Idaho Admin. Code r. 16.03.10.041

Current through September 2, 2024

Section 16.03.10.041 - SPECIALIZED REIMBURSEMENT: ELECTRONIC VISIT VERIFICATION (EVV)

01.Services Subject to EVV Requirement. Effective July 1, 2021, agencies providing the following services are required to submit claims using a compliant EVV system as mandated by Section 12006 of the 21st Century Cures Act:

a. Private Duty Nursing Services as described in Sections 200 through 210 of these rules;

b. Personal Care Services (PCS) as described in Sections 300 through 309 of these rules;

c. The following Aged and Disabled Waiver Services as described in Sections 320 through 329 of these rules:

i. Attendant Care;

ii. Homemaker; and

iii. Respite.

02.EVV Definitions.

a. Aggregator. System that collects provider EVV information from multiple software platforms and standardizes the information in MMIS for EVV data validation.

b. Claims Adjudication. The process of determining Medicaid financial responsibility for claims submitted to MMIS.

c. Electronic Visit Verification (EVV). EVV is software or device(s) that electronically captures information verifying service delivery information.

03.Claims Subject to EVV Requirements. To submit eligible claims for services with EVV requirements, providers must:

a. Maintain an EVV system chosen by their agency and certified as compliant with the MMIS aggregator, as determined by the Department and/or the MMIS Contractor;

b. Document and retain participant consent for use of electronic verification methods;

c. Develop and maintain policies and procedures outlining agency implementation and use of EVV technology, including strategies for safeguarding of participant information and privacy; and

d. Submit EVV data that captures these six (6) system-validated data elements for services rendered:

i. Date of service;

ii. Time the service begins and ends;

iii. Individual providing the service;

iv. Participant receiving the service;

v. Billable service performed; and

vi. Location of service delivery.

e. Provider claims for services requiring EVV will include the corresponding EVV data elements listed above. Provider EVV data will be submitted to the state's aggregator prior to billing claims. These claims are subject to a quality review in accordance with Subsection 210.10 of IDAPA 16.03.09, "Medicaid Basic Plan Benefits."

Idaho Admin. Code r. 16.03.10.041

Effective March 17, 2022