers, FMSAs and Consumer Directed Services employers must continue to use EVV during this period. However, HCS and TxHmL claims will not be denied for an EVV mismatch. HCS and TxHmL claims during this period are still subject to HHSC provider fiscal compliance reviews conducted by HHSC Provider Fiscal Compliance..

Email EVV Operations for questions.

July 1st, 2022

EVV Claims for HCS and TxHmL Will Deny for Mismatched Visits Starting July 1

Starting July 1, Electronic Visit Verification claims for Home and Community-based Services and Texas Home Living must have a matching EVV Visit, or claims will deny.

Refer to the June 20 notice for more information and resources.

Email EVV Operations for questions.

June 12th, 2022

EVV Portal and Training Updates

Texas Medicaid and Healthcare Partnership updated the Electronic Visit Verification Portal and related training materials on June 9.

There are also two new visit rejection codes related to EVV system transfers.

Refer to the EVV Portal and Training Updates notice on TMHP’s EVV webpage for more information.

Email questions to TMHP.

June 6th, 2022

EVV Policy Handbook Revision and Training Updates

The Electronic Visit Verification Policy Handbook has been revised.

Revisions include:

  • Adding new sections for the Consumer Directed Services option.
  • Updating Schedules policy.
  • Updating Visit Maintenance Reduction Features policy.

These revisions are effective June 1 and are outlined in the new revision log (PDF), located on the EVV webpage.

The handbook’s policies include EVV standards and policy requirements for:

  • Program providers
  • Financial Management Services Agencies
  • Consumer Directed Services employers
  • Payers, such as HHSC and managed care organizations

Computer-based training on the HHS Learning Portal were updated to include the policy revisions.

  • EVV Policy Training for Program Providers and FMSAs CBT
  • Initial EVV Policy Training for CDS Employers CBT
    • Note: The updates to the Spanish CBT will publish in June.

Email HHSC EVV Operations for questions about this notice.

May 30th, 2022

EVV Claims Matching for HCS and TxHmL Will Resume July 1

Electronic Visit Verification claims matching will resume for all Home and Community-based Services and Texas Home Living billing code combinations with dates of service of July 1, 2022 or after.

HHSC will post another notice with more information and resources to avoid EVV claims mismatches before July 1, 2022.

Email EVV Operations for questions about this notice.

May 8th, 2022

EVV Portal and Training Updates

Texas Medicaid and Healthcare Partnership updated the Electronic Visit Verification Portal and related training materials on April 29.

Refer to the EVV Portal and Training Updates notice on TMHP’s EVV webpage for more information.

Email TMHP EVV Operations with questions

March 7th, 2022

EVV Notice for HCS/TxHmL Program Providers

The migration of Home and Community-based Services (HCS) and Texas Home Living (TxHmL) forms and claims entry to Texas Medicaid & Healthcare Partnership (TMHP) has been moved from March 1, 2022, to May 1, 2022. The postponement allows more time for program providers to set up the necessary TMHP accounts and take relevant training courses. HCS and TxHmL program providers must continue to use the Client Assignment and Registration (CARE) system to submit claims using existing billing code combinations for service groups 12 and 15 for dates of service prior to May 1, 2022.

HHSC is aware that some program providers updated authorizations in the EVV systems to reflect the new billing code combinations for service groups 21 and 22 that were scheduled to take effect March 1. To avoid the re-entry of authorizations, HHSC and TMHP will take the following actions:

  • By March 4, the EVV Aggregator will accept billing code combinations for service groups 12, 15, 21 and 22 on EVV visits for dates of service through April 30, 2022, to prevent visit rejections.
    • For dates of service on or after May 1, 2022, the EVV Aggregator will only accept billing code combinations for service groups 21 and 22.
  • Turn on the EVV07 claims matching bypass for all HCS and TxHmL billing code combinations to avoid claim denials through May 31, 2022.
    • Claims matching for all HCS and TxHmL billing code combinations will resume June 1, 2022.
  • Publish an updated EVV Service Bill Codes Table to reflect these changes.

HCS and TxHmL claims will not be denied for an EVV mismatch. HCS and TxHmL claims during this period are still subject to HHSC provider fiscal compliance reviews conducted by HHSC Provider Fiscal Compliance.

**For visits that have been rejected by the aggregator due to incorrect billing code combinations, program providers must re-export the visit and ensure it is accepted in the EVV aggregator prior to submitting claims.

Please refer to HHSC’s ‘Continue Submitting Claims and Forms Using CARE System Until May 1, 2022’ notice for more information.

For technical questions related to the EVV Aggregator, contact TMHP. For other general EVV inquiries, contact HHSC EVV Operations.

March 3rd, 2022

EVV Policy Handbook Revisions Now Available

HHSC revised sections and appendices of the Electronic Visit Verification Policy Handbook.

The handbook includes EVV standards and policy requirements for:

  • Program providers.
  • Financial Management Services Agencies.
  • Consumer Directed Services employers.
  • Payers, such as HHSC and managed care organizations.

The revisions are effective March 1 and are briefly described in the 22-2 notice. For more information about the policy changes, refer to the new revision log (PDF) located on the EVV webpage.

Email HHSC EVV Operations with questions.

February 28th, 2022

EVV Portal and Training Updates

Texas Medicaid and Healthcare Partnership updated the Electronic Visit Verification Portal and related training materials on Feb. 28.

For more information, refer to the EVV Portal and Training Updates article on TMHP’s EVV webpage.

For questions, email TMHP EVV Operations.

January 8th, 2022

EVV Policy Handbook Revisions – Jan. 7th, 2022

HHSC revised parts of the Electronic Visit Verification Policy Handbook. These revisions are effective Jan. 7 and are listed in Revision Notice 22-1.

The handbook’s policies include EVV standards and policy requirements for:

  • Program providers.
  • Financial Management Services Agencies.
  • Consumer Directed Services employers.
  • Payers, such as HHSC and managed care organizations.

For questions, email HHSC EVV Operations.

November 21st, 2021

EVV Portal and Training Updates for November 2021

Texas Medicaid and Healthcare Partnership made improvements to the EVV Portal and related training materials on Nov. 11.

For more information, access the November 2021 EVV Portal and Training Updates article on TMHP’s EVV webpage.

FYI- When you click on the link above for updates from HHSC, please be sure to scroll to the bottom and click on “accept” as this is a disclaimer page.  You must do this 1st.   I have received some comments that some providers get confused when they see this page on the EVV website first pop up and they think they are on the wrong page, or there is a problem with the website page, etc…

Email TMHP with questions about these updates.

November 18th, 2021

Revised EVV Policy Handbook Now Available

The Electronic Visit Verification Policy Handbook was revised.

The handbook’s policies are effective Nov. 1, 2021 and include EVV standards and policy requirements for:

  • Program providers
  • Financial Management Services Agencies
  • Consumer Directed Services employers
  • Payers such as HHSC and managed care organizations

The handbook replaces policies previously on the HHSC EVV webpage.  See EVV Policy Handbook Revisions – November 2021 (PDF) for differences between previously published policies and the revised handbook.

The following computer-based training courses on the EVV Training page of the HHS Learning Portal now reflects the revised EVV Policy Handbook:

  • Initial EVV Policy Training for CDS Employers
  • EVV Policy Training for Program Providers and FMSAs

Use the applicable checklist within EVV Training Requirements Checklist (PDF) for EVV training requirements and completion options.

Email questions to HHSC EVV Operations.

November 17th, 2021

EVV Visit Maintenance Unlock Request Updates

HHSC published EVV Visit Maintenance Unlock Request spreadsheet updates.

These updates let the user request corrections to data element(s) on an EVV visit transaction(s) after the visit maintenance time frame has expired.

Program providers, Financial Management Services Agencies and Consumer Directed Services employers must use the request spreadsheets found on the EVV webpage.

The updates to the program provider and FMSA Request (Excel) include:

  • New fields
  • Added drop-down lists to applicable fields
  • Updated and simplified field headers
  • Revised instructions to:
    • Reflect EVV policy updates
    • List detailed steps and notes to complete the Request

The new Request for Consumer Directed Services employers (Excel) include:

  • A new request spreadsheet for CDS employers who selected Option 1 on Form 1722, Employer’s Selection for EVV Responsibilities, to complete visit maintenance. This includes:
    • Drop-down lists for applicable fields
    • Sections for CDS employers and payers to complete
  • Instructions reflect:
    • EVV policy updates
    • Detailed steps and notes to complete the request

    Review the instructions on the spreadsheets for more information.

    Email questions to your payer, either HHSC or a managed care organization

July 4th, 2021

EVV Visit Maintenance Policy Now Available

The Electronic Visit Verification Visit Maintenance Policy (PDF) is now available on the HHSC EVV webpage. The policy is effective July 1, 2021 and:

  • Requires the program provider, Financial Management Services Agency or Consumer Directed Services employer to ensure each EVV visit transaction is complete, accurate and validated.
  • Incorporates the Visit Maintenance: Last Visit Maintenance Date Policy.
  • Incorporates the Visit Maintenance Unlock Request Policy.
  • Includes the new visit maintenance time frame of 95 calendar days. (previously 60 calendar days) from the date of service delivery.

Email questions to HHSC EVV Operations at EVV@hhs.texas.gov.

July 4th, 2021

HHSC EVV Webpage Updates Now Available

The Texas Health and Human Services Commission updated and archived web sections and content, updated and added additional information related to the 21st Century Cures Act (Section 12006) and added new resources for the following Electronic Visit Verification webpages:

Email questions to HHSC EVV Operations at EVV@hhs.texas.gov.

July 3rd, 2021

Revised EVV Visit Transaction Rejection Guide Now Available

The Electronic Visit Verification Visit Transaction Rejection Guide (PDF) was revised and is now available.

The guide provides step-by-step instructions for program providers and Financial Management Services Agencies to identify and correct issues that result in transaction rejections in the EVV system.

The guide is published on TMHP’s EVV Training webpage.

Email TMHP with questions.

April 17th, 2021

EVV Policy Training for CDS Employers Now Available in Spanish

The computer-based training course, Initial EVV Policy Training for CDS Employers, is available in Spanish on the HHS Learning Portal.

To translate the HHS Learning Portal to Spanish, select Español from the drop-down menu in the upper left-hand corner of the webpage.

The policy training is tailored to the selection on Form 1722, Employer Selection for Electronic Visit Verification Responsibilities.

Registrants are not required to complete the Form 1722 Pre-Course Survey.

Follow the instructions throughout the course to complete and receive certification.

Email the HHSC EVV Mailbox for questions about EVV policy training.

March 16th, 2021

HHSC Publishes EVV Requirements of Signatures on Enrollment Documentation           (IL 2021-13)

HHSC has published IL 2021-13, EVV Notification Requirement (PDF), replacing IL 2020-01.

The letter addresses revisions on instructing LIDDAs on the requirements of signatures on enrollment documentation.

It also addresses new activity requirements for HCS, TxHmL, CDS program providers and LIDDA service coordinators.

For questions, email HCS Policy or CDS.

March 10th, 2021

Temporary EVV Policies for the Feb. 2021 Severe Winter Weather

In response to the recent severe winter weather, HHSC issued Temporary EVV Policies for Severe Winter Weather (PDF).

The flexibilities are for dates of service from Feb. 10, 2021 through Feb. 24, 2021.

The flexibilities are for program providers, financial management services agencies and consumer directed services employers required to use EVV.

Email questions to the HHSC EVV Mailbox.

February 7th, 2021

EVV Refresher Training on Feb. 19

The Texas Health and Human Services Commission and Texas Medicaid & Healthcare Partnership are hosting an Electronic Visit Verification webinar.

This training is a refresher and covers topics for Home and Community-based Services program providers, Texas Home Living program providers and financial management services agencies who submit EVV claims for HCS and TxHmL EVV-required services.

The training is not required and is not a substitute for annual EVV training requirements.

Certificates of completion will not be issued.

Attendees will have the opportunity to submit questions throughout the training.

Both HHSC and TMHP will conduct a live question and answer session.

The registration link is below and provides details, such as agenda topics.

HCS/TxHmL EVV Refresher Training – Claims Submission/Claims Matching Policies & Best Practices to Avoid EVV Claim Mismatches
Friday Feb. 19
10 a.m. – Noon
Register for the webinar.

Email HHSC EVV for questions.

Reminder:  Entering Schedules for EVV-Required Services

The Electronic Visit Verification system allows Home and Community-based Services, Texas Home Living program providers, CDS Employers and Financial Management Services Agencies to enter schedules for EVV-required services. This is not an HHSC requirement. Program Providers, FMSAs and CDS employers can choose to enter a schedule into the EVV system.

EVV is only required for the following services:

  • Community First Choice Personal Assistance Services/Habilitation
  • In-Home Day Habilitation in own home or family home settings
  • In-Home Respite in own home or family home settings

Email hcspolicy@hhsc.state.tx.us or txhml@hhsc.state.tx.us with questions.

January 24th, 2021

EVV Portal and Training Updates for January

On Jan. 14, Texas Medicaid & Healthcare Partnership made improvements to the Electronic Visit Verification Portal by updating the EVV Reason Code Usage and Free Text Report and updated the related training materials.

Read the TMHP article EVV Portal Improvements and Training Updates for details.

Email TMHP with questions about these updates.

January 24th, 2021

HCS & TxHmL Best Practices to Avoid EVV Claim Mismatches for CFC PAS/HAB Services

HHSC has published Best Practices to Avoid Electronic Visit Verification Claim Mismatches for Home and Community-based Services and Texas Home Living (PDF) program providers and financial management services agencies.

The best practices help HCS and TxHmL providers avoid claim denials related to EVV.

The best practices are linked above and on the HHS EVV Training webpage in the Best Practices section.

Email questions about EVV policy to HHSC EVV.

January 18th, 2021

EVV Compliance Oversight Reviews Delayed for EVV Usage and Misuse of EVV Reason Codes

HHSC told managed care organizations to delay compliance oversight reviews for EVV Usage and Misuse of EVV Reason Codes. Evaluation of visit data collected during the grace period ensures the compliance measures continue to align with current EVV policy.

EVV Usage and Misuse of EVV Reason Codes reviews for the compliance grace period ended on Aug. 31, 2020 for:

  • EVV visits with Sept. 1, 2019 to Aug. 31, 2020 dates of service.
  • Program providers required to use EVV by state law before the Cures Act Implementation identified on pages 3 and 4 of the Programs and Services Required to Use EVV (PDF) document.

Next Steps

  • HHSC will notify program providers 90 calendar days before reviews begin for EVV Usage and Misuse of EVV Reason Codes for EVV visits with dates of service on and after Sept. 1, 2020.
  • HHSC and MCOs will continue reviews for EVV Landline Phone Verification and Required Free Text.
  • Program providers can use the EVV Usage Report, and EVV Reason Code Usage and Free Text Report in the EVV Portal to track these compliance measures.

Program providers can contact their payer or email HHSC EVV with their questions or concerns.

January 10th, 2021

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EVV Notification Requirement for HCS/TxHmL Program Providers 

HHSC has published IL 2021-01 Electronic Visit Verification Notification Requirement (PDF).

The letter informs HCS and TxHmL program providers they are now required to use the EVV system for CFC PAS/HAB, in-home respite, and day habilitation provided in the home of an individual who has a residential location of “own/family home.”

Texas Government Code, §531.024172(c), requires that HHSC inform an individual who receives a service requiring the use of EVV that the individual is required to comply with the EVV system. HHSC has developed a form for providers to comply with this statute.

The Electronic Visit Verification Responsibilities and Additional Information form is included with the IL 2021-01 (PDF).

January 4th, 2021

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 EVV for HCS and TxHmL providers has gone live since January 1, 2021 (includes CDS and FMSA’s)

Resources for providers, including escalation processes, regarding EVV questions & concerns:
Process for organizations/associations escalating issues on behalf of their members:
  • Email HHSC EVV Operations, Electronic_Visit_Verification@hhsc.state.tx.us, regarding:
    • EVV Policy and Compliance Questions
    • General EVV Inquiries and Complaints
    • Good idea to CC your provider association, if you are a member (PPAT, PACSTX..)
  • Email TMHP, EVV@tmhp.com, regarding TMHP issues and EVV vendor complaints/issues.
    • Copy Evan Wilkerson on urgent TMHP or EVV vendor issues.
Reminder:  It’s critical that provider associations and their members send any issues to the official mailboxes (electronic_visit_verification@hhsc.state.tx.us and EVV@tmhp.com) for tracking purposes.  Providers and associations may email Evan Wilkerson (TMHP) on urgent issues, but be sure to also send to the official HHSC and TMHP email boxes.
December 20th, 2020

Cures Act EVV:

Preparing for Jan. 1, 2021 Implementation

HHSC will require Electronic Visit Verification for all Medicaid personal care services beginning on Jan. 1, 2021. This requirement is mandated by the federal 21st Century Cures Act. If HHSC does not comply, Texas will lose federal funding for Medicaid services.

Beginning Jan. 1, 2021:

  • Document all delivery visits for an EVV-required service in the EVV system. EVV-required services on the Programs, Services, and Service Delivery Options Required to Use EVV (PDF) document.
  • An EVV-required service claim will be paid only if:
    1. The EVV visit transaction that supports the claim is accepted into the EVV Portal before claim submission.
    2. The claim receives an “EVV01 – EVV Match” result code in the EVV Portal after the claims matching process is performed.

Program providers and financial management services agencies must complete the following before Jan. 1, 2021, to avoid impacts to EVV claims payment:

  • EVV system onboarding. This includes system setup and training.
    • If an EVV vendor system is selected from the state vendor pool, the EVV vendor provides the training. Refer to the TMHP EVV Vendors webpage for more information about EVV vendors and their contact information.
    • If an EVV proprietary system is selected, the program provider or FMSA handles system training.
  • EVV training requirements outlined in the Cures Act EVV: Training Requirements Checklists (PDF).
  • Document all visits for EVV-required services in the EVV system.

CDS employers must complete the following before Jan. 1, 2021, to avoid delays in payment to their CDS employees:

HHSC is providing the following support to program providers, FMSAs, and CDS employers. This is to reduce impacts to claims payment and payment to CDS employees as they adjust to the new EVV requirements.

  • If a visit is not captured through an electronic verification method, enter the visit manually into the EVV system and confirm acceptance into the EVV Portal to avoid claim denials. Instructions for manually entering a visit are posted in the following locations:
    • DataLogic/Vesta EVV system.
    • First Data/AuthentiCare EVV system in the “Custom Links” section.
  • HHSC has published Best Practices to Avoid EVV Claim Mismatches (PDF) to help program providers and FMSAs ensure a claim is not denied for reasons related to EVV.
  • HHSC has issued the 90 Day Visit Maintenance Temporary Policy (PDF). extending the time to complete visit maintenance for dates of service between Jan. 1, 2021 and March 31, 2021.
  • An EVV compliance grace period will be applied for one year to all Cures Act EVV Expansion services with dates of service between Jan. 1, 2021 and Dec. 31, 2021 for the compliance measures listed in EVV Compliance Oversight Reviews Policy (PDF).

The EVV Contact Information Guides provide points of contact for EVV-related questions and issues:

Visit the HHS EVV website for more information.

November 28, 2020

HCS and TxHmL CARE Service Authorization instructions for EVV

HCS and TxHmL are required to manually enter each individual’s service authorization in the EVV Vendor System.

Providers can find instructions here on how to find their service authorizations in CARE.

If additional assistance is needed after the service authorization is obtained, program providers can contact their EVV vendor for further instructions.

Existing EVV Users: Temporary EVV Policies for COVID-19 to End Dec. 31

HHSC is extending the Temporary EVV Policies for COVID-19 (PDF) through Dec. 31, 2020 for program providers currently required to use Electronic Visit Verification. HHSC will end the temporary policies after Dec. 31, 2020.

Program providers submitting EVV claims for dates of service on and after Jan. 1, 2021:

  • Must ensure a matching EVV visit transaction is accepted in the EVV Portal before billing the claim, or the claim will be denied.
  • Will no longer receive an EVV07 match code in the EVV Portal.
  • Will no longer have 180 days to complete visit maintenance.

Reminder: HHSC extended the practice period for the Cures Act Expansion. Claims for EVV services included in the Cures Act Expansion, will be denied without a matching EVV visit transaction for dates of service on and after Jan. 1, 2021.

Best Practices for Temporary EVV Policies for COVID-19

Program providers should continue to follow the Best Practices for Temporary EVV Policies for COVID-19 (PDF) to avoid recoupments for claims submitted between March 21, 2020 and Dec. 31, 2020.

Contact your payer for questions or email HHSC EVV.

Visit the HHS EVV webpage.

HCS and TxHmL Program Providers Required to Select an EVV Vendor
11/18/2020
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HCS and TxHmL Program Providers Required to Select an EVV Vendor

Effective Jan. 1, HHSC will require HCS and TxHmL program providers to use EVV for the following services:

  • Community First Choice Personal Assistance Services/Habilitation
  • In-Home Respite
  • In-Home Day Habilitation (Own Home or Family Home only)

HCS and TxHmL program providers are required to select an EVV vendor and complete EVV training to meet the Jan.1 deadlines. The requirement to select an EVV vendor and complete training applies to all contracted HCS and TxHmL program providers.

Beginning Jan. 1, 2020, service claims for CFC PAS/HAB will be denied by the claims adjudication system and not paid by HHSC if the program provider has not onboarded with an EVV vendor.

Read IL 20-07 (PDF) for more information about selecting an EVV vendor and completing training to be EVV-compliant by the Jan. 1 deadline.

Deadline Approaching Soon!!

October 21, 2020

Remember everyone:  Effective Dec. 1, HHSC will require HCS and TxHmL program providers to use EVV for the following services:

  • Community First Choice Personal Assistance Services/Habilitation (CFC PAS/HAB)
  • In-Home Respite
  • In-Home Day Habilitation (Own Home or Family Home only)

HCS and TxHmL program providers are required to select an EVV vendor and complete EVV training to meet the Dec.1 deadlines. The requirement to select an EVV vendor and complete training applies to all contracted HCS and TxHmL program providers.

Beginning Dec. 1, 2020, service claims for CFC PAS/HAB will be denied by the claims adjudication system and not paid by HHSC if the program provider has not onboarded with an EVV vendor.

Click here to read IL 20-07 (PDF) for more information about selecting an EVV vendor and completing training to be EVV-compliant by the Dec. 1 deadline.

Contact EVV if you have questions about EVV requirements.

Oct. 11th, 2020

EVV Revised Policies Effective Oct. 1

HHSC has revised the following electronic visit verification policies, effective Oct. 1. The information is for program providers and financial management services agencies. It is on the Policy section of the HHS EVV webpage.

Claims Matching Policy (PDF)

The policy:

  • Includes additional EVV claims match result codes
  • Identifies exceptions to the claims matching process

Claims Submission Policy (PDF)

  • The policy includes detailed information about the requirement to submit claims for EVV-required services to the appropriate HHSC claims management system.
  • The EVV Billing Policy has been incorporated into the policy.

Email HHSC EVV with your questions.

Oct. 11th, 2020

Updated EVV Service Bill Codes Table Effective Oct. 1

The EVV Service Bill Codes Table is updated effective Oct. 1. The table is on the HHS EVV webpage in the Service Bill Codes Table section. See:

  • Below for the major updates
  • The Revision History in the table for a complete list of the changes

Program providers and FMSAs can refer to the table for the list of EVV-relevant services and bill code information to avoid EVV visit transaction rejections and EVV claim mismatches.

Units Matching

The updated table shows that during the EVV claims matching process for dates of service on and after Oct. 1, billable units on the EVV visit transaction will be matched to billed units on the claim for:

  • EVV-relevant services delivered through the service responsibility option in Managed Care and fee-for-service Long-Term Care programs.
  • Community First Choice Personal Assistance Services/Habilitation in the Community Living Assistance and Support Services program (Service Group 2, Service Code 10CFC T2026).

Home and Community-based Services and Texas Home Living Programs

  • The table clarifies the EVV Requirements for In-Home Day Habilitation in the HCS Program when In-Home Day Habilitation and In-Home Respite services are provided in a member’s own home or family home setting.
  • The “Claims Place of Service” column in the “CARE LTC FFS” tab only includes place of service code 12 (Home Location) because EVV is only required to capture services that need an in-home visit.

Email HHSC EVV for questions.

 

 

 

Clarification: No EVV For In-Home DH (3 & 4-bed Homes or Host Homes)
September 11, 2020

HHSC is issuing this guidance from CMS to Home and Community-based Services program providers. It clarifies electronic visit verification requirements for in-home day habilitation.

All service events occurring on or after Dec. 1, 2020, for an EVV-required service, must be captured in the EVV system and accepted into the EVV Aggregator.

EVV is not required for In-Home Day Habilitation provided to someone in a:

  • Three or four-person home
  • Host home
  • Companion care residential setting

EVV is only required for the following services:

  • Community First Choice Personal Assistance Services/Habilitation
  • In-Home Day Habilitation in own home or family home settings
  • In-Home Respite in own home or family home settings

See IL 20-07 Electronic Visit Verification in the HCS and TxHmL Program (PDF) for information about EVV requirements.

Additional Guidance on Day Habilitation Services

Program providers billing claims for In-Home Day Habilitation services requiring EVV will continue to use the current claims procedure code, T2020. The EVV Service Bill Codes Table lists this code on the HHS EVV website.

HHSC is developing separate bill codes for Out-of-Home Day Habilitation and will provide guidance before implementing the new codes.

Email hcspolicy@hhsc.state.tx.us with questions.

No EVV For In-Home DH: 3 & 4-bed Homes or Host Homes

August 20th, 2020

HHSC just informed the three IDD associations that it received clarification from CMS that EVV will not be required for in-home day habilitation delivered in a three- or four-bed home or host home. HHSC will send notice regarding this to all affected stakeholders.   This does however mean that In-Home DH provided in an individual’s “Own Family Home” will still require staff to utilize EVV.

CURES Act EVV Training is Underway for HCS/TxHmL Providers

Program providers and FMSAs affected by the Cures Act EVV expansion must complete EVV policy and EVV Portal training before Dec. 1, 2020, and then annually. See the EVV Required Training Checklist (PDF) for more information.

To meet the training requirement, program providers and FMSAs attending these webinars must:

  1. Register for Session 1.
  2. Register for Session 2.
  3. Attend both sessions from start to finish.

To register, click the links below:

FMSAs

HCS/TxHmL

Additional Training Opportunities

Program providers and FMSAs can also meet training requirements by completing computer-based training online in the HHSC Learning Portal and TMHP Learning Management System. HHSC and TMHP are planning additional live training events this fall and will provide more information when available.

Email TMHP for questions about registration or the EVV Portal.

Email questions about EVV training requirements.

 For more Cures Act information, visit the HHS EVV Cures Act webpage.

 

If you miss the EVV training dates, you may take them on the HHSC learning portal:

https://learningportal.dfps.state.tx.us/

 

Please go to HHSC’s page on Electronic Visit Verification for the latest information/ updates to EVV.  Please see Training & Joint Training pages from HHSC as well!

https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/electronic-visit-verification

Updated Timeline for Cures Act EVV Expansion     

The updated timeline for expanding the Cures Act EVV requirement to all Medicaid personal care services is now available on the HHS Cures Act EVV website.

The timeline includes new information and resources about the EVV Practice Period beginning July 1, completing training requirements, and more.

This information is for Cures Act program providers and FMSAs (PDF) required to use Electronic Visit Verification by Jan. 1, 2021.

For questions, contact EVV.

New EVV Proprietary System Onboarding Documents Available

TMHP has posted new information about the EVV proprietary system onboarding process on the TMHP EVV Proprietary Systems webpage.

The documents located in the Onboarding section provide an overview of the approval process that a program provider or FMSA must complete before using their own EVV proprietary system. For more information, refer to the article on the TMHP EVV website (PDF).

Resources

Trainings Available:

EVV Policy Training (Provided by your payer)

  • The HHSC EVV Policy computer-based training (CBT).
  • The MCO Policy training. Contact your MCO for EVV Policy training opportunities.

EVV Aggregator and EVV Portal Training (Provided by TMHP)

There will also be instructor-led trainings (EVV Roadshow) in October. Find the schedule and register on the HHS Learning Portal.

Additional training resources are available on the HHSC EVV website and the TMHP EVV Provider Training webpage.

For questions about this alert, email Electronic_Visit_Verification@hhsc.state.tx.us.

 

Online, interactive EVV training courses are available

in the HHS Learning Portal and TMHP Learning Management System. Completing these courses help program providers meet EVV training requirements.

The HHS Learning Portal includes training about HHSC EVV Policy.

The TMHP Learning Management System includes training about:

  • EVV Vendor Selection
  • EVV Portal
  • EVV Portal Standard Reports and Search Tools
  • EVV Claims Submission and Billing