Revision 25-1; Effective March 12, 2025

Texas Government Code Chapter 532, Subchapter F authorizes HHSC to recognize an EVV proprietary system that complies with EVV standards and policy requirements. HHSC has contracted with TMHP to oversee the proprietary systems, including the approval and onboarding of new EVV proprietary system vendors and approving program providers or FMSAs as PSOs. Program providers or FMSAs approved by TMHP to operate an EVV proprietary system must comply fully with the EVV Policy Handbook, stand-alone EVV policies HHSC published on the EVV webpage and other EVV policies applicable to program providers and FMSAs.

An EVV proprietary system is an EVV system that TMHP has approved for a program provider or FMSA to use instead of the state provided EVV system. A program provider or FMSA purchases or develops an EVV proprietary system to exchange EVV data with the EVV Aggregator. The EVV proprietary system must comply with:

TMHP may not allow the use of an EVV proprietary system if the EVV proprietary system vendor is out of compliance with any EVV requirements.

Program providers or FMSAs must submit an electronic EVV Proprietary System Request Form to enter the PSO onboarding process.

A program provider or FMSA can choose from two onboarding paths:

  • the Standard Path to request approval to:
    • use an EVV proprietary system that has not been approved by HHSC, or
    • implement functionality TMHP did not review in a previously approved EVV proprietary system.
  • the Expedited Path to request approval to use an existing operational EVV proprietary system TMHP has fully approved.

Information about each onboarding path and the responsibilities, requirements and time lines for each Path are on the TMHP EVV Proprietary Systems webpage.

Program providers or FMSAs must meet applicable HHSC EVV Business Rules for Proprietary Systems posted on the TMHP Proprietary Systems webpage. They also must follow all HHSC EVV standards and policy requirements. These include:

  • State and federal laws that govern EVV
  • HHSC EVV Policy Handbook
  • HHSC EVV Business Rules for Proprietary Systems
  • EVV PSO onboarding process

A program provider or FMSA that receives TMHP approval to use an EVV proprietary system is known as a Proprietary System Operator (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 and TMHP if the EVV proprietary system is not compliant with EVV standards and requirements or when making significant changes to the EVV system.
  • Tell the payers when transferring from an EVV proprietary system and when status changes occur.

The PSO and EVV proprietary system may be subject to periodic verification, system testing and auditing as specified by TMHP.

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 24-1; Effective Sept. 12, 2024

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 use cost reports.

Contact the HHSC Provider Finance Department at ProviderFinanceDept@hhs.texas.gov or your MCO for more information about Medicaid cost reporting.

5020 EVV Proprietary System Operator Responsibilities

Revision 25-1; Effective March 12, 2025

The PSO and the EVV proprietary system vendor must meet the requirements in Texas Government Code Chapter 532, Subchapter F, the TAC, EVV policies and HHSC EVV Business Rules for Proprietary Systems governing the use of EVV proprietary systems.

The PSO and EVV proprietary system vendor must:

  • comply with the Health Insurance Portability and Accountability Act (HIPAA) and the American Disabilities Act (ADA).
  • assume responsibility for the design, development, operation and performance of the EVV proprietary system.
  • assume responsibility for all costs to develop, implement, operate and maintain the EVV proprietary system.
  • ensure the accuracy of EVV data collected, stored and reported by the EVV proprietary system.
  • submit EVV visit transactions to the EVV Aggregator.
  • make sure EVV visit transactions from the EVV proprietary system are accepted by the EVV Aggregator.
  • maintain all system data, backup data and historical data to comply with and support all legal, regulatory and general business purposes.
  • provide system access to state staff, TMHP staff, MCO staff if applicable and other state and federal entities as required.
  • provide HHSC-approved clock in and clock out methods associated with the EVV proprietary system, one of which must be the mobile method.
  • make sure use of the EVV proprietary system will not conflict with:

The PSO also must:

  • agree to forego use of a cost free EVV system provided by the state.
  • assume liability and risk for the use of the EVV proprietary system.
  • train EVV proprietary system users, including state and MCO staff.
  • prepare a training plan for initial and yearly training and provide an annual attestation of the training plan.
  • not charge the CDS employer, service provider, member, HHSC, MCO or TMHP for any clock in and clock out method.
  • assume responsibility for the functionality and accuracy of all clock in and clock out methods distributed to service providers and CDS employees.

5030 EVV Proprietary System Onboarding Process

Revision 25-1; Effective March 12, 2025

To begin the proprietary system onboarding process, a program provider or FMSA must follow the EVV PSO Onboarding Process posted on the TMHP Proprietary Systems webpage and submit an electronic EVV Proprietary System Request Form. A signature authority for the program provider or FMSA must sign the EVV Proprietary System Request Form.

After the EVV Proprietary System Request Form is submitted, 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 tell TMHP if the project timeline associated with the ORR session poses any risks to the program provider or FMSA. TMHP may require the program provider or FMSA to withdraw from the offered ORR session and continue to use their current EVV system until they have successfully transferred to the new EVV system in a future ORR session.

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 includes all the NPI/API or TIN combinations on the submitted EVV Proprietary System Request Form.

Key Personnel

The program provider or FMSA must identify the following key personnel for the EVV 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
    • Manages EVV system access.
    • Acts as the PSO’s primary point of contact after the Go-Live date.
      • If the EVV System Administrator is not an employee of the PSO, they are responsible for making sure the EVV proprietary system vendor notifies them of all communications.
    • Is listed on the EVV Proprietary System Access and Training Guide.
    • 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.
    • May be a program provider or FMSA representative, or an EVV proprietary system software vendor representative.
  • Signature Authority
    • 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.
      • Approving a Go-Live date for the proprietary system after TMHP approve the system.
      • Receiving and responding to correspondence about noncompliance.

Key personnel may be filled by the same person or different people.

Program providers, FMSAs and PSOs 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 25-1; Effective March 12, 2025

TMHP conducts a validation process referred to as Operational Readiness Review (ORR) to determine if a program provider or FMSA is approved to operate an EVV proprietary system.

TMHP reviews requests to enter an ORR session from program providers or FMSAs on a first-come, first-served basis. This is based on the date of receipt of the EVV Proprietary System Request Form. Program providers or FMSAs that submitted the EVV Proprietary System Request Form and have not completed the ORR are placed on a waiting list and will receive first choice of these sessions.

TMHP decides the number of program providers or FMSAs that will take part in each ORR session.

Program providers or FMSAs must make sure they have a fully developed and compliant EVV system which meets all HHSC requirements by the ORR begin date for their chosen session.

The Standard Path ORR includes the following steps:

  • Certification – Program providers or FMSAs must certify compliance with:
  • Documentation – Program providers or FMSAs must provide specified documents for TMHP review.
  • Demonstration – Program providers or FMSAs must show system functionality in specific TMHP scenarios.
  • Trading Partner Testing (TPT) – Program providers or FMSAs must complete TPT with TMHP per TMHP scenarios.

The Expedited Path ORR includes the following steps:

Program providers or FMSAs must receive a score of 100% for each required method to receive approval to use the proprietary system.

A program provider or FMSA that does not pass the ORR must continue to use their current EVV system or select the state provided EVV system to comply with 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 25-1; Effective March 12, 2025

TMHP determines the success or failure of the EVV proprietary system based on the outcome of the ORR.

If the program provider or FMSA achieves a 100% score for the ORR, TMHP will send an email to the program provider or FMSA to notify them of the approval. TMHP also will request a Go-Live date with the EVV proprietary system vendor.

The email is followed by a formal approval letter from TMHP.

If the program provider or FMSA fails the ORR:

  • TMHP will send an email to tell the program provider or FMSA of the failure.
  • TMHP 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 continue with their current EVV system, if applicable, or select and onboard with the state provided EVV system to comply with HHSC EVV standards and policy requirements.

Refer to 4000 EVV System and Setup, 4110 State Provided EVV Systems, 4130 Select an EVV System and 4700 EVV System Transfer for more information.

5060 EVV Proprietary System General Operations

Revision 25-1; Effective March 12, 2025

EVV Proprietary System Training

The PSO is responsible for training all EVV proprietary system users on the proper use of the EVV proprietary system including clock in and clock out methods. The PSO must make sure EVV proprietary system users complete EVV proprietary system training before using the EVV proprietary system.

Clock In and Clock Out Methods

The PSO and EVV proprietary system vendor 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.
  • Follow the HHSC EVV Policy Handbook, stand-alone EVV policies HHSC published on the HHSC EVV webpage and specific HHSC EVV Business Rules for Proprietary Systems related to the selected clock in and clock out method(s).
    • HHSC and TMHP may waive any rules and reports specific to a clock in and clock out method not selected.

The PSO must offer 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. One of the clock in and clock out methods offered must be the mobile method. 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 geolocation capability.

All EVV visits are subject to the requirements of 9050 Visit Maintenance Time Frame. For example, if the alternative device generates codes the EVV proprietary system must not allow codes to be used to create a visit transaction after the 95-day visit maintenance time frame.

Refer to 7000 Clock In and Clock Out Methods and 9000 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 and TMHP within two business days of discovery if the EVV proprietary system is not compliant with any EVV standards and policy requirements.
  • Must tell TMHP of any planned system changes that alter an approved component of the EVV proprietary system.
    • Based on the nature of the change, approval from TMHP 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 tell the PSO of any modifications to policy or the HHSC EVV Business Rules for Proprietary Systems. The PSO is responsible for:

  • Making sure the EVV proprietary system complies 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 specify a time frame to make updates to EVV proprietary systems that result from modifications to policies, requirements and HHSC EVV Business Rules for Proprietary Systems. HHSC typically provides a minimum of 90 days to complete the updates but may provide a different time frame based on the nature of the change. Changes may be required to be made in less than 90 days if HHSC finds the change is required to address an immediate need.

The PSO must make sure the EVV proprietary system vendor meets all required deadlines related to ongoing maintenance.

TMHP will help resolve production problems in the EVV proprietary system for data exchange with the EVV Aggregator as needed.

5070 Access to the EVV Proprietary System

Revision 25-1; Effective March 12, 2025

All PSOs must make sure:

  • State staff and MCOs with which it has a contractual relationship have immediate, direct, on-site access to the EVV proprietary system at no cost.
  • The MCO’s access is limited to 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 per applicable law.
  • State staff, MCOs and proprietary system users have access to standard and ad hoc reports and any data necessary to verify EVV usage in accordance with EVV Business Rules for Proprietary Systems.
  • The EVV proprietary system vendor provides authorized entities access to historical data.

Additionally, PSOs that are FMSAs must make sure CDS employers who select:

  • Option 1 or Option 2 on Form 1722, Employer’s Selection for Electronic Visit Verification Responsibilities, have access to the EVV proprietary system.
  • Option 3 on Form 1722, Employer’s Selection for Electronic Visit Verification Responsibilities, have read-only access to the EVV proprietary system if requested.

5080 Proprietary System Operator Compliance

Revision 25-1; Effective March 12, 2025

EVV Compliance Reviews

PSOs are subject to EVV Compliance Reviews.

Payers use EVV Portal to obtain the following reports for compliance reviews:

  • EVV Usage Report
  • EVV Reason Code Usage Report 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 11000 EVV Compliance Reviews for more information.

Compliance with HHSC EVV Business Rules for Proprietary Systems and HHSC EVV Policy

If HHSC determines a PSO or the PSO’s chosen EVV proprietary system is not in compliance with the HHSC EVV Business Rules for Proprietary Systems or HHSC EVV policy, HHSC may:

  • Require the PSO to correct their noncompliance and to make sure the EVV proprietary system vendor corrects their noncompliance within a time frame specified by HHSC.
  • Require the EVV Aggregator to reject EVV visit transactions from the EVV proprietary system until HHSC determines the noncompliance is corrected.
  • Cancel use of the EVV proprietary system if the PSO fails to correct the noncompliance within the specified time frame set by HHSC.
  • Cancel use of an EVV proprietary system without giving the PSO the opportunity to correct the noncompliance if the noncompliance is:
    • Egregious, as determined by HHSC.
    • Because of 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 noncompliance, HHSC may:

  • Require the EVV Aggregator reject all EVV visit transactions submitted from the EVV proprietary system until the PSO responds or corrects the noncompliance.
  • Cancel the use of the EVV proprietary system without giving the PSO the opportunity to correct the noncompliance.

Fraud, Waste and Abuse

Noncompliance 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.