Revision 21-1; Effective Nov. 1, 2021
The Electronic Visit Verification (EVV) Policy Handbook provides EVV standards and policy requirements that program providers and Financial Management Services Agencies (FMSAs) contracted with Texas Health and Human Services Commission (HHSC) and managed care organizations (MCOs) must follow. The EVV Policy Handbook also includes requirements for Consumer Directed Services (CDS) employers.
EVV standards and policy requirements do not replace or supersede program or licensure requirements. Program providers and FMSAs must follow all program and licensure rules and policies in addition to EVV policies.
The EVV Policy Handbook has EVV requirements for both HHSC and MCOs (the payers). Program providers and FMSAs must adhere to their individual contracts with HHSC or an MCO and contact the payer for questions on EVV and non-EVV requirements.
The requirements in this handbook apply to the programs and services identified in the HHSC Texas Administrative Code (TAC) Title 1, Part 15, Chapter 354, Subchapter O, RULE Section 354.4005, Applicability Code, Section Applicability.
1100 EVV Overview
Revision 21-1; Effective Nov. 1, 2021
A program provider, FMSA or CDS employer must use an EVV vendor system or an HHSC-approved EVV proprietary system to electronically document the delivery of an EVV service.
EVV is a computer-based system that electronically documents and verifies service delivery information, such as date, time, service type and location for certain Medicaid service visits.
An EVV system must capture the following data elements:
- The type of service provided
- The name of the recipient to whom the service is provided
- The date and times the provider began and ended the service delivery visit
- The location, including the address and geolocation, at which the service was provided
- The name of the service provider who provided the service
- Other information the commission determines is necessary to ensure the accurate adjudication of Medicaid claims
To ensure that EVV is used for all required services, HHSC or an MCO will not pay an EVV claim without a matching EVV visit transaction.
Texas HHSC determines when a program provider, FMSA or CDS employer must use EVV based on the services delivered. EVV is required for all programs and services listed in the Programs and Services Required to Use EVV document.
1200 State Laws and Texas Administrative Code
Revision 22-4; Effective Sept. 1, 2022
Texas law requires HHSC to implement an EVV program.
Program providers or FMSAs contracted with HHSC or an MCO must follow state law, TAC and associated policies established by HHSC when delivering Medicaid services.
Texas EVV statute and TAC include:
- Texas Government Code Section 531.024172
- Texas Administrative Code, Title, 1 Part 15, Chapter 354, Subchapter O
Live-in caregivers are not exempt from EVV requirements in Texas.
1300 Federal Law
Revision 21-1; Effective Nov. 1, 2021
The 21st Century Cures Act (the Cures Act), enacted by the U.S. Congress in Dec. 2016, added Section 1903(l) to the Social Security Act to require all states to use EVV.
The Cures Act requires the use of EVV for personal care services (PCS) provided under a State plan of the Social Security Act or under a waiver of the plan including sections 1905(a)(24), 1915(c), 1915(i), 1915(j), 1915(k) and Section 1115; and home health care services (HHCS) provided under 1905(a)(7) provided under a State plan of the Social Security Act or a waiver of the plan. This includes services delivered under the CDS option.
States must implement EVV by the following deadlines or risk a loss of federal Medicaid matching dollars:
- PCS by Jan. 1, 2020.
- Texas received approval for a one-year delay of the deadline to Jan. 1, 2021.
- HHCS by Jan. 1, 2023.
- Texas may apply for a one-year delay of the deadline to Jan. 1, 2024
Failure to implement EVV in accordance with the Cures Act will result in a reduction of federal Medicaid funding for Texas.
1400 Failure to use an EVV System
Revision 21-1; Effective Nov. 1, 2021
Program providers, FMSAs and CDS employers must ensure an approved EVV system is used to document the delivery of EVV-required services.
Failure to use an approved EVV system to document service delivery for required programs and services will result in denied or recouped EVV claims. Per the TAC Title, 1 Part 15, Chapter 354, Subchapter O, Rule Section 354.4009 HHSC and MCOs will not pay a claim for reimbursement unless the data from the EVV system corresponds with the claim line item and is consistent with an approved prior authorization.
Program providers and FMSAs who fail to use an EVV system may also be subject to contract actions, such as, but not limited to, corrective action(s) or contract termination. CDS employers who fail to use an EVV system may be subject to removal from the CDS option.
If the service provider or CDS employee fails to clock in and clock out of the EVV system, the program provider, FMSA or CDS employer must manually enter the visit into the EVV system. Manually entered visits will negatively impact EVV compliance.
In the event the EVV system is unavailable, the service provider or CDS employee must document service delivery information and submit the documentation to the program provider, FMSA or CDS employer for manual entry of an EVV visit.
Service delivery documentation should include:
- Program Provider, FMSA and CDS employer Name;
- Member First and Last Name
- Member Medicaid ID
- Services Delivered
- Date of the Visit
- Actual Time In and Actual Time Out
- Service provider First and Last Name
- Location of the Visit - in the home or in the community
Program providers, FMSAs and CDS employers must keep all service delivery documentation and manually enter EVV visits into the EVV system according to the service delivery documentation once the EVV system is operational or as otherwise instructed by HHSC.
1500 Resources and Communications
Revision 21-1; Effective Nov. 1, 2021
All program providers, FMSAs and CDS employers must sign up for GovDelivery to receive the most current news and alerts related to EVV.
Program providers, FMSAs and CDS employers can visit the HHSC EVV webpage to access the most up to date information such as:
- EVV News and Alerts
- Programs and services which require the use of EVV
- Statutes and rules governing EVV
- Service bill codes for EVV
- EVV contact information guide
- EVV training requirements and resources
1600 Key Terms
Revision 22-4; Effective Sept. 1, 2022
Key Terms are words regularly used throughout the EVV Policy Handbook. If a term is already defined in the handbook, the reference is provided below.
Auto-Verification (auto-verify) – An automatic process the EVV system performs to confirm an EVV visit transaction matches existing critical data elements and schedule data, if applicable, in the EVV system with no exceptions.
Business Day – Monday through Friday, except national or state holidays.
Consumer Directed Service (CDS) employer – Refer to 2800 CDS Employer and 16010 CDS Option Stakeholders.
Consumer Directed Services (CDS) option – A service delivery option in which a CDS employer employs and retains a service provider and directs the delivery of services.
Electronic Visit Verification (EVV) – Refer to 1100 EVV Overview.
EVV Aggregator – Refer to 6200 EVV Aggregator.
EVV Compliance Reviews – Refer to 10000 EVV Compliance Reviews.
EVV Claim – Documentation submitted to HHSC or an MCO for reimbursement of services required to use EVV.
EVV Portal – An online system established by HHSC that allows users to perform searches and view reports associated with visit data and EVV claim match results in the EVV Aggregator.
EVV proprietary system – Refer to 5000 EVV Proprietary System.
EVV system – An EVV vendor system or an EVV proprietary system used to electronically document and verify critical data elements related to the delivery of EVV services.
EVV System Administrator – A person appointed by a program provider or an FMSA to serve as the primary contact for administering access to an EVV system. Refer to 4130 Select an EVV System for more information.
EVV vendor system – Refer to 4110 EVV Vendor System.
EVV visit maintenance – Refer to 8000 Visit Maintenance.
EVV visit transaction – Refer to 6000 EVV Visit Transaction.
Exception – Refer to 8010 Required Visit Maintenance.
Financial management services agency (FMSA) – Refer to 2600 Financial Management Services Agency and 16010 CDS Option Stakeholders.
Member – Refer to 2700 Member and 16010 CDS Option Stakeholders.
Payer – Refer to 2100 Payers.
Program provider – Refer to 2500 Program Provider.
Reason Code Description and Reason Code Number – Refer to 9000 EVV Reason Code.
Service Delivery Documentation – Information written on paper or another format by the service provider when the EVV system is unavailable to document the delivery of service. Refer to 1400 Failure to use an EVV System for more information.
Service provider (or CDS employee) – A person who provides an EVV service to a member and is employed by or contracted with either a program provider or CDS employer. Note: Service providers who are contracted directly with HHSC or an MCO as a program provider must meet applicable EVV requirements for service providers and program providers.
Service Responsibility Option (SRO) – A service delivery option where a member or LAR selects, trains, and provides daily management of a service provider, while the fiscal, personnel and service back-up plan responsibilities remain with the program provider.
Signature Authority – A person who has legal authority to sign contracts and make transactional decisions.