Electronic Visit Verification - General Stakeholder Meeting November 19, 2019 - Colorado.gov

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Electronic Visit Verification - General Stakeholder Meeting November 19, 2019 - Colorado.gov
Electronic Visit Verification
  General Stakeholder Meeting
         November 19, 2019

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Electronic Visit Verification - General Stakeholder Meeting November 19, 2019 - Colorado.gov
Our Mission
 Improving health care access and
 outcomes for the people we serve
     while demonstrating sound
 stewardship of financial resources

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Electronic Visit Verification - General Stakeholder Meeting November 19, 2019 - Colorado.gov
Welcome Stakeholders
            • Restroom locations

            • HCPF Introductions
The purpose of this meeting is to engage providers,
          members, and other stakeholders as the Department
          works to implement EVV for community based services
          offered through both the State Plan and Waivers.
           And specifically to:
Meeting    • Review EVV, the legislative mandate, and the scope
Purpose      of implementation
           • Discuss EVV project updates
           • Provide a platform to gather stakeholder feedback

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We ask that you:

                • Mind E-manners

 Meeting        • Identify yourself when speaking

Guidelines      • Share the air

                • Listen for understanding

                • Stay solution and scope focused

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Introductions

         Brief Overview of EVV

         Live-in Caregiver Definition

Agenda   Scope of EVV Program

         Claim Edit Follow-up

         Sandata Call Center Report

         Stakeholder Engagement Discussion
• Electronic Visit Verification (EVV) is a technology
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            solution which verifies information through
            mobile application, telephony, or web-based
            portal

          • EVV is used to ensure that home or community-
            based services are delivered to people needing
            those services by documenting the precise time
            service begins and ends
What is   • Section 12006 of the 21st Century Cures Act
 EVV?       requires all state Medicaid agencies implement
            an EVV solution

          • States that do not implement EVV will incur a
            reduction of Federal funding

          • The Department intends to implement EVV for all
            Colorado required services in late summer 2020.
TYPE OF SERVICE     INDIVIDUAL       DATE OF THE

What must     PERFORMED        RECEIVING THE
                                  SERVICE
                                                   SERVICE

EVV
Capture?
              LOCATION OF       INDIVIDUAL     TIME THE SERVICE
            SERVICE DELIVERY   PROVIDING THE   BEGINS AND ENDS
                                  SERVICE
Which Types of Services Require EVV?
    EVV Required

       • Select Fee for Services (FFS) State Plan and HCBS Waiver
         Services

    EVV Excepted

       • Per Diem Services, Managed Care, Program for All-Inclusive
         Care for the Elderly (PACE), and other Capitated Services

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Which Services Require EVV?*
•   Personal Care                                 •   Independent Living Skills Training (ILST)
•   Pediatric Personal Care                       •   Life Skills Training
•   Home Health: RN, LPN, CNA, PT, OT, SLP        •   Physical Therapy (provided in the home)
•   Private Duty Nursing                          •   Occupational Therapy (provided in the home)
•   Hospice                                       •   Speech Therapy (provided in the home)
•   Homemaker                                     •   Behavioral Therapies (provided in the home or
                                                      community)
•   Respite (provided in the home or community)
                                                  •   Pediatric Behavioral Health
• Consumer Directed Attendant Support Services
  (CDASS)                                      • Youth Day
•   In-Home Support Services (IHSS)               •   Durable Medical Equipment (select services)

                                                                                     *Subject to change
Service Types Groupings
                                           Consumer Directed
                       Consumer Directed
    Behavioral                             Attendant Support      Durable Medical        Home Health –          Home Health –
                       Attendant Support
    Therapies                                Services – SLS         Equipment          Certified Nurse Aide       Nursing
                            Services
                                           Health Maintenance

  Home Health –                             Home Health –
                        Home Health –
   Occupational                            Speech/Language         Homemaker           Hospice - In Home      Hospice - Inpatient
                       Physical Therapy
     Therapy                                   Therapy

Independent Living
  Skills Training      In-Home Support        Occupational      Pediatric Behavioral   Pediatric Personal
                                                                                                                Personal Care
       and                 Services             Therapy              Therapies               Care
Life Skills Training

                                              Private Duty      Respite and Youth
                       Physical Therapy                                                  Speech Therapy
                                                Nursing                Day

                                                                                                                                11
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           • The Department recognizes that EVV services
             can happen in the home or in the community.

 Service   • It is essential that EVV does not disrupt this
             flexibility of service location.
Location   • Services that happen in a facility or professional
            building are exempt from EVV. Unless noted
            otherwise.
Questions
   or
Comments
Key Terminologies
            Term                          Meaning
State EVV Solution       State EVV system available to providers at
                         no cost

Provider Choice System   EVV system procured, purchased, and used
                         by a provider

Alternate Vendor         Vendor who manages a provider choice
                         system

Data Aggregator          Where provider choice systems will submit
                         EVV data to the State Solution
Colorado selected a vendor that will provide EVV
            solutions, while also allowing providers to use
            alternative/existing EVV systems, if they meet
            state specifications:

             ✓ Providers choosing to use an alternate
               vendor must ensure that their system is
State EVV      configured to Colorado EVV rules and
               requirements.
 Model:
 Hybrid      ✓ Provider Choice Systems must connect to
               the Data Aggregator

             ✓ Self-paced aggregator training must be
               completed prior to connecting to the Data
               Aggregator
State EVV Solution
    Overview
Colorado EVV Technologies

Mobile Application                         Telephony

                     Provider Web Portal
                          (Santrax)
Mobile Application: MVV
         • Mobile Visit Verification (MVV): A GPS enabled mobile application
           downloaded on a smartphone or tablet

         • “Bring your own device” method that works on iPhone and Android

         • GPS Enabled

                • Captures location when a caregiver clocks-in/clocks-out

                • No continual location reporting

         • Direct care workers log-in with unique Sandata ID or email address

         • Available in English, Spanish, Somali, Russian, Chinese Mandarin, and
           Arabic Egyptian
Rural Area Considerations
          • State EVV Solution application will work in rural areas or
            telephony can be used

          • MVV will automatically switch to “Disconnected Mode” when
            smartphone or tablet is not connected to a network

          • EVV data will be saved for a later transmission when the
            caregiver logs-in and network connectivity (cellular or wi-fi)
            is established
Telephony Visit Verification (TVV)
            • Each provider ID has two toll-free, multi-language
              numbers

            • Both numbers are accessible 24 hours a day, 7 days a
              week

            • Non-GPS option

            • Client phone is preferred for TVV

            • Location captured through ANI technology

            • Member identified by Sandata Client ID

            • Direct care workers identified by Sandata ID
Provider Portal
           • Used for visit maintenance and administrative tasks

           • Limited capacity for manual entry of EVV data

           • Used by providers who utilize State EVV Solution

           • View and verify visits

           • Address exceptions or errors

           • State enforced manual entry threshold
Project Updates
Colorado EVV Implementation Timeline
•   Good Faith Effort Exemption request was approved 9/18/19

•   Additional time will be used to explore solutions to exempt live-in caregivers

•   The State EVV Solution and Data Aggregator are now live and available for use

•   The Department strongly encourages providers to use EVV during the Soft-Launch

•   DME providers may begin using EVV in early 2020

•   Colorado anticipated EVV mandate will be late summer 2020
                                                                                     DME
Good Faith Effort Request Approved

 Early                   Colorado
 Adoption -                                   CMS
                         Anticipated
 Voluntary                                    Mandate
                         Mandate
 Soft Launch                                  • January 1, 2021
                         • Summer 2020
                                              • Pre-payment
 • Began October         • CCR Rule in          claims review
   1st, 2019               Effect

State exploring live-in caregiver solutions
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Proposed Live-in Caregiver Definition
   A live-in caregiver is a caregiver who permanently or for an extended period of time resides in
   the same residence as the Medicaid member receiving services. Live-in caregiver status is
   determined by meeting requirements established by either the U.S. Department of Labor or
   Internal Revenue service. Verification of live-in caregiver status must be validated by the
   provider though an official Department form. The Department permits live-in caregiver
   establishment beyond the above definitions in limited circumstances, at Department discretion.

   Examples may include:
       • Joint custody arrangements
       • Children in Foster Care
       • Members transitioning out of residential service

Note: Live-in caregiver status is established by the member/caregiver relationship. If a caregiver
provides services to more than one member, the establishment of live-in status only pertains to
relationships where documentation has been provided and approved.

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EVV Project Scope
SERVICE
                             TYPE         CLIENTS       VISITS         PROVIDERS
                             BHSVC               10               15                1
                             HHBAS                  2              8                2
                             HHNUR                  4              4                2

           Program           HMKR
                             IHSS
                                                145
                                                    3
                                                                 876
                                                                   3
                                                                                    5
                                                                                    2

          Size Since         OT
                             PEDBT
                                                    2
                                                    5
                                                                   2
                                                                   9
                                                                                    2
                                                                                    3

           Go-Live           PRSNL               77              582                9
                             PT                  12               13                2
                             RSPT                   4             12                1
                             SLT                    3              8                1
                             No Service          39              118                7
*Data pulled on 11/13/2019
                             TOTAL             306           1650                  37
SERVICE TYPE   VERIFIED VISITS        UNVERIFIED VISITS        PERCENT VERIFIED

    Verified vs.
                                     BHSVC                                                     15                 0.0%

                                     HHBAS                                                      8                 0.0%

    Unverified                       HHNUR

                                     HMKR                             50                   826
                                                                                                4                 0.0%

                                                                                                                  5.7%

       Visits                        IHSS                                                       3                 0.0%

                                     OT                                                         2                 0.0%
Verified:
 • Complete visit                    PEDBT                             3                        6                33.3%
 • All data points collected
                                     PRSNL                        206                      376                   35.4%
 • Cures-compliant visit
 • Can match to a claim line         PT                                                        13                 0.0%

                                     RSPT                              3                        9                25.0%
Unverified:
 • Incomplete visit                  SLT                               1                        7                12.5%

 • One or more data points missing   No Service                                            118                    0.0%
 • Not a Cures-compliant visit
                                     TOTAL                        263                     1387
 • Cannot match to a claim line
Claim Edit Follow-up
    From Provider Newsletter:

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Claim Edit Follow-up

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Questions
   or
Comments
Sandata Call Center Update

Contact:
Phone: 855-871-8780 or email
Email: CO-HCPF-EVVProviderHelpdesk@etraconline.net

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Calls Presented

Presented - calls that come into the call center (Dark Green)
Answered - calls that were answered by a call center representative (Light Green)
Abandoned - calls that were not answered by the call center (Gray)

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% of Calls Answered in 60 Seconds

Percentage is the amount of calls that were answered in 60 seconds over all calls received.

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% of Calls Captured

Percentage is the amount of calls that were answered from all calls presented.

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Average Answer and Talk

Call Minutes:   9.8            9.9                9.4   7.8   11.4   9.1   10.8   9.9   7.2   7.1

       Average time of call, in seconds.
       Average time to answer call, in seconds.

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Electronic Visit Verification
       Roadmap 2019
Project
                                       Develop
                  Kickoff                and                Develop
                                                            Colorado         Collect          User
                                       Finalize                            Stakeholder
                   2018                Training
                                                           Rules and
                                                           Regulation       Feedback       Acceptance
                                         Plan                Draft         on EVV CCR       Testing

Electronic Visit                                                                                               State
                                                                                                              System
Verification                                                                                                    and
                                                                                                             Aggregator
Implementation              Register
                                                 Release
                                                Technical               Provider
                                                                                           Collect
                                                                                         Stakeholder
                                                                                                                Live
                                              Specifications
Roadmap                        for
                            Training
                                               for Provider
                                                  Choice
                                                                        Welcome
                                                                         Letter
                                                                                          Feedback
                                                                                             on
                                                 Systems                                  Scheduler

 2018-2020

             Interface
                                              Provider
             Testing                          Training                   Begin                            Go Live
                                                                                                         Mandatory
                                             Call Center                  Soft                              Use
                                              Available
                                                                        Launch                           Summer*
                                                                                                           2020

                                                                                                       *Subject to change
Soft-Launch
• Began October 1, 2019 when the State EVV Solution and Data Aggregator went live.
• Providers may begin to collect EVV data and transmit to the Department.
• Optional participation until EVV is mandated, estimated late summer 2020.
• Opportunity to familiarize providers with EVV prior to claims integration. Claims will
  continue to pay and EVV errors will appear on remittance advice.
• Opportunity for caregivers to practice EVV collection and for members to become
  accustomed to EVV.
• Help the Department identify and develop supplemental training materials.

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Stakeholder Engagement
      Discussion
Stakeholder Meeting Updates
Subcommittees
  •   Consumer Direction and Family Caregiver
  •   Training and Communications (Sunset November 2019)
  •   Systems (Sunset November 2019)
  •   Privacy (Sunset February 2019)

General EVV Stakeholder Meeting
 • How would you like to use this time?

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Questions

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Contact Information

     Lana Eggers
   EVV@state.co.us

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Thank you!

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