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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354MEDICAID HEALTH SERVICES
SUBCHAPTER APURCHASED HEALTH SERVICES
DIVISION 11GENERAL ADMINISTRATION
RULE §354.1177Electronic Visit Verification (EVV) System

(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 things:

    (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 reimbursement;

  (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 and Limitations);

  (2) Private Duty Nursing (PDN) as provided under Chapter 363, Subchapter C of this title (relating to Private Duty Nursing Services); and

  (3) Personal Care Services (PCS) as provided under Chapter 363, Subchapter F of this title (relating to Personal Care Services).

(e) Provider requirements. A health care service provider that provides the services listed in subsection (d) of this section must:

  (1) use an EVV system to document the provision of health care services;

  (2) comply with all documentation requirements as defined by HHSC;

  (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 system.

(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.


Source Note: The provisions of this §354.1177 adopted to be effective April 13, 2014, 39 TexReg 2497

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