14 Aug Electronic Visit Verification resources
Electronic Visit Verification is required to be implemented as of January 1, 2021.
Below are Q & A clarifications from NYS DOH. These answers have not been formally released by NYS and are still “DRAFT” but they are expected to be released.
In addition to the questions below, OPWDD has said that remote services (day hab, com hab, and telehealth) do not require EVV.
Q: If in home respite or com hab claims do not have complete EVV data after 1-1-2021, would eMedNY deny the claim?”
A: NYS continues to build the EVV system that will encompass linked EVV data and payable claims. At this time, a claim payment is not linked to complete EVV data submission for that claim. NYSDOH reserves the right to conduct visit validation beginning 1/1/2021.
Q: Some Community Habilitation services are provided in the community. Is EVV still required if the services are not provided in the home?
A: Community Habilitation (CH) services are frequently provided in the community outside of the person’s home. A CH service claim would not require EVV reporting if the services being claimed are delivered entirely in the community. CH Services that are delivered entirely in the community are CH services that are not provided completely or partially in the home. Please see EVV Applicable Billing Codes document for OPWDD CH rate codes that are impacted.
Q: Do Community Habilitation Remote (CH-R) services through OPWDD apply to EVV?
A: CH-R services are subject to EVV if they meet the following criteria:
- Is considered a Medicaid Personal Care Service (PCS) as described above, in other words the staff provide ADL and or IADL supports
- The services begin or end or are delivered entirely or partially in the person´s home
- The services are not provided in a congregate facility
If the Group CH-R is delivered in a certified residence under the OPWDD Comprehensive HCBS Waiver, Appendix K, it is not subject to EVV.
To learn more about OPWDD CH-R guidance, please review the EVV Program Guidelines and Requirements document.
List of billing codes that are subject to federal and state EVV requirements
These are effective 1-1-2021 and includes OPWDD com hab, respite, HCBS TBI, CDPA, etc.
https://www.health.ny.gov/health_care/medicaid/redesign/evv/repository/app_billing_codes.htm
Interface Control Document (ICD)
As discussed on recent Technical Assistance Calls, NYSOH is posting a draft Interface Control Document (ICD) for review and comment. The ICD describes the relationship between the Electronic Medicaid of New York (eMedNY) information system and EVV Submitters and specifies the requirements of both participating systems. This includes the concept of operations, the file structure and protocols that govern the interchange of data, and the communication paths along which the data is expected to flow. The ICD can be found here.
Comments can be sent to [email protected].
EVV Event Calendar
DOH will host a series of technical collaboration calls to assist with questions related to EVV implementation.
Ancor letter urging EVV implementation delay
Click here to read the letter to CMS/Seema Verma urging an EVV implementation delay from ANCOR, ACCSES & other national provider associations.