|(a) Definitions. For purposes of this section, the
following terms have the following meanings:
(1) DADS--Department of Aging and Disability Services.
(2) Electronic visit verification (EVV) system--A telephone
or computer-based system that allows confirmation that services were
provided to an eligible recipient according to an approved HHSC prior
authorization or DADS Plan of Care.
(3) HHSC--The Texas Health and Human Services Commission
or its designee.
(b) EVV system requirements. An EVV system must:
(1) allow for verification and documentation of the
delivery of services in the home or in the community and data associated
with those services and must require the confirmation of, among other
(A) the service recipient's identity;
(B) the health care service provider's identity;
(C) the date and time the health care service provider
begins and ends each service delivery visit;
(D) location at which the service is provided; and
(E) any additional requirements as established by HHSC;
(2) support the services requested in the approved
HHSC prior authorization or DADS Plan of Care and claims filed for
(3) be certified by HHSC in accordance with subsection
(c) of this section; and
(4) satisfy the policy guidelines specified by HHSC.
(c) Certification. HHSC will certify an entity providing
EVV services to health care service providers to provide EVV services
based on demonstrated ability to comply with minimum standard requirements
approved by HHSC.
(d) Services requiring EVV system use. An EVV system
must be used for the following attendant and nursing services:
(1) Home Health Skilled Nursing as provided under §354.1039(a)(1)
and (2) of this chapter (relating to Home Health Services Benefits
(2) Private Duty Nursing (PDN) as provided under Chapter
363, Subchapter C of this title (relating to Private Duty Nursing
(3) Personal Care Services (PCS) as provided under
Chapter 363, Subchapter F of this title (relating to Personal Care
(e) Provider requirements. A health care service provider
that provides the services listed in subsection (d) of this section
(1) use an EVV system to document the provision of
health care services;
(2) comply with all documentation requirements as defined
(3) comply with applicable federal and state laws regarding
confidentiality of information about a person who is receiving services
described in this chapter;
(4) ensure that HHSC may review documentation generated
by an EVV system or obtain a copy of that documentation at no charge
to HHSC; and
(5) at any time, allow HHSC direct access to the EVV
(f) Use of provider-based EVV systems. HHSC at its
discretion may grandfather a health care service provider's proprietary
EVV system into the HHSC EVV program for a specified certification
period provided the system meets the following requirements:
(1) demonstrates the ability to meet all standards
and requirements set forth in this rule and HHSC policy;
(2) can comply with all necessary data submission,
exchange and reporting requirements as outlined in HHSC policy; and
(3) was in place for use prior to June 1, 2014.
(g) Use of EVV data for claims reimbursement.
(1) HHSC will not pay a claim for reimbursement unless
the data from the EVV system corresponds with the health care services
for which reimbursement is claimed and is consistent with an approved
HHSC prior authorization or DADS Plan of Care.
(2) Paid claims may be subject to retrospective review
and recoupment, if appropriate.