The PA Office of Medical Assistance Programs (OMAP) issued a new Bulletin that applies to personal assistance and community habilitation services under the Office of Long-Term Living (OLTL) and the Office of Developmental Programs (ODP). The key changes from earlier guidance include:
- Providers 85% Compliance Requirement Effective January 1, 2025: Providers must ensure at least 85% of EVV records are verified without manual edits.
- Starting January 2026, DHS will issue alerts to fee-for-service providers whose manual edits exceed 15% in the prior quarter. Managed care organizations (MCO) will also receive lists of noncompliant providers for follow-up.
- Providers failing to meet the 85% thresholds for two consecutive quarters will be required to submit corrective action plans. Continued noncompliance may lead to sanctions, potentially including loss of license.
- FMS and Participant-Directed Models are also responsible for EVV compliance. Persistent noncompliance can result in termination from participant-directed service models.
- Additional Resources: DHS EVV Guidance and Handbook now available.
- Compliance Reports are available on the Sandata platform. The reports allow providers to identify the non-compliant visit dates, participants, and caregivers to initiate internal corrective action.
If you have any questions, contact Fady Sahhar.