2000, EVV Stakeholders

Revision 24-1; Effective Sept. 12, 2024

The following EVV stakeholders must meet all state and federal EVV requirements:

• Payers (HHSC and MCOs)
• Texas Medicaid and Healthcare Partnership (TMHP)
• State provided EVV system vendor
• Program providers delivering services under the agency option
• FMSAs
• Medicaid members and SRO participants
• CDS employers

2100 Payers

Revision 24-1; Effective Sept. 12, 2024

Payers pay Medicaid claims, administer the EVV program and enforce EVV requirements. In Texas, the payers are HHSC and the MCOs.

Payer responsibilities include:

• Following state and federal requirements when processing claims for EVV-required services
• Developing EVV policies, processes, and procedures
• Providing EVV policy training to program providers, FMSAs and CDS employers
• Conducting EVV compliance reviews of program providers, FMSAs and CDS employers

HHSC requires EVV for Medicaid personal care services authorized by the following HHSC programs:

• Long-term Care (LTC) Fee-for-Service (FFS)
• Acute Care FFS
• Managed Care

HHSC is the payer for LTC and acute care services administered by the state, known as FFS. TMHP makes acute care payments on behalf of HHSC.

LTC FFS

Acute Care FFS

MCOs are the payers for managed care services.

Managed Care

More information about managed care is on the HHSC managed care website.

2200 Texas Medicaid and Health Care Partnership

Revision 24-1; Effective Sept. 12, 2024

Texas Medicaid and Healthcare Partnership (TMHP) is the state’s claims administrator and is responsible for the Medicaid Management Information System (MMIS) where the EVV Aggregator resides. TMHP is also responsible for the EVV Portal, the state provided EVV system vendor, the EVV proprietary system vendors and coordinates all data exchange for EVV systems.

TMHP responsibilities include the following:

• Processing claims for EVV services, including forwarding claims to MCOs
• Paying claims for Acute Care FFS on behalf of HHSC
• Managing the EVV Aggregator and EVV Portal
• Managing the state provided EVV system vendor on behalf of HHSC
• Training on the EVV Portal

The TMHP EVV webpage has more information.

2300 State Provided EVV System Vendor

Revision 24-1; Effective Sept. 12, 2024

The state provided EVV system vendor contracts with the state’s claims administrator to provide a cost free EVV system for program providers and FMSAs.

The state provided EVV system vendor’s responsibilities include:

• Adhering to all HHSC state provided EVV system vendor business rules for system operation and functionality
• Following all EVV requirements described in:
  • The EVV Policy Handbook
  • 1 TAC, Part 15, Chapter 354, Subchapter O, Electronic Visit Verification
  • Chapter 531, Texas Government Code, Section 531.024172, Electronic Visit Verification System, or its successors
• Supporting multiple clock in and clock out methods
• Providing EVV ongoing and annual system training
• Providing technical support

Refer to 4100 EVV System Selection for more information.

2400 EVV Proprietary System Operator

Revision 24-1; Effective Sept. 12, 2024

An EVV Proprietary System Operator (PSO) is a program provider or FMSA that has been approved to use an HHSC-approved EVV proprietary system.

EVV PSO responsibilities include:

• Adhering to all HHSC EVV Business Rules for Proprietary Systems
• Following all EVV requirements described in:
  • The EVV Policy Handbook
  • 1 TAC, Part 15, Chapter 354, Subchapter O, Electronic Visit Verification
  • Texas Government Code Section 531.024172, Electronic Visit Verification System, or its successors
• Supporting multiple clock in and clock out methods
• Providing EVV system training and technical support

Refer to 5000 EVV Proprietary System for more information.

2500 Program Provider

Revision 24-1; Effective Sept. 12, 2024

A program provider is an entity that contracts with HHSC or an MCO to provide an EVV service.

Program provider responsibilities include:

• Following all EVV requirements described in:
  • The EVV Policy Handbook
  • 1 TAC, Part 15, Chapter 354, Subchapter O, Electronic Visit Verification
  • Chapter 531, Texas Government Code, Section 531.024172, Electronic Visit Verification System, or its successors
• Adhering to policies and requirements of their Medicaid program
• Meeting other applicable HHSC and MCO requirements
• Completing all required EVV training
• Using the EVV system
• Training service providers on the use of EVV
• Making sure service providers use the EVV system to clock in at the beginning of service delivery and clock out at the end of service delivery
• Managing program provider, service provider and member data within the EVV system

2600 Financial Management Services Agency

Revision 24-1; Effective Sept. 12, 2024

A financial management services agency (FMSA) is an entity that contracts with HHSC or an MCO to provide financial management services to a CDS employer.

FMSA responsibilities include:

• Following all EVV requirements described in:
  • The EVV Policy Handbook
  • 1 TAC, Part 15, Chapter 354, Subchapter O, Electronic Visit Verification
  • Chapter 531, Texas Government Code, Section 531.024172, Electronic Visit Verification System, or its successors
• Adhering to policies and requirements of their Medicaid program
• Meeting other applicable HHSC and MCO requirements
• Selecting an EVV system
• Assisting the CDS employer with completing and updating Form 1722, Employer’s Selection for EVV Responsibilities, and entering selections into the EVV system
• Completing all required EVV training
• Using the EVV system
• Managing FMSA, CDS employers, member, and service provider data within the EVV system

Refer to 17010 CDS Option Stakeholders for more information.

2700 Member

Revision 24-1; Effective Sept. 12, 2024

A member is a person eligible to receive Medicaid services that require the use of EVV.

Member responsibilities include:

• Reviewing and signing applicable program specific documentation describing a member’s rights and responsibilities
• Telling the program provider if a service provider asks the member to clock in or clock out of the EVV system

2800 CDS Employer

Revision 24-1; Effective Sept. 12, 2024

CDS employer responsibilities include:

• Completing all required EVV training
• Training their CDS employees on the use of the EVV system
• Making sure CDS employees use the EVV system to clock in when services begin and clock out when services end
• Approving time worked
• Signing up for GovDelivery to receive the most current news and alerts related to EVV

Refer to 17000 CDS Employer Policies for more information.