General EVV
EVV is a technology that electronically verifies the delivery dates and times of home and community-based services to the individuals needing those services. EVV uses multiple technologies such as telephonic, mobile applications, and web portal verification inputs to help electronically validate services and prevent fraudulent claims. Federal law (21st Century Cures Act) requires that all state Medicaid agencies implement an EVV solution to manage their personal care services by January 1, 2020, and home health care services (HHCS) by January 1, 2023. As of July 1, 2020, providers are required to use EVV to receive payment for any claim for PCS visits and the Department of Human Services (PA-DHS) began to deny PCS claims without a corresponding visit(s) recorded in the PA-DHS EVV Aggregator. The PA-DHS Aggregator integrates EVV data for both providers using the PA-DHS EVV System and providers using a third-party (Alternate) EVV system.
EVV can help improve the quality of care by making caregiver activities transparent and measurable. Also, EVV reduces the likelihood for error or fraud by identifying the participant, recording the individual caregiver's location and clock-in and clock-out times, and services provided.
The soft launch period is a time for provider agencies, caregivers, and clients to adapt to the use of EVV without impact to claims. During the soft launch period, provider agencies are expected to utilize the PA-DHS EVV System or their Alternate EVV system that will interface with the PA-DHS Aggregator. During this time, PA-DHS and its EVV vendor will be available to answer questions and concerns that may come up regarding EVV. Additionally, PA-DHS will analyze usage data to determine which providers are not utilizing EVV adequately and will reach out to provide direct technical assistance. Also during this time, PA-DHS will generate reports which indicate the percent of required claims that fail to meet EVV requirements.
The PCS soft launch period ended on December 31, 2021.
The HHCS soft launch period began August 10, 2022 and will end December 31, 2022.
The 21st Century Cures Act requires electronic verification of visits for Medicaid-funded personal care services and home health care services before they can be paid by PA-DHS. Beyond verification, there should not be any impact on billing.
CMS requires the electronic verification of a minimum of the following six data elements:
- the service performed
- the individual receiving the service
- the individual(s) providing the service
- the location(s) of the service
- the date(s) of the service
The time the service begins and ends.
Additional staff should not be needed. It is very important to make sure that both caregiver staff and office staff are fully trained and compliant with EVV and billing practices associated with EVV data.
This will help ensure a smooth and successful EVV implementation for provider agencies.
Yes, all providers of Medicaid-funded personal care services or home health care services that require an in-home visit in Pennsylvania need to comply with the 21st Century Cures Act. Providers can elect to use their own Alternate EVV system. Fee-for-service providers have the option to use their own Alternate EVV system or the free PA-DHS EVV system.
The PA-DHS Aggregator is a system that will integrate data from third-party systems (also referred to as Alternate EVV) and/or the PA-DHS EVV System (the EVV system for fee-for-service programs provided free by PA-DHS) into a single uniform platform to facilitate payments of claims.
The PA-DHS Aggregator allows providers to use an Alternate EVV system for visit verification. The six Centers of Medicare and Medicaid Services (CMS) data requirements are transmitted from the Alternate EVV system to the PA-DHS Aggregator using Sandata's standard data specification. The PA-DHS Aggregator includes a read-only web portal for the provider to view their data and a payer web portal that includes alerts, real-time data views and reporting.
The PA-DHS EVV website will continue to be updated with additional information. Agencies and Individuals are encouraged to sign up to receive notices from the PA-DHS EVV Listserv by sending a request to RA-PWEVVNotice@pa.gov.
If you have questions about the EVV program, you can send an email to RA-PWEVVNotice@pa.gov or call 717-787-2600.
Implementation
The PA-DHS EVV System went live for PCS providers in October 2019 . The PA-DHS EVV system was updated to include HHCS in August 2022 and is now available to both PCS and HHCS providers. Providers opting to use the PA-DHS EVV system are able to access the PA-DHS Sandata EVV system once their training has been completed.
No, SCEs will not be required to use EVV.
The 21st Century Cures Act mandates EVV for all Medicaid personal care services and home health care services that require an in-home visit by a provider. CMS has further clarified that personal care services that are provided to inpatients or residents of a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities, or an institution for mental diseases, as well as personal care services that do not require an in-home visit, are not subject to the EVV requirement.
The Unique Registry ID was developed to use an identifier other than the caregiver's Social Security number and would be portable across IT systems. It was developed to address privacy concerns and also to address portability across IT systems. PA-DHS is working on a process for agency model workers to obtain a Unique Registry ID, as well as participants who self-direct. PA-DHS is rolling out the unique ID requirement in phases. Direct care workers in Office of Long-Term Living (OLTL) waivers in participant-directed programs were the first group required to obtain the unique ID. Based on that experience, PA-DHS is making several enhancements to the system before rolling it out to agency workers. Once the enhancements are completed, PA-DHS will provide additional instructions to agencies regarding the requirement.
PA-DHS is not requiring the capture of tasks in this phase of EVV implementation; however, PA-DHS will be assessing whether to include tasks in the future since PA-DHS understands the long-term goal for standardization and auditing purposes.
If a direct care worker has a Direct Care Workers Unique Registry ID, the provider will use this ID as the assigned ID for reporting purposes. If the direct care worker does not have the Unique Registry ID, then the provider will use the last five digits of the caregiver's social security number for reporting purposes.
The Office of Developmental Programs (ODP) has established a resource on ODP rounding rules which can be found on the PA-DHS EVV website.
No. PA-DHS will continue to follow existing rules and practices related to billing for units of services for OLTL and ODP.
ODP billing practices currently meet Department of Labor standards. ODP allows providers to bundle time for claims submissions and the rate assumptions include calculations for nonproductive time to account for the time that cannot be billed for use.
The PA-DHS EVV system will receive ongoing participant and authorization data from the EVV portal and claims may be submitted directly into the PROMISe portal. You will continue to use the PROMISe portal to see if your claims were accepted.
Yes. Every employee who has access to the PA-DHS EVV System’s mobile application will need a unique email address. The employee will be required to create a new email address if they do not have an individual email address to log-in to the EVV application. The caregiver's email address will be utilized to identify the caregiver delivering care to the participant. The email address is used as the caregiver's username to access the application and to respond to password reset requests.
The individual should first enter themselves as a user and receive a temporary password. They would then log into the EVV portal, change their password, and continue on with the ability to click into the client, employee or scheduling module. This automatically adds the user as an employee. For accessing the mobile application, the individual would look for themselves in the employee module, enter their email address, check the mobile user box and save. Once they get the email with the temporary password, they would complete the registration process with the mobile application. Note, while the username can be the same, passwords for Sandata Mobile Connect and EVV are different.
Classroom, webinar, and video on-demand training will be offered to agency administrators and agency supervisors in August 2022 for any new agencies to Home Health Care EVV wishing to utilize the PA-DHS EVV offered to agencies free of charge.
Video on Demand training is available and offered forfree to all adminstrators and supervisors. Additionally, Video on Demand is available to the direct caregivers
If opting to use the free PA-DHS EVV System, all agency providers must attend training before receiving login credentials for the PA-DHS EVV System. It is recommended that each provider agency have two staff members attend classroom or webinar trainings ( in May/June 2022) if at all possible. Agency provider training attendees will be responsible for training their agency's caregiver staff.
Training for the PA-DHS EVV System is offered free of charge to all Medicaid providers affected by EVV deployment. Providers only bill for services rendered. Administrative costs such as training are built into the service rates and therefore are not considered billable. Each agency is responsible for training its staff. Training materials and access to the self-paced, online training system is available on the PA-DHS EVV website.
Providers bear the responsibility of meeting the federal requirements of EVV. One of the requirements of the federal mandate is that location of service must be captured as part of the visit detail that is captured electronically. There are several EVV options for providers to use in order to meet this requirement:
- 1. Using a mobile application on a smart device that captures GPS coordinates to record the location.
- 2. Using a landline telephone as part of a telephonic verification;
- 3. Using fixed Voice-Over-Internet Protocol (VOIP) devices as part of telephonic verification. Non-fixed VOIP devices may only be used if paired with another method for verifying location, such as an in-home fixed visit verification device; or
- 4. Using a cell phone as part of telephonic verification in conjunction with a method for verifying the location, such as an in-home fixed visit verification device.
Providers must use one of these options to meet the location requirement and must ensure that caregivers have the ability to do their jobs and capture EVV appropriately.
A paper timesheet is not required. Any issues or corrections due to a missed clock-in or clock-out may be addressed through the web portal by the administrator. For any manual entries, however, supporting hard copy documentation should be kept. The intent of this requirement is to ensure providers are prepared to provide physical documentation (hard copy) of the reason for manual corrections if requested during an on-site audit. Providers have flexibility in how to implement this requirement as long as physical documentation can be provided upon request. This statement does not dictate that providers must use paper time sheets, however that is one option to satisfy this requirement. If documentation is kept electronically, such as in the provider’s EVV system, providers must be capable of producing hard copies of this documentation, as requested.
The intent of this requirement is to ensure providers are prepared to provide physical documentation (hard copy) of the reason for manual corrections if requested during an on-site audit. Providers have flexibility in how to implement this requirement as long as physical documentation can be provided upon request. This statement does not dictate that providers must use paper time sheets, however that is one option to satisfy this requirement. If documentation is kept electronically, such as in the provider’s EVV system, providers must be capable of producing hard copies of this documentation, as requested.
Yes. All ODP Personal Care Services and Home Health Services subject to EVV are permitted to bill units that are based on the total accumulated continuous or non-continuous service time across an individual calendar day or across multiple calendar days. The begin and end date submitted on a claim detail line informs the system what date range it should look for time in the EVV Aggregator for the same provider, individual and service. Once all continuous or non-continuous service time in the aggregator is located, the system will total all the time found and use the total time to calculate units. The total calculated units in the EVV aggregator are then compared to the units submitted on the claim.
PA-DHS does not expect the caregiver to use the participant's phone, although this can be a resource for telephony visit verification.
PA-DHS is not supplying devices for EVV. If necessary, consumers may be able to apply for a device through the Lifeline program. View more information on the Lifeline program.
DHS will not cover the costs associated with data plans.
EVV does not require participants to have a landline home phone. Caregivers can capture their visit information using the application on their smartphone or by calling the telephone number associated with the telephony visit verification system.
DHS Sandata
The PA-DHS EVV System is available for providers. The system is only to be used for ODP, OLTL and OMAP fee-for-service PCS and/ or HHCS clients.
PA-DHS will not charge providers for the use of the PA-DHS EVV System. However, agency providers who choose to use an Alternate EVV system may be charged for that system. Such providers will be responsible for working with PA-DHS and its vendor, Sandata, to integrate with the PA-DHS Aggregator and will be responsible for any interface costs charged by the provider's Alternate EVV vendor.
The PA-DHS EVV System allows for visits to be captured through the mobile application and through telephony visit verification. Corrections to EVV data can be made by providers through the web portal.
Provider agencies will continue to use the same process you use today to see if your claims were accepted or rejected. There should be few rejected claims since the PA-DHS EVV System makes sure you have all the required claims data before submission. For providers using the PA-DHS EVV System, training is available to show how to resubmit claims through the PA-DHS EVV System.
No. While the PA-DHS EVV System will be offered free of charge to providers, Pennsylvania is using an open EVV system model and providers may use their own EVV vendor (Alternate EVV) so long as it captures the six required items and can interface with the PA-DHS Aggregator. Technical specifications for Alternate EVV systems to interface with the PA-DHS Aggregator are available on the PA-DHS EVV website.
Yes, a caregiver can check-in using the mobile application and check-out using telephony (or vice versa).
No. While the PA-DHS EVV System will be offered free of charge to providers, Pennsylvania is using an open EVV system model and providers may use their own EVV vendor (Alternate EVV) so long as it captures the six required items and can interface with the PA-DHS Aggregator. Technical specifications for Alternate EVV systems to interface with the PA-DHS Aggregator are available on the PA-DHS EVV website.
No. The mobile application only captures the GPS location when the service begins (at check-in) and ends (at check-out).
If it is the current PA-DHS program office policy to round units, then you will still be able to do so with the PA-DHS EVV System.
System access is protected by a unique user ID and password. Providers should maintain the confidentiality of that information. The DHS EVV System vendor, Sandata, uses encryption and other security protocols on their servers. Sandata installs and maintains up-to-date firewalls and virus protection, conducts a periodic review of users and access rights, reviews and applies security patches and reviews and analyzes system activity logs. Additionally, when communicating via email to the agencies, Sandata Customer Care will use encryption when responding if the email contains confidential information.
The PA-DHS EVV system will capture and record six required items: type of service, individual receiving the service, individual providing the service, date of the service, location of the service delivery, and the time the service begins and ends. The PA-DHS EVV system will comply with the requirements set forth in federal law. The PA-DHS EVV System may assist providers in satisfying Pennsylvania State regulations for other auditing and compliance purposes, but providers are responsible for ensuring their continued compliance with all state requirements.
No.
EVV exceptions are generated by the PA-DHS EVV System when one or more of the six required items is missing.
For providers using Alternate EVV systems, the Alternate EVV technical specifications included on the PA-DHS EVV website detail the information that must be captured and submitted to the PA-DHS Aggregator.
For PCS services providers utilizing the PA-DHS EVV have the option to select 13 different language options ( with the exception of T1019). HHCS services will not be translated and will only be available in English.
Yes. There are multiple ways to edit schedules and these are covered in the Classroom, Webinar and/or Video on Demand training.
The PA-DHS EVV System support the following browsers: Mozilla Firefox (v44.0 or higher), Microsoft Edge or Google Chrome. Other browsers may not provide full functionality of the PA-DHS EVV system and are not recommended.
The telephone system used for PCS services only, in the PA-DHS EVV System has English and Spanish call prompts. Additionally, the EVV caregiver training materials and help reference guides are also provided in English.
Telephonic visit verification and the mobile application will be made available in English for both personal care services and home health care services. Personal care services are additionally offered in and the following languages: Egyptian Arabic, French, Fulani, Hindi, Mandarin Chinese, Nepali, Portuguese, Russian, Serbian, Somali, Spanish, Swahili, Vietnamese.
Yes, there is a drop-down list of service options that can be selected. For those providers opting to use the scheduling module within the PA-DHS EVV System, the scheduled visit information will be pre-populated and will not require the selection of services by the caregiver when entering visit information. If an unscheduled service is delivered at the point of care, the caregiver will need to select a service from the drop-down list.
Providers will be able to make manual corrections in the PA-DHS EVV (not the PA-DHS Aggregator) in Visit Maintenance tab of the PA-DHS EVV.
PA-DHS wants to ensure that necessary services are provided and understand that there will be instances where the visit has not been pre-authorized. In cases where the visit has not been pre-authorized, the provider agency will need to follow up to correct the authorization in the system.
PA-DHS is not requiring the use of Schedules, however highly recommends agencies use Schedules. During “Clock-in” and “clock-out” visit capture will supersede any recorded schedules.
Where exceptions occur, the provider agency will have the ability to make edits, error corrections and changes to the visit (not the schedule) through manual entry in the web portal.
For 1-to-1 Caregiver to member services, If the caregivers clock in simultaneously, this will generate an exception and will need to be fixed through the web portal by the administrator. However, for 2 to 1 Caregiver to member services, you must have two caregivers clocked in simultaneously. Only the time the two caregivers are clocked in simultaneously can be submitted for billing.
Check-in and check-out times are required information that must be captured as part of the visit. In instances where the check-in and check-out times are unable to be captured through the mobile application or telephony, the times can be fixed through manual entry in the PA-DHS EVV System.
The GPS coordinates will be captured in the PA-DHS Sandata mobile application at check-in and check-out. The perimeter for locations is set at 1/4 mile in the PA-DHS EVV System. However, even if the recorded location is outside the 1/4 mile perimeter, this will not cause an exception in the PA-DHS EVV System. The provider will be able to enter multiple addresses where services are provided and these addresses can be updated as needed. If an error occurs, any system errors may be corrected through the web portal by the administrator.
Although location is a required element and must be submitted as part of the EVV record, PA-DHS is not currently validating against the location for billing purposes. If this policy changes in the future, PA-DHS will communicate that to providers.
Yes. Every caregiver will have unique login credentials.
Yes. Providers will be able to enter multiple addresses for locations where services are provided into the PA-DHS EVV System, and these addresses can be updated by the provider as needed.
The PA-DHS EVV System allows group visits to be captured in two ways: 1) establish Group Visit via Sandata Mobile Application, 2) create Group Visit manually in Provider Portal. This is covered in the PA-DHS EVV System training.
Visit information is generally available in the PA-DHS EVV portal in near real time. Data is typically uploaded and available within a few minutes.
Yes, and access is available 24 hours a day, seven days a week. PA-DHS Sandata EVV telephony visit verification toll-free numbers are provided after training on the system is completed.
An exception will be generated in the DHS Sandata EVV system.
There is nothing to install. Your agency, including all users, will access the PA-DHS EVV System via the web. This requires a current web browser, a sufficient internet connection and the ability to access the website of the PA-DHS Sandata EVV system.
A smartphone is not required for the PA-DHS EVV System. The PA-DHS EVV System allows for the use of either the mobile application or telephony visit verification to record the required visit information. Both the mobile application and telephony visit verification allow for verifying caregiver visit date, time and location. A smart device is only necessary if the caregiver uses the mobile application to capture the visit data; however, the use of the mobile application is optional and PA-DHS does not prefer the use of the mobile application over telephony. For caregivers using the mobile application as part of the PA-DHS EVV System, PA-DHS has a bring-your-own-device (BYOD) practice where employees may use their personal computing devices, such as smartphones and tablets, to download and access the mobile application. The mobile application called Sandata Mobile Connect is a free application that is available on IOS and Android operating systems.
If cellular coverage is not a viable option for a specific visit, caregivers can capture the information in the mobile application and then open the application once they get to a location with cell phone coverage to upload the information at that time. Caregivers also have the option to use telephony visit verification to capture visit information.
The PA-DHS EVV System provides a standard extract of information function to permit delivery to third-party accounting and payroll systems. Reports from the PA-DHS EVV System can be exported in PDF, Excel, and .csv formats. The ability to integrate specifically with QuickBooks format will be dependent on the provider's system requirements.
Alternate EVV
Providers may use an Alternate EVV system so long as the Alternate EVV system captures the six required EVV items and can integrate with the PA-DHS Aggregator
A PCS or HHCS provider may use an Alternate EVV system chosen by the provider, but the Alternate EVV system must align with the data being captured by the PA-DHS EVV System. Providers using an Alternate EVV system will need to review with their vendor and follow with the technical specifications and related addendums that are available on the PA-DHS EVV website. Providers interested in utilizing an Alternate EVV system, or have questions prepared specific to Alternate EVV, should contact the Sandata Alternate EVV support team by email at PAAltEVV@sandata.com or by phone at 855-705-2407 to ensure the data interfaces will align.
No, it is not necessary if the provider does not have custom coding of a previously certified Alternate EVV vendor. However, it is advisable that the provider reach out to the PA Alternate EVV Support Team to confirm the certification of the Alternate EVV vendor. It is advisable to submit a test file or a very small initial file in production to the PA Alternate EVV Support Team to verify everything is working correctly and that data is being received by the PA-DHS Aggregator.
If a provider agency chooses to use an Alternate EVV system that has not been certified or recertified with the PA Alternate EVV team, PA-DHS recommends completing the certification process as soon as possible.
The data in the PA-DHS Aggregator must be consistent across the EVV program. Therefore, Alternate EVV systems must send the same values in the format and manner specified in the technical specifications. Providers will need to use the PA-DHS EVV System if the Alternate EVV vendor cannot accommodate the values, format, or interface requirements defined in the Alternate EVV technical specifications. The technical specifications are available on the PA-DHS EVV website.
Participant-Directed
PPL is using an Alternate EVV system. Training began on this system in July 2019 with full implementation by October 2019. PALCO is using an Alternate EVV system and will provide updates as soon as they are available.
Yes, PPL conducted training for both direct care workers and common-law employers. PALCO will provide trainings once their EVV system is implemented.
HHAeXchange
Yes, EVV information collected by the MCOs will be shared through the DHS Aggregator.
The DHS Sandata system is not designed to send information to HHAeXchange. HHAeXchange has an interface to transmit data to Sandata.If a provider bills to MCOs, the EVV data in HHAeXchagne goes to the managed care organizations (MCO) and will also be transmitted to DHS Aggregator.
DHS recognizes that some providers may already be using, or may seek to explore, systems that provide more services and information than required under the EVV structure for all of the provider's program needs. Certain vendor system, including HHAeXchange and Sandata, may provide this additional functionality. Any such vendor system will need to be compatible with the DHS EVV solution that is provided through Sandata and/or HHAeXchange. Please be advices that DHS does not endorse the use of any particular system, upgrades, add-ons or additional services from any vendor, nor should providers be led to believe that such services are suggested or required by DHS, the Commonwealth of Pennsylvania or the federal government. DHS is responsible only for ensuring that EVV requirements are implemented pursuant to federal law.