Revision 21-1; Effective Nov. 1, 2021
The following EVV stakeholders must meet all state and federal EVV requirements:
- Payers (HHSC and MCOs)
- Texas Medicaid and Healthcare Partnership (TMHP)
- EVV vendors
- Program providers delivering services under the agency option
- FMSAs
- Medicaid members and SRO participants
- CDS employers
2100 Payers
Revision 22-4; Effective Sept. 1, 2022
Payers are responsible for paying Medicaid claims, administering the EVV program and enforcing EVV requirements. In Texas, the payers are HHSC and the MCOs.
Payer responsibilities include, but are not limited to:
- Following state and federal requirements when processing claims for services required to use EVV
- 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. Acute care payments are made by TMHP on behalf of HHSC.
LTC FFS
Programs |
---|
Community Attendant Services (CAS) |
Family Care (FC) |
Community Living Assistance and Support Services (CLASS) Waiver |
Primary Home Care (PHC) |
Deaf Blind Multiple Disability (DBMD) Waiver |
Home and Community-based Services (HCS) Waiver |
Texas Home Living (TxHmL) Waiver |
Acute Care FFS
Programs |
---|
Personal Care Services (PCS) |
Community First Choice (CFC) |
Youth Empowerment Services (YES) Waiver |
Home and Community-based Services-Adult Mental Health (HCBS-AMH) Waiver |
MCOs are the payers for managed care services.
Managed Care
Programs |
---|
STAR Health, including MDCP covered services |
STAR+PLUS |
STAR+PLUS Home and Community Based Services (HCBS) |
STAR Kids, including MDCP covered services |
STAR+PLUS Medicare-Medicaid Plan (MMP) |
2200 Texas Medicaid and Health Care Partnership
Revision 21-1; Effective Nov. 1, 2021
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 EVV vendor pool and coordinates all data exchange for EVV systems.
TMHP responsibilities include, but are not limited to, 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
- Selecting and managing the approved EVV vendors on behalf of HHSC
- Training on the EVV Portal
The TMHP EVV webpage has more information.
2300 EVV Vendors
Revision 22-4; Effective Sept. 1, 2022
An EVV vendor is contracted with the state’s claims administrator to provide a cost free EVV system for program providers and FMSAs.
EVV vendor responsibilities include, but are not limited to:
- Adhering to all HHSC EVV vendor business rules for system operation and functionality
- Following all EVV requirements described in:
- The EVV Policy Handbook
- Texas Administrative Code, Title 1, Part 15, Chapter 354, Subchapter O
- Texas Government Code Section 531.024172 or its successors
- Supporting multiple clock in and clock out methods
- Providing EVV system training and technical support
Refer to 4100 EVV System Selection for more information.
2400 EVV Proprietary System Operator
Revision 22-4; Effective Sept. 1, 2022
An EVV Proprietary System Operator (PSO) is a program provider or FMSA that uses an HHSC-approved EVV proprietary system.
EVV PSO responsibilities include, but are not limited to:
- Adhering to all HHSC EVV Business Rules for Proprietary Systems
- Following all EVV requirements described in:
- The EVV Policy Handbook
- Texas Administrative Code, Title 1, Part 15, Chapter 354, Subchapter O
- Texas Government Code Section 531.024172 or its successors
- Supporting one or more 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 22-4; Effective Sept. 1, 2022
A program provider is an entity that contracts with HHSC or an MCO to provide an EVV service.
Program provider responsibilities include, but are not limited to:
- Following all EVV requirements described in:
- The EVV Policy Handbook
- Texas Administrative Code, Title 1, Part 15, Chapter 354, Subchapter O
- 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
- Ensuring 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 22-4; Effective Sept. 1, 2022
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, but are not limited to:
- Following all EVV requirements described in:
- The EVV Policy Handbook
- Texas Administrative Code, Title 1, Part 15, Chapter 354, Subchapter O
- 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 16010 CDS Option Stakeholders for more information.
2700 Member
Revision 22-4; Effective Sept. 1, 2022
A member is a person eligible to receive Medicaid services requiring the use of EVV.
Member responsibilities include, but are not limited to:
- Reviewing and signing Form 1718, Responsibilities and Additional Information, if receiving EVV services through managed care
- Reviewing and signing program specific documentation describing a member’s rights and responsibilities if receiving EVV services administered by the state
- Notifying the program provider if a service provider asks the member to clock in or clock out of the EVV system
2800 CDS Employer
Revision 22-4; Effective Sept. 1, 2022
A CDS employer is a member or legally authorized representative (LAR) who participates in the CDS option.
CDS employer responsibilities include, but are not limited to:
- Completing all required EVV training
- Training their CDS employees on the use of the EVV system
- Ensuring 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 16000 CDS Employer Policies for more information.