10 Colo. Code Regs. § 2505-10-8.001

Current through Register Vol. 47, No. 20, October 25, 2024

Section 10 CCR 2505-10-8.001 - ELECTRONIC VISIT VERIFICATION (EVV)

8.001.1Definitions

8.001.1.A. Alternate Location means any location entered into the EVV Record that was not automatically collected as a part of the EVV record.

8.001.1.B. Colorado Medicaid ID means the Colorado Medicaid identification number assigned to each Medicaid member by the Department.

8.001.1.C. Department means the Colorado Department of Health Care Policy & Financing.

8.001.1.D. Direct Care Worker means the person providing a service to a client. The Direct Care Worker may be an employee of a Provider.

8.001.1.E. Direct Care Worker ID means the last five digits of the Direct Care Worker's social security number.

8.001.1.F. Edited EVV Entry means an EVV record that has had any element modified via Visit Modification as defined in Section 8.001.3.C.1.b.

8.001.1.G. Electronic Visit Verification (EVV) means the use of technology, including mobile device technology, telephony, or Manual Visit Entry, to verify the required data elements related to the delivery of a service mandated to be provided using EVV by the "21st Century Cures Act," P.L. No. 114-255, or this rule.

8.001.1.H. Electronic Visit Verification Record (EVV Record) means a record of a visit recorded by an EVV System containing all data points in Section 8.001.3.A.1.b . of this rule.

8.001.1.I. Electronic Visit Verification System (EVV System) means the State EVV Solution or a Provider Choice System used by a Provider to comply with the EVV requirements in this rule.

8.001.1.J. Exception means a data integrity alert identified by the State EVV Solution or Provider Choice System.

8.001.1.K. Geo-fencing means the practice of utilizing a virtual perimeter in a geographic area.

8.001.1.L. Live-in Caregiver means 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 the U.S. Department of Labor, Internal Revenue Service, or Department-approved extenuating circumstances. Documentation of Live-in Caregiver status must be collected and maintained by Provider or Financial Management Services Vendor.

8.001.1.M. Manual Visit Entry means an EVV recorded after the time of service delivery, including all data elements as defined in Section 8.001.3.A.1.b.

8.001.1.N. Mobile Visit Verification Application (MVV Application) means a mobile device application that is used by the Direct Care Worker to record visit data at the start and end of the visit.

8.001.1.O. Provider means an actively enrolled Medicaid provider in good standing as defined in Section 8.076.

8.001.1.P. Provider Choice System means an alternative to the State EVV Solution made available by the Department. A Provider Choice System is provided by a Provider and satisfies all requirements as defined in this rule, is compatible with the State EVV Solution, and is consistent with Federal and State law.

8.001.1.Q. Provider EVV Portal means the web-based administrative tool used by Providers using the State EVV Solution to manage EVV activity and add Manual Visit Entry data elements and to monitor all activity recorded in the EVV System for Provider Choice Systems.

8.001.1.R. Reason Codes means standard codes established by the Department used to explain a Manual Visit Entry, Visit Modification, or acknowledge an Exception for missing required visit information.

8.001.1.S. State EVV Solution means the portion of the EVV System that manages data related to the visit and includes the MVV Application, TVV System, and the Provider EVV Portal made available by the Department.

8.001.1.T. Telephonic Visit Verification System (TVV System) means a toll-free telephone number system used by Direct Care Workers to record visit data at the start and end of a visit.

8.001.1.U. Threshold means the Departmentally-defined acceptable limit, determined as a percent, of EVV data recorded after the time of service delivery through Visit Modification or Manual Visit Entry.

8.001.1.V. Visit Modification means the edit of required visit data elements, as defined in Section 8.001.3.A.1.b, after the time of service delivery.

8.001.2Provider Applicability

8.001.2.A. When providing services in the home or community, Providers of the following services reimbursed by the Department as fee-for-service must utilize EVV:

1. Behavioral Services, as defined in Sections 8.212, and 8.500.94.B.3;

2. Consumer Directed Attendant Support Services as defined in Sections 8.510 and 8.500.90.I;

3. Home Health Services as defined in Section 8.520.1.K;

4. Homemaker Services as defined in Sections 8.490.1 and 8.500.94.B.9;

5. Independent Living Skills Training as defined in Section 8.516.10.A.1;

6. In-Home Support Services as defined in Sections 8.506.4.C and 8.552.1.M;

7. Life Skills Training as defined in Section 8.553.1.I;

8. Pediatric Behavioral Therapies provided under Early, Periodic Screening, Diagnosis and Treatment (EPSDT) Services as defined in Section 8.280.1;

9. Pediatric Personal Care as described in Appendix A to Sections 8.500-8.599;

10. Personal Care Services provided as defined in Sections 8.489.10.11 and 8.500.94.B.14;

a. Personal Care Services provided in a Provider-owned residential type setting and paid via per diem are excluded from the EVV requirements outlined in this rule.

11. Physical Therapy and Occupational Therapy as described in Section 8.200.3.A.6;

12. Private Duty Nursing as defined in Section 8.540.1;

13. Respite as defined in Sections 8.492.10.11 and 8.508.100.F;

14. Speech Therapy, as described in Section 8.200.3.D.2; and

15. Youth Day Services when provided in the home or community as defined in Section 8.503.40.A.13.

8.001.3Provider Responsibilities

8.001.3.A. The Department will make available the State EVV Solution to all Providers of services specified in Section 8.001.2.A . of this rule. The State EVV Solution will include an MVV Application, TVV System, and Provider EVV Portal.

1. The State EVV Solution made available by the Department must be used by all Providers except for Providers using a Provider Choice System pursuant to Section 8.001.3.B . of this rule. Providers using the State EVV Solution must do the following:

a. Utilize the MVV Application or the TVV System made available by the Department as the primary method for collecting visit data.

i. If the visit did not take place at the location captured by MVV or TVV, the Provider must indicate the actual visit location as an Alternate Location.

ii. If the MVV Application and TVV System are unavailable during an EVV visit, the Direct Care Worker and the Direct Care Worker's associated Provider, as applicable, are responsible for entering any uncaptured data elements for that visit via Manual Visit Entry. Manual Visit Entry must be used as the last alternative for recording the visit data.

b. Collect, for each visit, the following data:

i. The Colorado Medicaid ID of the client receiving the service;

ii. Information to identify the Direct Care Worker providing the service;

iii. The time the visit begins and ends;

iv. The EVV-required service performed;

v. The date the visit occurs; and

vi. The location of the visit.

8.001.3.B. The Department will allow all Providers of services specified in Section 8.001.2.A . of this rule to utilize a Provider Choice System.

1. Providers using a Provider Choice System must utilize an EVV Provider Choice System that satisfies all technical specifications as identified by the Department to:

a. Collect and submit to the Department, for each visit, the data elements contained in Section 8.001.3.A.1.b . of this rule;

i. When a Provider enters visit data via Manual Visit Entry, the Provider Choice System must indicate that the data was entered manually.

ii. When a Provider modifies existing visit data, the Provider must indicate the reason code for modification and enter reason code notes, if pertinent or required.

b. Utilize a Direct Care Worker ID for all individuals providing services to clients, as identified in Section 8.001.1.E. of this rule;

c. Identify all Exceptions using standard codes identified by the Department;

d. Utilize the Reason Codes identified by the Department;

e. Resolve any Exceptions noted in the State EVV Solution; and f. Submit data to the State EVV Solution in a format and at a frequency identified by the Department.

2. A Provider Choice System must maintain compliance with the requirements identified in this rule, including incorporating into the system any changes in data requirements that must be transmitted to the State EVV Solution. It is the responsibility of providers using a Provider Choice System to ensure successful interaction between their Provider Choice System and the State EVV Solution.

3. Any costs related to the development of a Provider Choice System will not be the responsibility of the Department.

4. The Department will not provide training or support on the interaction of individual Provider Choice Systems with the State EVV Solution.

5. If a Provider is unable to obtain a compatible Provider Choice System, the Provider must use the State EVV Solution made available by the Department.

8.001.3.C. Visit Entry and Visit Modifications

1. All visit data points as defined in Section 8.001.3.A.1.b . must be completed at time of service delivery.

a. If a visit is entered administratively, and not by a caregiver at the time of service, the visit is considered a Manual Visit Entry.

b. If any data elements are edited after the time of service delivery, the edits are considered to be a Visit Modification resulting in an Edited EVV Entry.

2. Manual Visit Entries and Edited EVV Entries are subject to Department audit based on published Department Thresholds, in accordance with Section 8.076.

3. Providers must maintain all documentation required to substantiate the data elements required by Section 8.001.3.A.1.b of this rule to support Manual Visit Entries, Visit Modifications, and Exceptions. If this documentation cannot be maintained in the EVV System utilized by the Provider, the documentation must be maintained outside of the EVV System. The documentation must be made available to the Department or the Department's designee upon request, as required by Section 8.130.2.

4. Providers must resolve any Exceptions associated with Manual Visit Entries and Visit Modifications.

5. Exemptions

a. Live-in Caregivers who have completed Department required documentation are not mandated to collect EVV data, unless otherwise required by their Provider as defined by 8.001.1.O. of this rule.

i. Falsification or misrepresentation of information on Live-in Caregiver documentation may result in Department revocation of an individual's Live-in Caregiver exemption. If Live-in Caregiver exemption is revoked, the caregiver and provider must complete EVV pursuant to this rule.

6. EVV Record Restrictions

a. The Department will not allow or accept biometric data, pictures, video, or voice recordings to identify clients or substantiate Medicaid visit data.

i. Visit data that includes biometric data, pictures, video, or voice recordings is not required and must not be submitted.

b. The Department will not allow or accept visit data that includes continual GPS tracking during a visit. The Department will only accept location information at the beginning and/or end of a Medicaid visit.

i. Visit data that includes continual GPS tracking is not required and must not be submitted.

c. The Department will not utilize geo-fencing to restrict location of Medicaid service delivery.

i. Visit data that restricts location of service delivery using geo-fencing is not required and must not be submitted

8.001.3.D. Providers of the services specified in Section 8.001.2.A. of this rule must adhere to the following:

1. Comply with all provisions of this rule.

2. Use the State EVV Solution or a Provider Choice System to collect and maintain EVV data as required in Sections 8.001.3.A.1.b. and 8.001.3.B.1.a.

3. Consistent with Section 8.130, maintain a record of clients subject to EVV requirements to whom they are providing services and the required data elements pertaining to these clients. The required data elements include:

a. Colorado Medicaid ID;

b. Last name;

c. First name;

d. One known address at which the client may routinely receive services; and

e. Telephone number.

4. Maintain a current list of Direct Care Workers who are providing services subject to EVV requirements to clients enrolled in Colorado Medicaid and the required data elements pertaining to the Direct Care Workers. The required data elements include:

a. Last name;

b. First name; and

c. Direct Care Worker ID.

5. Maintain all documentation certifying the status of Live-in Caregivers providing services otherwise subject to EVV requirements set forth in this rule. Evidence of valid Live-in Caregiver status must be available upon Department request.

6. Utilize EVV for all services subject to the provisions of this rule.

7. Report any known or suspected falsification of EVV data to the Department within two business days of discovery.

8. Complete all required EVV training.

8.001.3.E. Compliance

1. Providers are required to comply with the requirements of this rule beginning on August 3, 2020.

a. Providers that fail to comply with this rule after August 3, 2020 may be subject to Compliance Monitoring and a Request for Written Response in accordance with Section 8.076.

b. Providers that fail to comply with this rule after October 1, 2020 may be subject to Compliance Monitoring, Request for Written Response, or Overpayment Recovery.

c. Providers that fail to comply with this rule after January 1, 2021 may be subject to Compliance Monitoring, Request for Written Response, Overpayment Recovery, Denial of Claims, Suspension, Termination, or Nonrenewal of their Colorado Medicaid Provider Agreement in accordance with Section 8.076.

2. If the Department determines that there is a credible allegation of fraud, the Provider may be subject to a Suspension of Payments in accordance with Section 8.076.4.

10 CCR 2505-10-8.001

47 CR 11, June 10, 2024, effective 6/30/2024