Electronic Visit Verification (EVV) Public Meeting Insights

Electronic Visit Verification (EVV) Public Meeting November 20, 2020 5/28/2025 1

EVV Public Meeting All phone lines are muted Questions should be submitted through the chat feature We will not be answering submitted questions during today s presentation Questions will be addressed after the presentation through a Listserv communication Please reference the slide number, if applicable, when you submit your question 5/28/2025 2

Agenda General EVV Reminders Office of Medical Assistance Programs (OMAP) Updates Office of Long-Term Living (OLTL) Updates Office of Developmental Programs (ODP) Updates Frequent Issues and Resolution Steps DHS System Implementation Updates Frequently Asked Questions 5/28/2025 3

EVV Public Meeting General EVV Reminders 5/28/2025 4

General EVV Reminders Section 12006 of the 21st Century Cures Act requires all states to implement the use of EVV for Medicaid-funded personal care and home health care services that require an in-home visit EVV must be implemented for personal care services (PCS) by January 1, 2021 and for home health care services by January 1, 2023 5/28/2025 5

General EVV Reminders Do I fall under CURES Act requirements? Yes, if you are the following provider type AND specialty combination(s): Provider Type Specialty Provider Type Specialty 51-Home and Community Habilitation 510 In-Home & Community Supports 54 - Intermediate Service Organization 540 - ISO Agency with Choice 513- Respite Out of Home 541 - ISO - Fiscal/Employer Agent 363 Companion Service 362 Attendant Care/PersonalAssistant Servi ce 431 - Homemaker/Chore Service 512 Respite Care - Home Base 430 - Homemaker Agency Provider Type Specialty Provider Type Specialty 59 OLTL Programs 362 Attendant Care/Personal Assistant Service 55 - Vendor 554 Respite, overnight camp 555 Respite, day camp 512 - Respite Care Home Base 5/28/2025 6

General EVV Reminders Do I fall under CURES Act requirements? Additionally, you are REQUIRED to be enrolled in one or more of these service programs to fall under the CURES ACT mandate. Service Programs Act 150 Program OBRA Waiver Community HealthChoices Waiver Consolidated Waiver Person/Family Directed Support Waiver ID Base Program Adult Autism Waiver Community Living Waiver 5/28/2025 7

EVV Public Meeting Office of Medical Assistance Programs (OMAP) Updates 5/28/2025 8

OMAP FFS Training All OMAP Fee-For-Service (FFS) Providers intending to use the DHS Sandata EVV system must receive training for the DHS Sandata EVV System. Training will be done using a train the trainer model. 5/28/2025 9

OMAP FFS Training The webinar was conducted on August 28, 2020. Providers may still do self-paced training if they were unable to attend the webinar. The training may be accessed at https://www.dhs.pa.gov/providers/Billing- Info/Pages/EVV.aspx. DHS will issue log-in credentials to access the DHS EVV system or the EVV Aggregator once a provider completes the mandatory training. 5/28/2025 10

OMAP MA Bulletin Timelines MA Bulletins have been prepared for OMAP providers. MA Bulletin 05-20-02 for FFS providers was issued on August 26, 2020. A MA Bulletin for PH-MCO providers is currently under review and will be issued in the near future. 5/28/2025 11

OMAP FFS Timeline FFS providers are expected to be using either the DHS EVV system or the Alternate EVV system of their choosing at this time. FFS EVV administrators are required to complete and return the EVV System Account Verification document and return it to DHS, per MA Bulletin 05-20-03. Completed forms will continue to be accepted after September 1, 2020. Forms will continue to be accepted beyond September 1, 2020, so providers need to submit the form as soon as possible. 12 5/28/2025

OMAP FFS Provider Communication The Department will do a targeted outreach to providers based on their status. Currently, there are 14 agencies that have not submitted EVV data through the aggregator and those are among the agencies the outreach is targeting. 5/28/2025 13

OMAP FFS Resources Medical Assistance Bulletin 05-20-03 titled "Electronic Visit Verification for Personal Care Services Provided in the Fee-for-Service Delivery System" may be viewed at the following link: https://www.dhs.pa.gov/docs/Publications/Documents/FORM S%20AND%20PUBS%20OMAP/MAB2020082601.pdf More information can be found on the Department's EVV webpage at the following link: https://www.dhs.pa.gov/providers/Billing- Info/Pages/EVV.aspx 5/28/2025 14

OMAP PH-MCO Timeline PCS claims for PH-MCOs with a date of service on and after November 1, 2020, will be matched to information in PROMISeTMand compared to information in the EVV Aggregator. If the information does not match, error status code 927 or 928 will post and have a Pay & List disposition Encounters will still pay at this time Beginning with dates of service on or after January 1, 2021, the above referenced PH-MCO encounters posting error status code 927 or 928 will post and have a deny disposition. 5/28/2025 15

Activating New Clients in DHS EVV By default, any new Client will show in the DHS EVV Provider Portal with Status "Pending." As a reminder, providers must confirm their clients by updating their status from "Pending" to "Active." When in Edit Client, navigate to the Program tab. Under the Client Status heading, the field "Status" is displayed. 5/28/2025 16

Activating New Client in DHS EVV 5/28/2025 17

Activating New Clients in DHS EVV For more details, providers using the DHS EVV solution should refer to: Administrators: Client Module course in the Pennsylvania DHS Electronic Visit Verification (EVV) Self-Paced Training for Agency Providers All Other Staff: EVV Sandata Training Guide (on DHS EVV Webpage), pages 53-60 of 245 5/28/2025 18

EVV Public Meeting Office of Long-Term Living (OLTL) Updates 5/28/2025 19

OLTL Updates EVV Visit Data Requirements The technical specification and addendum documents released by DHS are required to be followed as part of the EVV implementation. Required fields outlined in these documents are required to complete EVV implementation for all providers in all programs. Entering false data in any of the required fields is not compliant for EVV implementation. Example: The last 5 digits of the direct care worker s social security number is a required field and must be submitted to uniquely identify the individual providing the care. 5/28/2025 20

ODP/OLTL Policy Bulletin Bulletin 07-20-04, 54-20-04, 59-20-04,00-20-03 outlines documentation requirements when manual edits are required to correct EVV visit data. The intent of this requirement is to ensure providers are prepared to provide physical documentation (hard copy) of the reason for manual corrections if requested during an on-site audit. Providers have flexibility in how to implement this requirement as long as physical documentation can be provided upon request. This statement does not dictate that providers must use paper time sheets, however that is one option to satisfy this requirement. If documentation is kept electronically, such as in the provider s EVV system, providers must be capable of producing hard copies of this documentation, as requested. 5/28/2025 21

OLTL Updates All claims and encounters for personal care services subjected to EVV requirements for dates of service on or after January 1, 2021 must have a corresponding EVV visit or claims payment will be impacted. Alternate/Third Party EVV Systems OBRA and Act 150 providers using an Alternate EVV system who have not already reached out to begin the Aggregator Certification process must contact Sandata Alternate EVV support team as soon as possible to begin this process. Community HealthChoices (CHC) Providers All CHC providers must be actively working with the CHC-MCOs to ensure they are in compliance with all EVV requirements. If your agency has not already started collecting EVV data and sending the appropriate data to each contracted MCO, please reach out to the MCOs as soon as possible to begin this process. 5/28/2025 22

EVV Public Meeting Office of Developmental Programs (ODP) Updates 5/28/2025 23

ODP Updates All ODP providers who render personal care services (PCS) are subject to EVV. For claims that contain PCS with dates of service January 1, 2021 and forward, there MUST be a matching EVV record in the DHS Aggregator in order for the claim to pay. PCS claims without a matching EVV record will post either error status code 927 or 928 and have a deny disposition. 5/28/2025 24

ODP Updates Vendor Fiscal (PALCO) Effective August 16, 2020, PALCO is requiring All participant- directed services are captured electronically by the SSP. EVV training materials and registration forms are available on the PALCO website: https://www.palcofirst.com/programs/pennsylvania/office-of- developmental-programs/ 5/28/2025 25

EVV Implementation Frequent Issues & Resolution Steps 5/28/2025 26

Frequent Visit Exceptions 5/28/2025 27

Frequent Visit Exceptions When performing Visit Maintenance, agencies should only see the following exceptions in DHS Sandata EVV or the DHS Aggregator (ALT EVV users): 1. Invalid Service 2. Missing Service 3. Unknown Client 4. Unknown Employee 5. Unmatched Client ID / Phone 6. Visits Without In-Calls 7. Visits Without Out Calls If your visit lists an exception other than #1-7, please contact: DHS Sandata EVV -- PAC Support- papac1@dxc.com DHS Aggregator (Alt-EVV)- PAALTEVV@Sandata.com ** Please be sure to provide examples** 5/28/2025 28

Claims Verification Steps Error Status Codes (ESCs) are actively setting for all claims with services subject to EVV that are submitted through PROMISe for fee-for-service programs. Providers should be actively reviewing these ESCs to determine if their claims and EVV data are matching appropriately. The ESC guide published on the DHS EVV website outlines when claims would deny beginning January 1, 2021. 5/28/2025 29

EVV ESC METRICS FOR ODP & OLTL Percentage for the month of October Status After January 1st Error Description By Program Office Oct 2020 OLTL Pay & List 925 - EVV VISIT VERIFIED 1356 6.36% Deny 927 - UNITS BILLED EXCEED UNITS VERIFIED IN EVV 111 0.52% Deny 928 - EVV VISIT NOT FOUND 19866 93.12% ODP Pay & List 925 - EVV VISIT VERIFIED 63010 27.70% Deny 927 - UNITS BILLED EXCEED UNITS VERIFIED IN EVV 6614 2.91% Deny 928 - EVV VISIT NOT FOUND 157855 69.39% CHC Pay & List 925 - EVV VISIT VERIFIED 1742081 73.84% Deny 927 - UNITS BILLED EXCEED UNITS VERIFIED IN EVV 86006 3.65% Deny 928 - EVV VISIT NOT FOUND 531301 22.52% 5/28/2025 30

Claims Verification Steps 5/28/2025 31

Claims Verification Steps 5/28/2025 32

Claims Verification Steps 5/28/2025 33

Claims Verification Steps Always filter visits by "All Visits" Verified status will show under the Visit Status in the DHS Aggregator portal. If the Visit Status shows Incomplete you will need to make corrections/updates to the visit. 5/28/2025 34

Claims Verification Steps If the Visit Status shows Verified , then you do not need to make corrections/updates to the visit. 5/28/2025 35

EVV Implementation DHS System Implementation Updates 5/28/2025 36

DHS EVV Implementation If providers have not already started implementing Electronic Visit Verification (EVV), providers are at risk at being out of compliance on January 1, 2021. Alternate/Third Party EVV Systems Fee-For-Service providers using an Alternate EVV system who have not already reached out to begin the Aggregator Certification process must contact Sandata Alternate EVV support team by phone at 1-855-705-2407 or by email at PAAltEVV@sandata.com as soon as possible to begin this process. Providers must receive their production credentials and confirm their EVV data is viewable in the Aggregator Portal to complete the certification process. 5/28/2025 37

DHS EVV Implementation Providers Electing to use the Department of Human Services (DHS) Sandata EVV System Providers electing to use the DHS Sandata EVV system must complete Sandata s self-paced training in order to receive credentials to use the system for OBRA, Act 150, and Offices of Developmental Programs and Medical Assistance Programs fee- for-service participants. Upon completing the self-paced training, providers will be issued a Welcome Kit, including their agency s production credentials. Providers must setup their agency and direct care workers in the EVV Provider Portal and train the rest of their staff on how to use the system, including the Sandata Mobile Connect and telephonic visit verification (TVV) visit capture modalities to their direct care workers. application 5/28/2025 38

DHS Sandata EVV System The DHS Sandata EVV system is only available for fee-for-service providers. Self-paced, online training is available for new providers or provider administrators wanting to use the DHS Sandata EVV system. Registration Link: https://sandatalearn.com?KeyName=PAEVVAgency Select- Pennsylvania DHS Electronic Visit Verification (EVV) Self- Paced Training for Agency Providers **This is NOT the training for DHS Aggregator** 604 unique provider agencies have completed training and received Welcome Kits to date 5/28/2025 39

DHS Sandata EVV System It is expected that fee-for-service providers planning to use the DHS Sandata EVV system are actively using the system now or will begin using the system as soon as possible. If you are a fee-for-service provider who completed training, but have yet to receive a Welcome Kit for your agency within 5 business days of completing your training, please contact PAC at 800-248-2152 or papac1@dxc.com Please check spam/junk folders for Welcome Kit and/or login credential emails. 5/28/2025 40

DHS Sandata EVV System While all agencies are expected to be actively using EVV now, an agency may still opt to use the DHS Sandata System. Any agency still needing to use the DHS Sandata EVV system MUST complete the training before December 4, 2020 in order to receive Welcome Kits, and Credentials before January 1, 2020. 5/28/2025 41

DHS Sandata EVV System DHS expects that any agency intending to use the DHS Sandata EVV system has completed the following: 1. LMS EVV Training 2.Received your Welcome Kit Credentials 3.Set up your Agency Administrators and DCWs 4.Trained your Agency Employees on DHS Sandata EVV And are now: 1.Using EVV for all your EVV eligible care 2.Verifying your visits against your claim data. 5/28/2025 42

DHS Sandata EVV System October 30, 2020 Sandata release: Client: SSN field is grayed out. When a FFS client s information is entered, the SSN field is now grayed-out and cannot be edited. This ensure the SSN field cannot be edits on the client s profile. Visit Maintenance: Orange exceptions now display correctly Exceptions that require acknowledgment are now indicated with an orange dot on the Visit Maintenance screen. This change creates consistency between the Visit Maintenance and Visit Details screens. Global: County field added. County field was added to the following screens: Visit Detail screen in Sandata EVV and Aggregator Edit Client screen in Sandata EVV Billing/Scheduling Edit Client, Create Client and View/Add Additional Addresses screens in Sandata EVV. 5/28/2025 43

DHS Sandata EVV System Sandata Updates/Recent Releases: A release of the newest version of the Sandata Mobile Connect app was deployed on November 19, 2020. The app update was submitted to both the Google Play Store and the Apple App Store on this date. Please note that based on the store s processing time, it may take up to two weeks for the app update to become available. 5/28/2025 44

DHS Sandata EVV System DHS Sandata EVV Billing Option is scheduled to be available in Quarter 2 of 2021. Any provider using the DHS Sandata EVV will receive notice when Billing is live and functional. When Billing is live, providers will be directed to take the recommended "Scheduling and Billing Training" in the DHS Sandata LMS system. 5/28/2025 45

Alternate EVV Certification Process Providers using Alternate EVV systems in receipt of production credentials: 212 Providers using Alternate EVV systems with confirmed data in the DHS Aggregator: 79 Providers using Alternate EVV systems still needing to contact Sandata to confirm data: 133 Providers using Alternate EVV systems currently with credentials but have gone "silent" : 57 5/28/2025 46

Alternate EVV Certification Process The following Alternate EVV vendors have completed the PA Alternate EVV certification process with Sandata to date: 5/28/2025 47

Alternate EVV Certification Process The following Alternate EVV vendors have completed the PA Alternate EVV certification process with Sandata to date: 5/28/2025 48

Alternate EVV Certification Process Do you have Alternate EVV Production Credentials? Did you complete ALL the steps? As noted previously, less than half of the 192 agencies with production credentials have completed all 8 steps. You are required to confirm your data is flowing correctly in the DHS Aggregator with the Sandata Alternate EVV Support team. If you have not sent PAALTEVV@Sandata.com an email confirming your live data is in the DHS Sandata Aggregator, please do so as soon as possible. As we get closer to Jan 1, 2021, DHS expects support call volumes to increase. 5/28/2025 49

Alternate EVV Certification Process When contacting the Sandata Alternate EVV support team, detailed setup information is required, including what systems are used to collect EVV data. Missing information may lead to additional delays for PA EVV program compliance. Sandata Alternate EVV Support Team may be contacted by phone at 855-705-2407 or by email at PAAltEVV@sandata.com 5/28/2025 50