Electronic Visit Verification (EVV) Proprietary …Systems describe the business outcome expected...

transcript

Electronic Visit Verification (EVV) Proprietary Systems Workgroup

4th Meeting

December 3, 2019

Steve Abshier

HHSC EVV Operations

Housekeeping and Introductions (1 of 3)

GoToWebinar Etiquette

• All participants will remain muted

• Questions or comments may be submitted using the Question feature

• If you’re planning on using your phone for audio, it’s important that you follow the instructions that came with your invite.

• You may have audio issues if you don’t input the audio PIN after joining the webinar.

Roll Call

• Did everyone sign in that is here in person?

• We will have a log of all attendees on the phone from the meeting registration.

• Introduction of panel

Purpose of Workgroup

• Consult with Medicaid program providers to implement an open model EVV system.

• Obtain feedback on proposed processes.

• Use program provider experiences and feedback to improve or enhance where possible.

Meeting Rules and Expectations

• All documents, concepts, and materials presented in this workgroup are considered informal drafts unless otherwise documented.

• Discussions must remain on topic.

• On-topic feedback will be collected, but HHSC will not provide a formal response to each comment.

• Participation in the workgroup is not required to seek HHSC approval of your proprietary system.

• This workgroup will not make final decisions.

Workgroup Membership (1 of 2)

Software vendor participation

• May only attend if invited by a provider.

• Providers are only allowed two slots and may use one slot for their software vendor, at their discretion.

• Provider must attend with software vendor.

• The proprietary system option is not an opportunity for software vendors to contract with the State of Texas.

Workgroup Membership (2 of 2)

As a member of the workgroup, your role is to:

• Provide constructive feedback on proposed documents and processes.

• Share experiences that should be considered while developing the proprietary system option.

• Review materials in advance of meetings when possible and provide written feedback.

Workgroup Member Role

• Review documents ahead of next meeting.

• Provide feedback in writing to HHSC EVV mailbox (preferred):

• Use email subject: Proprietary workgroup feedback – [organization name].

• Provide the actual rule number that you are commenting on

• Provide feedback at the next meeting.

Recap from Last Meeting (1 of 2)

• We did not receive any written feedback since our last meeting.

• We did not have any Action Items or unanswered questions from our prior meeting.

• The EVV Proprietary System Website is now functional and material from the first 3 workgroup meetings have been posted.

• Continue to monitor for new updates.

Recap from Last Meeting (2 of 2)

• We have combined the material for this meeting and the meeting scheduled for January 7th, 2020 and this will complete the material that we planned to cover.

• Due to making such great progress with our workgroup meetings, we will cancel the two remaining meetings scheduled for January 7th and January 28th.

Trish BurkettTechnology Program Manager

HHSC EVV Operations

Business Rules

• The HHSC EVV Business Rules for Proprietary Systems describe the business outcome expected from the EVV system.

• These rules will not provide detailed design specifications about how the EVV system must operate.

Service Delivery Verification

Service Delivery (EVV Visit) Transaction Documentation

SDV‐10P

**‘EVV System’ must allow ‘System Users’ to document the amount of time associated with non‐EVV relevant services that are delivered during

an EVV service delivery period. The system must store that data, not require multiple clock‐in/clock‐out activity in order to account for non‐EVV relevant service delivery and must not use the non‐EVV relevant service time in the calculation

of the units.

Service Delivery (EVV Visit) Transaction Validation

SDV‐12P

‘EVV System’ must auto‐verify a service delivery

transaction received via approved method (except ‘GUI’) that matches to a previously entered ‘Schedule’ when applicable.

SDV‐13P

‘EVV System’ must auto‐verify a service delivery

transaction received that matches Texas Medicaid EVV program criteria, in lieu of a ‘Schedule’, without ‘System User’ performing‘Visit Maintenance’.

SDV‐15P

**‘EVV System’ must verify ‘Proprietary System Operator’ profile prior to verifying servicedelivery transaction. ‘System Users’ must be allowed to correct errors.

SDV‐19P

**‘EVV System’ must adhere to the HHSC EVV Policy Handbook in regard to ‘Call MatchingWindow’.

SDV‐49P

**‘EVV System’ must adhere to the HHSC EVV Policy Handbook in regard to ‘OptionalExpanded Time for Auto‐Verification’.

SDV‐50P

**‘EVV System’ must adhere to the HHSC EVV Policy Handbook in regard to ‘OptionalAutomatic Downward Adjustment’.

SDV‐51P

**‘EVV System’ must adhere to the HHSC EVV Policy Handbook in regard to ‘Optional Alertfor Reaching Weekly Authorized Hours’.

Visit Maintenance

SDV‐52P

**‘EVV System’ must allow ‘System Users’ to modify billed hours by either entering bill time in and bill time out, or by directly modifying the billed hours, to reflect that actualvisit hours will not be billed in full.

Visit Maintenance

SDV‐53P

**‘EVV System’ must use bill time in and bill time out, when entered, to calculate billedhours in the same manner as actual service delivery time is calculated.

Transmission of Service Delivery (EVV Visit) Transactions

SDV‐32P

**‘EVV System’ must transmit ‘Confirmed EVV Visit Transactions’ to the ‘EVV Aggregator’ within 24 hours of completion, or after errors have been corrected. ‘Proprietary System Operator’ must ensure that 98% of initial transactions submitted to the ‘EVV Aggregator’ contain complete and accurate data elements and that 100% of subsequent transaction submitted to the ‘EVV Aggregator’ must contain complete and accurate data elements. For the purpose of this rule, “complete and accurate” is defined as no file‐level errors, no field

formatting errors and all required fields populated, per the EVV Visit Data Layout Edits Crosswalk, found in Appendix K.

Transmission of Service Delivery (EVV Visit) Transactions

SDV‐33P

**‘EVV System’ must process responses from ‘EVV Aggregator’ and alert ‘System Users’ to the status (acceptance or rejection) of each individual ‘EVV Visit Transaction’ within 24hours of response receipt. Rejection alerts must include the reason for the rejection.

Reporting Requirements

Standard System Reports

EVR‐1P

**‘Proprietary System Operator’ must provide reporting to support program requirements and monitoring to ‘System Users’. The following standard reports must be available on demand to ‘System Users’ (if applicable), see Appendix G:• CDS Service Delivery Log• Landline Phone Verification Report• Non‐EVV Relevant Time Logged

EVV Proprietary System Specifications

VSS‐9P

**‘Proprietary System Operator’ must establish an Issue Resolution Process. The process must include ‘Proprietary System Operator’ steps to respond to and resolve any complaints or issues with product(s) or service(s) as well as Root Cause Analysis and Corrective Action (‘RCCA’) information.

The ‘RCCA’ must include the following at a minimum:• steps to prevent re‐occurrence

• the number of ‘Members’ affected by the issue,• impacted stakeholders including ‘MCOs’ and ‘HHSC’ and

‘Accenture/TMHP’

Questions

• Any questions in the following sub-sections since there are no rules open for comment:

• Reason Codes

• Audit Trail & Quality

• System Security

• Proprietary System Operator Testing/Preparedness

Questions

• Any additional questions regarding the changes made in v0.91 of the business rules:

• Service Delivery (EVV Visit) Transaction Documentation

• Visit Maintenance

• Transmission of Service Delivery (EVV Visit) Transactions

Kristin DavidsonProgram Manager

Sam DanielTechnology Solution Architect

Texas Medicaid and Healthcare Partnership

Operational Readiness

• Proprietary System Request Form

• HHSC & TMHP Readiness Review team will be conducting a review of each PSO to ensure compliance with the Business Rules through a variety of:

• PSO Attestation

• PSO Demonstration of their EVV System

• PSO Documentation

• PSO successful execution of TMHP Test Scenarios (aka Trading Partner Testing or TPT)

• Walkthrough of the scenario inventory

Remaining Appendices

• Appendix J:

• Payer Plan Code Web Service

• Appendix K:

• EVV Visit Data Layout Edits Crosswalk

Jordan NicholsDirector

HHSC EVV Operations

Revisit the Proposed Timeline

Revised Key Dates (subject to change)

• January 31, 2020: Publication of the HHSC EVV Proprietary Business Rules and TMHP Onboarding Process (Moved from March 2020)

• March 2020: Trading partner testing with TMHP opens; PSOs should plan for 60 to 90 days to complete testing (moved from April 2020)

• March 2020: Vendor selection and proprietary system go/no-go decision for new EVV providers (moved from August 1, 2020)

• Oct. 30, 2020: Proprietary system must be implemented for new EVV providers if a vendor is not selected 35

Key Considerations

• A decision regarding reimbursement for the use of a proprietary system is not likely until mid-2020.

• Beginning Jan. 1, 2021, a claim will not be paid without a matching EVV transaction.

• Therefore, you must have a functional and HHSC-approved EVV system in place to receive reimbursement.

• You must be able to obtain HHSC approval of your system no later than Oct. 31, 2020, to prepare for the Jan. 1, 2021 date.

• If you cannot implement on or before Oct. 31, 2020, you must select an HHSC-approved vendor and implement your proprietary system later.

Next Steps

• December 20, 2019: Deadline for workgroup members to submit any additional feedback

• HHSC EVV Business Rules for Proprietary Systems published in January 2020

• EVV Policy updates for Proprietary Systems published in January 2020

• TAC Rules to be published later

• Until TAC is published, the EVV Policy Handbook will include the necessary rules and policies that aren’t covered in the Business Rules

• Complete EVV Proprietary System Request Form37

Questions

• Questions from the room

• Questions from GoToWebinar chat

Resources

• HHSC Proprietary Systems Website: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/evv-proprietary-systems

• Continue to check this page for updates to:

• Timeline and key dates

• Workgroup presentations and materials

• General project updates

Resources

• Website: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/electronic-visit-verification

• Email: Electronic_Visit_Verification@hhsc.state.tx.us

• Sign up to get HHSC EVV notices: https://public.govdelivery.com/accounts/TXHHSC/subscriber/new?topic_id=TXHHSC_247

• Website:http://www.tmhp.com/Pages/EVV/EVV_Home.aspx

• Email: EVV@TMHP.com40

Thank you

Electronic_Visit_Verification@hhsc.state.tx.us

Electronic Visit Verification (EVV) Proprietary …Systems describe the business outcome expected...

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