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UPDATED: Temporary EVV Policies for Novel Coronavirus (COVID-19)

Date: 08/11/20

The temporary Electronic Visit Verification (EVV) policies in response to COVID-19 (PDF) have been extended through October 23, 2020 for providers currently required to use EVV, unless the U.S. Secretary of Health and Human Services ends the public health emergency earlier. If the public health emergency ends earlier, Texas Health and Human Services (HHS) will provide additional information.

Use of the EVV System

All service delivery for an EVV-required service must be documented in the EVV system. Effective March 21, 2020, if the normal electronic verification method (landline, mobile or alternative device) is not available due to COVID-19, program providers may allow service attendants to manually document service delivery visits on paper.

Program providers must:

  • Enter manual service delivery information into the EVV system and ensure it is accepted into the EVV Aggregator/Portal within 180 calendar days from the date of the visit.
  • Keep all supporting service delivery documentation. Service delivery documentation must include the following:
    • Program Provider Name
    • HHS Contract Number or Managed Care Organization (MCO) National Provider Identifier (NPI)
    • Member First and Last Name
    • Member Medicaid ID
    • Date of the Visit
    • Actual Time In and Actual Time Out
    • Attendant First and Last Name
    • Location of the Visit (in the home or in the community)

Claims are subject to retrospective review by the payer. Program providers must have an accepted EVV visit transaction that supports the billed claim in the EVV Aggregator/Portal within 180 calendar days from the date of the visit, or claims may be recouped.

EVV Visit Maintenance Completion Timeframe

Program providers will have 180 calendar days from the date of the visit to complete visit maintenance for all visits beginning March 21, 2020.

EVV Claims Matching

The temporary EVV Claims Matching policy was revised to include information about the June 29 EVV Portal updates. Providers can now refer to the Informational Match Result field in the EVV Portal to see the result of the claims matching process when receiving an EVV07 in the Claims Match Result field. Review June 29 TMHP EVV Portal Updates (PDF) for additional information.

Effective March 21, 2020, EVV claims matching will not be performed for EVV-required services.

  • All claims will display “EVV07-Match Not Performed” in the Match Result field in the EVV Portal.
  • Claims will be forwarded to the appropriate payer with match code EVV07 and will not be denied for an EVV mismatch.
  • Program providers must:
    • Bill in accordance with the member’s authorization.
    • Only bill for actual hours worked.
    • Complete all required visit maintenance within 180 calendar days from the date of the visit.
    • Ensure EVV visit transactions that support the claim are accepted into the EVV Aggregator/Portal within 180 calendar days from the date of the visit.

Billing Prior to Completing Visit Maintenance

Effective March 21, 2020, program providers may submit a claim for an EVV-required service prior to completing all required visit maintenance.

New EVV Reason Code Description for COVID-19

HHS has added a new EVV reason code and description combination to identify service exceptions related to COVID-19, beginning March 21, 2020

Reason Code: Disaster
Number: 130
Description: F – Public Health Disaster

Program providers must select this code for service delivery exceptions related to COVID-19, for example:

  • The normal electronic verification method (landline, mobile or alternative device) is unavailable due to member being relocated, and the visit is manually entered.
  • A member has requested an alternate attendant due to infection concerns.
  • A member refuses service due to infection concerns.

Program providers may, but are not required to, use additional reason codes to document more specific information related to the exception. For example:

  • If the member refuses service due to infection concerns, the program provider:
    • Must enter 130 F – Public Health Disaster
      AND
    • May also enter 100 E – Member agreed or requested staff not work.
  • If the member has requested an alternate attendant due to infection concerns, the program provider:
    • Must enter 130 F – Public Health Disaster
      AND
    • May also enter 100 D – Fill-in for regular attendant.

Free Text Requirements

When using reason code 130 F – Public Health Disaster, program providers must use free text to document any missing actual clock-in or clock-out time not electronically captured by the EVV system.

EVV Compliance

As a reminder, program providers are under a grace period for EVV compliance reviews until August 31, 2020. Therefore, program providers will not be measured for misuse of reason codes or EVV usage at this time.

Additional Information

Program providers who are unable to access the EVV system because of COVID-19 should notify their payer or HHS when possible.

If you have any questions related to EVV during this time, please email Electronic_Visit_Verification@hhsc.state.tx.us. Additional information can also be found on the HHS 21st Century Cures Act webpage.

*Please note: Previously, the end date for this guidance was April 30, 2020, then extended to May 31, June 30 and July 31, 2020. Per HHS, guidance dates have been extended through October 23, 2020.