Revision 22-4; Effective Sept. 1, 2022
Section 531.024172 of the Texas Government Code provides the authority for HHSC to recognize an EVV proprietary system as complying with EVV standards and policy requirements. Program providers or FMSAs approved by HHSC to operate an EVV proprietary system must comply fully with the EVV Policy Handbook.
An EVV proprietary system is an HHSC-approved EVV system that a program provider or FMSA may use instead of an EVV vendor system that:
- 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.
Program providers or FMSAs must submit an EVV Proprietary System Request Form directly to TMHP to enter the PSO Onboarding Process.
There are two onboarding paths a program provider or FMSA can choose:
- The Standard Path is for requesting approval to use an EVV system that has not been previously approved by HHSC.
- The Expedited Path is for requesting approval to use an existing operational EVV system that HHSC has previously approved. The list of approved EVV Proprietary Systems is on the TMHP EVV Proprietary Systems webpage.
View the PSO Onboarding Process guide on the TMHP EVV Proprietary Systems webpage for more information about each Path.
Program providers or FMSAs must meet applicable HHSC EVV Business Rules for Proprietary Systems posted on the TMHP Proprietary Systems webpage and follow all HHSC EVV standards and policy requirements. These include, but are not limited to:
- State and federal laws governing EVV
- HHSC EVV Policy Handbook
- HHSC EVV Business Rules for Proprietary Systems
- PSO Onboarding Process
After the program provider or FMSA has received HHSC approval to use an EVV proprietary system, they are known as a PSO. Refer to 2400 EVV Proprietary System Operator for more information.
The PSO must:
- Follow all requirements specified through HHSC or MCO program provider or FMSA contracts.
- The PSO will be subject to HHSC and MCO EVV Compliance Reviews and other compliance monitoring under the program provider or FMSA contract(s). Refer to 5080 Proprietary System Operator Compliance for more information.
- Inform HHSC if the EVV proprietary system is not compliant with EVV standards and requirements or when making significant changes to the EVV system.
- Notify the payers when transferring from an EVV proprietary system and when status changes occur.
The PSO may be subject to periodic verification, system testing and auditing as specified by HHSC.
PSOs, EVV proprietary system vendors and outside entities may only use the HHS logo on materials and websites if approved by the HHSC Office of Communications.
5010 Reimbursement for Use of an EVV Proprietary System
Revision 22-4; Effective Sept. 1, 2022
HHSC does not directly reimburse program providers and FMSAs for the use of an EVV proprietary system. However, program providers and FMSAs can report costs related to their EVV proprietary system through established Medicaid cost reporting processes.
HHSC evaluates this data when setting future Medicaid rates. Not all Medicaid programs utilize cost reports.
Contact the HHSC Provider Finance Department at ProviderFinanceDept@hhs.texas.gov or contact your MCO for more information about Medicaid cost reporting.
5020 EVV Proprietary System Operator Responsibilities
Revision 22-4; Effective Sept. 1, 2022
The PSO is required to meet Texas Government Code Section 531.024172 and HHSC EVV Business Rules for Proprietary Systems governing the use of EVV proprietary systems.
A PSO:
- Must comply with the Health Insurance Portability and Accountability Act (HIPAA) and the American Disabilities Act (ADA).
- Agrees to forego use of a cost free EVV system provided by the state.
- Assumes responsibility for the design, development, operation and performance of the EVV proprietary system.
- Assumes responsibility for all costs to develop, implement, operate and maintain the EVV proprietary system.
- Is responsible for the accuracy of EVV data collected, stored and reported by the EVV proprietary system.
- Submits EVV visit transactions to the EVV Aggregator.
- Is responsible for ensuring EVV visit transactions from the EVV proprietary system are accepted by the EVV Aggregator.
- Assumes liability and risk for the use of the EVV proprietary system.
- Must maintain all system data, backup data and historical data to comply with and support all legal, regulatory and general business purposes.
- Must train EVV proprietary system users, including state and MCO staff.
- Must provide system access to state staff, TMHP staff, MCO staff (if applicable) and other state and federal entities as required.
- Must provide HHSC-approved clock in and clock out methods associated with the EVV proprietary system at no cost to the program provider, FMSA, CDS employer, service provider, member, HHSC, MCO or TMHP.
- Assumes responsibility for the functionality and accuracy of all clock in and clock out methods distributed to service providers and CDS employees.
- Must ensure use of the EVV proprietary system will not conflict with:
- EVV Member Responsibilities and Additional Information
- EVV policies or requirements
- HHSC EVV Business Rules for Proprietary Systems
- Texas Government Code Section 531.024172
5030 EVV Proprietary System Onboarding Process
Revision 22-4; Effective Sept. 1, 2022
To begin the proprietary system onboarding process, a program provider or FMSA must follow the PSO Onboarding Process posted on the TMHP Proprietary Systems webpage and submit an EVV Proprietary System Request Form directly to TMHP. The EVV Proprietary System Request From must be signed by a signature authority for the program provider or FMSA.
After submission of the EVV Proprietary System Request Form, HHSC, TMHP and the program provider or FMSA will meet to review the detailed requirements for the PSO Onboarding Process and the major milestones associated with the assigned ORR session.
The program provider or FMSA must notify HHSC if the agreed project timeline associated with the ORR session has any conflicts. If HHSC, TMHP and the program provider or FMSA determine the timeline is at risk, HHSC may require the program provider or FMSA to use an EVV vendor system until HHSC approves the EVV proprietary system for use.
Program providers or FMSAs may use their EVV proprietary system for one or more NPI/API or TIN combinations when onboarding if the program provider or FMSA intends to use the same EVV proprietary system for each NPI/API or TIN combination.
Key Personnel
The program provider or FMSA must identify the following key personnel for proprietary system administration:
- Onboarding Project Manager
- Manages the PSO Onboarding Process for the program provider or FMSA.
- Acts as the program provider or FMSA’s primary point of contact during the PSO Onboarding Process.
- Provides progress updates and escalates issues that may arise to TMHP and HHSC during the PSO Onboarding Process.
- May be a program provider or FMSA representative or a proprietary system software vendor representative.
- EVV System Administrator (Refer to 1600 Key Terms for more information)
- Manages EVV system access.
- Acts as the PSO’s primary point of contact after the Go-Live date.
- Is listed on the EVV Proprietary System Access and Training Guide on the HHSC EVV Proprietary Systems webpage.
- May be a program provider or FMSA representative or a proprietary system software vendor representative.
- EVV Training Contact
- Is responsible for providing EVV system training.
- Is listed on the EVV Proprietary System Access and Training Guide on the HHSC EVV Proprietary Systems webpage.
- May be a program provider or FMSA representative or a proprietary system software vendor representative.
- Signature Authority (Refer to 1600 Key Terms for more information)
- Must have legal authority to sign contracts and make transactional decisions for the program provider or FMSA.
- Is responsible for:
- Signing the EVV Proprietary System Request Form.
- Certifying compliance with the HHSC EVV Business Rules for Proprietary Systems and HHSC EVV policies.
- Selecting a Go-Live date for the proprietary system after HHSC approves the system.
- Receiving and responding to HHSC correspondence regarding non-compliance.
Key personnel may be filled by the same person or different people.
Program providers and FMSAs must maintain current key personnel contact information and provide new or updated contact information to HHSC within five business days of any change.
5040 EVV Proprietary System Operational Readiness Review
Revision 22-4; Effective Sept. 1, 2022
HHSC and TMHP conduct a validation process referred to as ORR to determine if a program provider or FMSA is approved to operate an EVV proprietary system.
HHSC reviews requests to enter an ORR session from program providers or FMSAs on a first-come, first-served basis. This is determined by the date of receipt of the EVV Proprietary System Request Form. Program providers or FMSAs that submitted the EVV Proprietary System Request Form and who have not completed the ORR are placed on a waiting list and will receive first choice of these sessions.
HHSC determines the number of program providers or FMSAs taking part in each ORR session.
Program providers or FMSAs must ensure they have a fully developed and compliant EVV system which meets all HHSC requirements by the ORR begin date for their chosen session.
Program providers or FMSAs participating in a Standard Path ORR must demonstrate compliance through four methods:
- Certification – Program providers or FMSAs must certify compliance with Texas Government Code Section 531.024172, HHSC EVV Business Rules for Proprietary Systems and HHSC EVV Policy Handbook.
- Documentation – Program providers or FMSAs must provide specified documentation for HHSC review.
- Demonstration – Program providers or FMSAs must show system functionality using specific HHSC-approved scenarios.
- Trading Partner Testing – Program providers or FMSAs must complete Trading Partner Testing with TMHP according to specific HHSC-approved scenarios.
Program providers or FMSAs participating in an Expedited Path ORR must demonstrate compliance through two methods:
- Certification – Program providers or FMSAs must certify compliance with Texas Government Code Section 531.024172, HHSC EVV Business Rules for Proprietary Systems and HHSC EVV Policy Handbook.
- Trading Partner Testing – Program providers or FMSAs must complete Trading Partner Testing with TMHP according to specific HHSC-approved scenarios.
Program providers or FMSAs must receive a score of 100% for each method to receive HHSC approval.
A program provider or FMSA that does not pass the ORR must continue to use their current EVV system or select an EVV vendor system to comply with HHSC EVV standards and policy requirements.
Refer to 4130 Select an EVV System for more information.
5050 Success or Failure of the Operational Readiness Review
Revision 22-4; Effective Sept. 1, 2022
HHSC determines the success or failure of the EVV proprietary system based on the outcome of the ORR.
If the program provider or FMSA achieve a 100% score for the ORR, TMHP on behalf of HHSC will send an email to the program provider or FMSA:
- Requesting a preferred Go-Live date.
- Asking if they want to be added to the public-facing list of EVV Proprietary Systems approved by HHSC.
The email is followed by a formal letter with HHSC’s approval.
If the program provider or FMSA fails ORR:
- TMHP on behalf of HHSC will send an email notifying the program provider or FMSA of the failure.
- HHSC will send a formal letter listing the failed scenarios, test cases and a list of the HHSC EVV Business Rules for Proprietary Systems that were not validated.
- The program provider or FMSA must either continue with their current EVV system, if applicable, or select and onboard with an EVV vendor system to comply with HHSC EVV standards and policy requirements.
Refer to 4000 EVV System and Setup, 4110 EVV Vendor Systems, 4130 Select an EVV System and 4700 EVV System Transfer for more information.
5060 EVV Proprietary System General Operations
Revision 22-4; Effective Sept. 1, 2022
EVV Proprietary System Training
The PSO is responsible for training all EVV proprietary system users on the proper use of the EVV system including clock in and clock out methods.
Clock In and Clock Out Methods
The PSO must:
- Select one or more clock in and clock out methods from the three HHSC-approved methods described in Section 7000 Clock In and Clock Out Methods.
- Allow manual entry of EVV visit data.
- Successfully demonstrate each selected clock in and clock out method and get written approval from HHSC during the ORR.
- Follow the HHSC EVV Policy Handbook and follow specific HHSC EVV Business Rules for Proprietary Systems related to the selected clock in and clock out method(s).
- HHSC may waive any rules and reports specific to a clock in and clock out method not selected.
The PSO is responsible for the functionality and accuracy of all clock in and clock out methods distributed to service providers and CDS employees.
Any alternative device approved by HHSC must derive the exact clock in and clock out date and time. An alternative device must only be used in the member’s home unless the alternative device has a geo-location capability.
All EVV visits, including those created using the alternative device are subject to the requirements of 8050 Visit Maintenance Time Frames. For example, if the alternative device generates codes, the EVV proprietary system must not allow codes to be entered to create a visit after the visit maintenance time frame.
Refer to 7000 Clock In and Clock Out Methods and 8000 Visit Maintenance for more information.
EVV Proprietary System Maintenance
The PSO:
- Is fully responsible for ongoing maintenance of the EVV proprietary system and must not make changes that conflict with any EVV standards and policy requirements.
- Must inform HHSC within two business days of discovery if the EVV proprietary system is not compliant with any EVV standards and policy requirements.
- Must notify HHSC of any planned system changes that alter an HHSC-approved component of the EVV proprietary system.
- Based on the nature of the change, approval from HHSC may be required before the PSO implements the change.
HHSC may modify EVV standards and policy requirements, including the HHSC EVV Business Rules for Proprietary Systems. HHSC will notify the PSO of any modifications to policy or the HHSC EVV Business Rules for Proprietary Systems. The PSO is responsible for:
- Making updates to the EVV proprietary system to comply with the latest versions of the policies or HHSC EVV Business Rules for Proprietary Systems within the HHSC-approved time frame.
- Certifying compliance with the latest versions of the policies or HHSC EVV Business Rules for Proprietary Systems.
HHSC will provide PSOs a specified time frame to make updates to their EVV proprietary system resulting from modifications to policies, requirements and HHSC EVV Business Rules for Proprietary Systems. Typically, HHSC will provide a minimum of 90 days for PSOs to complete the updates but may provide a different time frame depending on the nature of the change. PSOs may be required to make changes in less than 90 days if HHSC determines that the change is required to address an immediate need.
HHSC will specify ORR steps the PSO must complete before implementation.
TMHP will assist the PSO with resolving production problems in the EVV proprietary system for data exchange with the EVV Aggregator as needed.
5070 Access to the EVV Proprietary System
Revision 22-4; Effective Sept. 1, 2022
All PSOs must:
- Provide immediate, direct, on-site access to state staff and MCOs with which it has a contractual relationship at no cost to the state or MCO.
- Limit MCO access to the MCO’s respective member visit data only, and only for dates of service within the time frame covered by the PSO contract with the MCO.
- This access must be allowed indefinitely after the PSO’s contract with the MCO ends, in accordance with applicable law.
- Provide HHSC, MCOs and proprietary system users access to standard and ad hoc reports and any data necessary to verify EVV usage in accordance with EVV Business Rules for Proprietary Systems.
- Ensure access by the program provider, FMSA, PSO, HHSC and MCOs, if applicable, to historical data which may live in the old EVV system.
Additionally, PSOs that are FMSAs must:
- Provide access for CDS employers who select Option 1 or Option 2 on Form 1722, Employer’s Selection for Electronic Visit Verification Responsibilities, to the EVV proprietary system.
- Provide EVV proprietary system read-only access to CDS employers who select Option 3 on Form 1722, Employer’s Selection for Electronic Visit Verification Responsibilities, if requested.
5080 Proprietary System Operator Compliance
Revision 22-4; Effective Sept. 1, 2022
EVV Compliance Reviews
PSOs are subject to EVV Compliance Reviews.
Payers use EVV data in the EVV Aggregator as the system of record for compliance reviews, specifically the:
- EVV Usage Report
- EVV Reason Code Usage and Free Text Report located in the EVV Portal and EVV system
- EVV Landline Phone Verification Report
Payers may perform other compliance reviews based on data in the EVV proprietary system.
Refer to 10000 EVV Compliance Reviews for more information.
Compliance with HHSC EVV Business Rules for Proprietary Systems and HHSC EVV Policy
If HHSC determines that a PSO is not in compliance with the HHSC EVV Business Rules for Proprietary Systems or HHSC EVV policy, HHSC may:
- Require the PSO to correct the non-compliance within a time frame specified by HHSC.
- Require the EVV Aggregator to reject EVV visit transactions from the proprietary system until HHSC determines the non-compliance is corrected.
- Cancel the use of the EVV proprietary system if the PSO fails to correct the non-compliance within the specified time frame set by HHSC.
- Cancel the use of an EVV proprietary system without giving the PSO the opportunity to correct the non-compliance if the non-compliance is:
- Egregious, as determined by HHSC.
- Due to a substantiated allegation of fraud, waste, or abuse by the Office of Inspector General.
If a PSO does not respond to HHSC within the time frame specified in a notice of non-compliance, HHSC may:
- Require the EVV Aggregator reject all EVV visit transactions submitted from the EVV proprietary system until the PSO responds or corrects the non-compliance.
- Cancel the use of the EVV proprietary system without giving the PSO the opportunity to correct the non-compliance.
If HHSC cancels the use of a proprietary system, the PSO will be removed from the List of EVV Proprietary Systems Approved by HHSC.
Fraud, Waste and Abuse
Non-compliance with EVV standards and policy requirements may result in:
- Fraud, waste and abuse investigations.
- The recoupment of funds for any EVV claim paid or any overpayment based on inaccurate data.
HHSC may require the EVV Aggregator reject all EVV visit transactions submitted from an EVV proprietary system effective immediately if HHSC confirms an allegation of fraud, waste or abuse related to the functionality of the EVV proprietary system.