Reminder – APL 22-014 Electronic Visit Verification Implementation Requirements
| Date: | April 14, 2022 |
| To: | Personal Care Services (PCS) and Home Health Care Services (HHCS) Providers |
| From: | Health Plan of San Joaquin (HPSJ) |
| Type: | Regulatory |
| Subject: | Reminder – APL 22-014 Electronic Visit Verification Implementation Requirements |
| Business: | Medi-Cal Managed Care |
The following is a reminder of the Provider Alert sent on October 20, 2022, regarding All Plan Letter 22-014 which was released to provide guidance regarding the implementation of federally mandated Electronic Visit Verification (EVV) requirements. For the complete details regarding APL 22-014 please visit the following link: https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-014.pdf
Providers rendering Medi-Cal services subject to EVV must comply with the requirements established by the Department of Health Care Services (DHCS). EVV is required for Medicaid funded personal care services (PCS) and home health care services (HHCS) for in-home visits by a provider. This includes PCS and HHCS delivered in the members’ homes as part of a Community-Based Adult Services (CBAS), Whole Child Model, Community Supports or any other Medi-Cal benefit. Through EVV the following information should be captured: type of service performed, the individual receiving the service, the date of the service, the location of service delivery, the individual providing the service, and the time the service begins and ends. Please refer to the following link for EVV Provider Type, Procedure, and Place of Service Code: https://www.dhcs.ca.gov/Documents/EVV-Provider-Types-and-Codes.pdf.
California implemented EVV for PCS on January 1, 2022 and is required to implement EVV for HHCS by January 1,2023.
EVV System – Provider Self-Registration and Training
Provider agencies and individual nurse providers (INPs) who provide PCS and HHCS are required to register in the Provider Self Registration portal.
Information on the self-registration portal can be found on the DHCS website
and via the following links:
- https://www.dhcs.ca.gov/provgovpart/Pages/EVV.aspx
- https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-014.pdf
- https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-014.pdf
All claims for PCS and HHCS services must be submitted with allowable current procedural terminology and healthcare common procedure coding system codes as outlined in the Medi-Cal Provider Manual. Providers should also indicate the proper Place of Service Code or Revenue Code on claims and/or encounters to indicate the rendering of PCS or HHCS in a member’s home.
All providers subject to EVV requirements must comply with EVV requirements when rendering PCS and HHCS. HPSJ will monitor for compliance with these requirements. Non-compliance with any of the requirements can result in any or all of the following: corrective action, denial of payment, reassignment of members.
Community Supports providers for personal care and homemaker services, respite, and day habilitation services are required to register no later than October 19, 2022. However, please reach out should you need focused technical assistance for this process.
To support EVV requirements, the State of California has contracted with Sandata to provide a state sponsored EVV system. Sandata includes the ability to capture data elements during the visit, data portals that allow providers to view and report on visit activity, and an EVV aggregator. The EVV aggregator will also receive data for providers that choose to use their existing EVV system, support California’s Open EVV model, and provide a meaningful data and analytics dashboard.
Providers and subcontractors also have the option to implement EVV requirements using an alternate EVV system. Any alternate EVV system must comply will all business requirements and technical specifications including the ability to capture and transmit information to the EVV aggregator. Providers and subcontractors who choose to use an alternate EVV system are required to register in the EVV self-registration portal and must participate in state-sponsored training provided by Sandata.
If you have questions or need assistance, please call our Provider Services team at (209) 942-6340. You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.