ODP Clarification on Combining Partial Units for Services Subject to EVV

ODP Announcement 22-098 is intended to provide additional clarification on combining partial units as it pertains to Personal Care and Home Health Care Services that are subject to electronic visit verification (EVV), i.e. Respite — unlicensed, Homemaker, Companion, In-Home and Community Supports and Community Supports, Nursing, Occupational Therapy, Physical Therapy, Speech/Language Therapy, and Therapies — Counseling.

All Personal Care and Home Health Care 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 beginning and end date submitted on a claim detail line informs the system what date range it should look in 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.

As long as the total calculated units found in the EVV aggregator is equal to or greater than the units submitted on the claim detail line, the claim will pass EVV validation and continue moving through the claims adjudication process, where it is subject to plan validation and additional Medical Assistance and ODP specific edits and audits in the Medicaid Management Information System (PROMISe).

Please note that the ODP EVV Technical Guide Version 2.0 is being updated to reflect this clarification about combining partial units for services subject to EVV.

For additional information about EVV, please view the DHS EVV website. Providers with additional questions regarding this matter should contact their respective ODP Regional Office.