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Tags Posts tagged with "21st Century Cures Act"

21st Century Cures Act

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As a reminder, section 12006 of the 21st Century Cures Act requires all states to implement the use of EVV for Medicaid-funded personal care and home health care services. EVV must be implemented for personal care services by January 1, 2020, and for home health care services by January 1, 2023.

OLTL waiver services included in the initial implementation of EVV:

  • Personal Assistance Services (Agency and Participant-Directed Model)
  • Participant-Directed Community Supports
  • Respite (unlicensed settings only)

As part of the soft launch period, claims submitted to PROMISeTM for services subjected to EVV will be validated against EVV visits submitted through the Department of Human Services (DHS) Sandata system or DHS Aggregator. During claims processing in PROMISeTM, EVV validation against the DHS Aggregator will continue to be performed and EVV Error Service Codes (ESCs) will set without impacting claim payment. The ESCs for EVV will become active on December 13, 2019, for claims submissions with dates of service on or after November 1, 2019. Providers are expected to review when the EVV edit(s) set and actively make corrections either to the data stored in the DHS Aggregator or the claim itself to ensure errors do not repeat.

Please see this chart of EVV-specific ESCs for reference. If you have questions about EVV, please refer to the Frequently Asked Questions document on the DHS EVV website or contact the EVV Resource Account.

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(From OLTL)

EVV Implementation Update

The 21st Century Cures Act requires implementation of electronic visit verification (EVV) by January 1, 2019 for personal care services (PCS).  On July 30, 2018, the President signed a law delaying penalties for implementation to January 1, 2020 for PCS.  The requirement for implementation of EVV for home health services by January 1, 2023 has not changed.

This delay will allow Pennsylvania an opportunity to extend implementation activities and training, to make sure that providers are fully ready for the implementation of EVV.  The tentative plan for Pennsylvania’s implementation of EVV is:

  • January 2019 – PA guidance will be distributed
  • Spring 2019 – provider training will be offered with phased-in system use
  • Summer 2019 – full implementation of system

As shared previously, we will utilize an open system for EVV.  This means that providers who already have an EVV system will be able to submit information to the state’s EVV vendor.  The Department of Human Services is using the existing PROMISe™ fiscal agent contract with DXC for EVV.

Providers who do not have their own EVV will be able to utilize the Department’s system for compliance.

For Office of Long-Term Living waivers, including Agency and Participant-Directed Services, PCS includes:

  • Personal Assistance Services
  • Respite (unlicensed settings only)

Additional information will be shared when it becomes available.  You may also look for information on our website at http://dhs.pa.gov/provider/billinginformation/electronicvisitverification/index.htm.  For further questions regarding EVV, please email [email protected].

A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

Please share this email with other members of your organization as appropriate. Also, it is imperative that you notify the Office of Long-Term Living for changes that would affect your provider file, such as addresses and telephone numbers. Mail to/pay to addresses, email addresses, and phone numbers may be updated electronically through ePEAP, which can be accessed through the PROMISe™ provider portal. For any other provider file changes please notify the Bureau of Quality and Provider Management Enrollment and Certification Section at 1-800-932-0939 Option #1.

To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

NOTICE: This confidential message/attachment contains information intended for a specific individual(s) and purpose. Any inappropriate use, distribution or copying is strictly prohibited. If received in error, notify the sender and immediately delete the message.

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This week, both the US Senate and US House introduced bipartisan legislation (HR 5912 in the House and S 2897 in the Senate) designed to delay implementation of the Electronic Visit Verification (EVV) provision of the 21st Century Cures Act and require public input from stakeholders. The bill was led by Senators Lisa Murkowski (R-AK) and Sherrod Brown (D-OH) and co-sponsored by a range of Democrats and Republicans in the Senate and House. The EVV delay bill gives states an additional year to implement EVV, having it take effect on January 1, 2020 instead of January 1, 2019.

In late 2016, Congress had ordered states to install EVV systems as a way of preventing fraud in Medicaid as part of the 21st Century Cures Act, but many challenges arose after the bill passed. This is partially due to CMS not releasing guidance on the EVV statute until May 2018, leaving states in the dark for a full 18 months following passage of the EVV law. Even despite CMS’ recent guidance, many concerns remain about which disability supports and services are required to comply with the rule. Additionally, because there has been little stakeholder input, questions abound about privacy, costs, and other aspects of compliance.

Please contact your legislators and ask them to support the EVV delay bill. The American Network of Community Options and Resources (ANCOR) has been instrumental in advocating for this legislation; RCPA is proud to be a member of ANCOR and appreciates their initiative on this issue.

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The Office of Developmental Programs (ODP) is requesting that providers of ODP services complete a survey regarding their current practices and use of Electronic Visit Verification (EVV) systems, and to identify providers who will need a system. Providers are requested to complete the survey by Friday April 20, 2018.

The 21st Century Cures Act requires electronic visit verification systems for Medicaid-funded person care services (PCS) and home health care services. The Centers for Medicare and Medicaid Services (CMS) states that personal care services consist of services that support activities of daily living (ADL) such as movement, bathing, toileting, transferring, and personal hygiene, or that offer support for instrumental activities of daily living (IADL), such as meal preparation, money management, shopping, and telephone use. For more information of the EVV requirement for PCS, use this link.

EVV use for PCS must be implemented by January 1, 2019, and home health by January 1, 2023. The Department of Human Services (DHS) has been reviewing information from current stakeholders and understands that many providers already use an EVV system and DHS needs to utilize an open system that can compile data from those existing systems. DHS plans to use the existing PROMISe fiscal agent contract with DXC to comply with the federal requirement for EVV by January 1, 2019. This will be an open system that will receive information from existing EVV systems being used by providers AND will provide EVV for PCS providers who do not have their own system.

DHS also recently released a request for information directed at EVV vendors. This information will give DHS an understanding of the full capabilities of EVV systems and the needs of providers, and inform DHS’ next steps with the possibility of a future procurement. Read ODP’s announcement here.

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