Electronic Visit Verification (EVV) Public Meeting Updates August 14, 2020

Electronic Visit Verification (EVV) Public Meeting August 14, 2020 3/21/2025 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 3/21/2025 2

Agenda Office of Medical Assistance Programs (OMAP) Updates Office of Long-Term Living (OLTL) Updates Office of Developmental Programs (ODP) Updates EVV Compliance Reminders Alternate EVV Certification DHS Sandata EVV System Updates/Reminders Frequently Asked Questions 3/21/2025 3

EVV Public Meeting Office of Medical Assistance Programs (OMAP) Updates 3/21/2025 4

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. Trainers can attend EITHER a live webinar or a self- guided online training course. 3/21/2025 5

OMAP FFS Training Providers may enroll for the training webinar beginning August 10, 2020 at https://www.sandatalearn.com?KeyName=PAEVVAgency The webinar will be conducted on August 28, 2020. Providers may do self-paced training if they re unable to attend the webinar available at https://www.dhs.pa.gov/providers/Billing-Info/Pages/EVV.aspx. Further information regarding training sessions will be sent to providers via a listserv email. 3/21/2025 6

OMAP MA Bulletin Timelines MA Bulletins have been prepared for OMAP providers and are currently undergoing executive review. Issuance is anticipated to occur mid-August for FFS providers. 3/21/2025 7

OMAP FFS Timeline FFS providers are expected to be using either the DHS EVV system or the Alternate EVV system of their choosing no later than September 1, 2020 PCS claims with a date of service on and after September 1, 2020, through December 31, 2020, will be matched to information in PROMISeTM and compared against 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 Claims will still pay during this time period Beginning with dates of service on or after January 1, 2021, claims posting error status code 927 or 928 will post and have a deny disposition 8 3/21/2025

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 928 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. 3/21/2025 9

EVV Public Meeting Office of Long-Term Living (OLTL) Updates 3/21/2025 10

OLTL Updates All OLTL 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 for claims submitted through PROMISeTM to be paid. PCS claims without matching EVV will post error status code 927 or 928 in a deny disposition The Community HealthChoices (CHC) Managed Care Organizations (MCOs) must also verify EVV data as part of the claims adjudication process. 3/21/2025 11

OLTL Updates OLTL strongly encourages providers who are not already capturing EVV visits electronically, to do so NOW and ensure those visits are being sent and stored in the DHS Aggregator or the CHC-MCO HHAeXchange system. OLTL providers capturing PCS visits electronically should ensure they understand the meaning of any EVV edits that are setting and understand what corrections are needed to take place on the claim and/or EVV record for a claim to pay in the future. 3/21/2025 12

OLTL Updates Community HealthChoices (CHC) Providers Providers serving Participants in CHC must implement an EVV system, follow all implementation directions provided by the CHC-MCOs, and send EVV visit data to the CHC- MCOs. Providers have the option to utilize the HHAeXchange system offered by the CHC-MCOs or select their own Alternate EVV system. As a reminder, providers using the HHAeXchange system offered by the CHC-MCOs do not need to complete Aggregator training or the Alt-EVV certification process. 3/21/2025 13

OLTL Updates Fee-For-Service (FFS) Providers OLTL providers serving participants in the OBRA waiver or the Act 150 program must implement EVV for these programs by either: Completing training and using the DHS EVV Sandata system. Integrating an Alternate EVV system with the DHS EVV Aggregator to send EVV data for OBRA waiver and Act 150 participants. Working with HHAeXchange (if applicable) to send the OBRA waiver and Act 150 EVV data separate from Community HealthChoices (CHC) data. Providers choosing this option must confirm this process is completed with HHAeXchange. 3/21/2025 14

EVV Public Meeting Office of Developmental Programs (ODP) Updates 3/21/2025 15

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 3/21/2025 16

ODP Updates ODP strongly encourages providers who are not already capturing EVV visits electronically, to do so NOW and ensure those visits are being sent and stored in the DHS Aggregator. Providers already capturing PCS visits electronically should ensure they understand the meaning of any EVV edits that are setting and understand what corrections are needed to take place on the claim and/or EVV record for a claim to pay in the future. 3/21/2025 17

ODP Updates Agencies with Choice (AWCs) AWCs are required to comply with all Departmental requirements as a condition of participation in the Medical Assistance program. Support Service Professionals (SSP) and/or Managing Employers are required to participate in the Department s required EVV process. 3/21/2025 18

ODP Updates Agencies with Choice (AWCs) In accordance with ODP Bulletin 00-08-08, Agency with Choice Financial Management Services (AWC FMS), the AWC FMS provider is the employer of record responsible for certain employer functions, which includes ensuring that Waiver and non-Waiver provider requirements are met. The individual or surrogate, as the managing employer of their qualified SSPs, is responsible to verify time worked by qualified SSPs and approve and sign timesheets. This includes participation in the EVV process. AWCs, therefore, have the authority to require SSP participation in the EVV process as a condition of employment. Please contact your Administrative Entity with any questions you may have. 3/21/2025 19

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/ 3/21/2025 20

EVV Public Meeting EVV Implementation Updates and Reminders 3/21/2025 21

EVV Implementation 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 and community visit EVV must be implemented for personal care services (PCS) by January 1, 2021 EVV must be implemented for home health care services by January 1, 2023 3/21/2025 22

EVV Implementation The CURES Act requires that EVV systems must collect and verify the following six elements: Type of service performed Individual receiving the service Date of the service Location of service delivery Individual providing the service Time the service begins and ends 3/21/2025 23

EVV Implementation The implementation of EVV does not impact the provision of PCS. EVV should not be a barrier to participants receiving PCS. EVV does not change the method and location for PCS delivery. 3/21/2025 24

EVV Implementation The location of service delivery is a required item that must be submitted. GPS is not required but is one way to capture location. Caregivers can clock in and clock out using EVV in the community regardless of whether the address is in the system. 3/21/2025 25

EVV Implementation EVV validations are not performed against the location of service delivery stored in the EVV Aggregator during claims processing. The location of service delivery used during claims processing is represented by the place of service code on the claim. During normal claims processing, the place of service code on the claim detail line is always validated to ensure the location in which the service was rendered is permissible as specified in the waiver. Because this validation occurs normally during claims processing, there will be novalidation against the location of service delivery found in the EVV Aggregator record. 3/21/2025 26

EVV Implementation Telephony Visit Verification (TVV) Cell phones may only be used in conjunction with a location device. Providers cannot require participants to have a land line or cell phone. It is the provider s responsibility to ensure caregivers have the necessary equipment for EVV. If a provider solely uses TVV, the provider agency should consider either offering other visit capture modalities to capture visits in the community or using the DHS Sandata EVV system. 3/21/2025 27

EVV Implementation EVV Visit Data Requirements The technical specification and addendum documents released by DHS are required to be followed as part of the EVV implementation. Please refer to the DHS EVV website for the current AltEVV addendum. DHS must be able to aggregate all data by aligning data elements. 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. As an 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. 3/21/2025 28

DHS Aggregator Open Model Fiscal Employer Agent Alternate EVV Systems (FFS) CHC-MCOs EVV System (HHAeXchange) DHS Aggregator DHS Sandata EVV System (FFS) Alternate EVV Systems (FFS) PROMISeTM When an EVV service is on the claim(s) transaction, the claim is validated against EVV visit data in the DHS Aggregator 3/21/2025 29

EVV Compliance Reminders/Tips Providers currently submitting EVV data either through the DHS Sandata EVV system or their own Alternate EVV system need to verify that their PROMISeTMEVV ESCs are setting on claims the way they would expect. If providers are receiving errors they believe are inaccurate, providers should contact the Provider Assistance Center (PAC) at 800-248-2152 or papac1@dxc.com Please refer to the EVV ESC guidance document for additional information. The document can be found on the DHS EVV website or by clicking here 3/21/2025 30

EVV Edits for ODP and OLTL EVV ESC Code EVV ESC Description Resolution ESC 925 EVV Visit Verified No action is needed by the provider ESC 926 EVV Internal Record Format Error No action is needed by the provider ESC 927 Units billed exceed units verified in EVV Provider needs to review visit data and claim units, make corrections where needed, and then resubmit the claim ESC 928 EVV Visit Not Found Provider needs to review and ensure the EVV record is found in the Aggregator, contains valid data and resubmit claim ESC 929 EVV Web Service Timeout No action is needed by the provider ESC 930 EVV Internal Error No action is needed by the provider ESC 931 EVV-PROMISe Internal Error. Error may set if > 31 days billed on a claim detail line If the claim service line spans > 31 days, the provider should rebill the claim with up to 31 days on the service line The EVV ESCs document can be found on the DHS EVV website here: https://www.dhs.pa.gov/providers/Documents/Billing%20Information/EVV%20Error%20Service%2 0Codes.pdf 3/21/2025 31

Provider EVV Utilization July 2020 Percentage for the month of July Status After January 1st Error Description By Program Office OLTL 925 - EVV VISIT VERIFIED 2.79% Pay & List 689 927 - UNITS BILLED EXCEED UNITS VERIFIED IN EVV 928 - EVV VISIT NOT FOUND ODP 925 - EVV VISIT VERIFIED 0.30% Deny 96.91% Deny 74 23923 15.40% Pay & List 33805 927 - UNITS BILLED EXCEED UNITS VERIFIED IN EVV 928 - EVV VISIT NOT FOUND CHC 925 - EVV VISIT VERIFIED 2.07% Deny 82.53% Deny 4547 181213 55.24% Pay & List 1236056 927 - UNITS BILLED EXCEED UNITS VERIFIED IN EVV 928 - EVV VISIT NOT FOUND 2.27% Deny 42.49% Deny 50815 950893 32 3/21/2025

EVV Compliance Reminders/ Tips To validate if your visits are verified or need corrections: All DHS Aggregator users should be checking the DHS Aggregator to ensure completed visits are in a verified status. Claims will fail EVV validation if the visit is not in a verified status. DHS Sandata EVV users check their DHS Sandata EVV system. HHAeXchange users should validate visits in HHAeXchange If your agency is using a combination of these, then you will need to check all of them regularly. **Reminder- DHS Aggregator is read-only. 3/21/2025 33

EVV Compliance Reminders/Tips Verified status will show under the Visit Status in the DHS Aggregator portal. If the Visit Status does not show Verified you will need to make corrections/updates to the visit. 3/21/2025 34

EVV Compliance Reminders/Tips It is recommended that DHS Aggregator users re- take the DHS Sandata Learn Aggregator course as a refresher every 6 months to ensure they are familiar with its functionality and to learn how to view and translate EVV visit data sent and stored in the Aggregator. The course is only 30 minutes in length. 3/21/2025 35

EVV Implementation Alternate EVV Certification Process 3/21/2025 36

Alternate EVV Certification Process Alternate EVV systems currently testing: 46 Alternate EVV systems with testing completed: 26 Alternate EVV systems in receipt of production credentials: 118 Alternate EVV systems with confirmed data in the DHS Aggregator: 61 Alternate EVV Providers still needing to contact Sandata to confirm data: 64 3/21/2025 37

Alternate EVV Certification Process Key Points Any provider intending to use an Alternate EVV system other than HHAeXchange for FFS services should have already begun the testing process. Providers starting this process now, run the risk of not being able to meet the January 1, 2021 claims denial deadline. We really want you to succeed and not have your claims denied come January 1st -- so please do not wait! **It is the providers responsibility to follow-up with their vendors throughout the entire certification process. 3/21/2025 38

Alternate EVV Certification Process The following Alternate EVV vendors have completed the PA Alternate EVV certification process with Sandata to date: Axiscare Kaleidoscope Kantime Brightstar KDG Careficient Kichi Code Cell Trak Matrixcare ClearCare MITC Direct Care Innovations Post-EVV E-System Generations Homecare Systems Salo Solutions Setworks Horizon Information Therap Julisoft Unicentric Kaleida Systems, Inc 3/21/2025 39

Alternate EVV Certification Process PA DHS AltEVV Testing & Certification Process Provider downloads and reviews the Technical Specs and Alternate EVV Addendum for OLTL and ODP (2 Documents) Step 1 When Provider is prepared to Test and receive credentials; Provider reaches out via email to PA ALT EVV support team Step 2 PA ALT EVV support team at Sandata creates testing credentials and Provider completes DHS Aggregator Training Step 3 Provider and Vendor work together to conduct testing Step 4 Once testing is complete, the Provider submits the completed testing checklist to the PA ALT EVV Step 5 Provider emails to the PA ALT EVV support team at Sandata and identifies Go-Live date/requests production credentials. Step 6 Provider confirms live data is in the DHS Sandata Aggregator Step 7 Sandata Notifies Provider of AltEVV testing completion via email Step 8 3/21/2025 40

Alternate EVV Certification Process Do you have ALT EVV Production Credentials? Yes? Did you complete ALL Steps? As noted previously, only half of the 118 agencies with production credentials have completed all 8 steps! You are expected to confirm your data is flowing correctly in the DHS Aggregator with PAALTEVV Support team. If you have not sent PAALTEVV@Sandata.com an email confirming your live data is in the DHS Sandata Aggregator, do not wait any longer! As we get closer to Jan 1, 2021, PA DHS expects support call volumes to increase. This could affect your claims if you wait to long to confirm data and have an issue. 3/21/2025 41

Alternate EVV Certification Process Skipping any step in the Certification process runs the risk of your EVV data not being compliant and claims being denied starting January 1, 2021. Don t Assume Anything. Validate every EVV visit so you aren t receiving claims rejections starting January 1. 3/21/2025 42

Alternate EVV Certification Process FFS providers utilizing an Alternate EVV (other than HHAeXchange) system need to contact the Sandata Alternate EVV support team to be certified and integrate with the DHS Aggregator Contact information is as follows: Phone: 855-705-2407 Email: PAAltEVV@sandata.com The certification process takes approximately 8 to 12 weeks depending on the testing required. The process can also depend on whether the Alternate EVV vendor is new to the process and provider responsiveness. Please note, due to many Agencies waiting until July to start testing, some steps may take longer due to increased volume of requests. We appreciate your patience! 3/21/2025 43

Alternate EVV Certification Process It is important to monitor your email and spam folders regularly. A Quick Reference Guide for the Alternate EVV certification process outlines the steps of the process and the expectations for Sandata, providers, and Alternate EVV vendors. The Quick Reference Guide for the Alternate EVV certification process is available on the DHS EVV webpage here: https://www.dhs.pa.gov/providers/Billing- Info/Documents/ALT%20EVV%20Provider%20Testing%20Quick%20Reference%20Guide_june2020.pdf 3/21/2025 44

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 3/21/2025 45

Alternate EVV Certification Process For optimal system performance, it is recommended that completed visits should be sent in near real time. Alternate EVV completed visit data should be uploaded to the DHS Aggregator Upload frequencies should be set based on provider service volume at a frequency of no more than once a day It is expected that information is sent as it is added/changed/deleted in the Alternate EVV system Rejection responses will be delivered on a separate API call that is initiated by the third party in near real time. 3/21/2025 46

EVV Implementation DHS Sandata EVV System 3/21/2025 47

DHS Sandata EVV System The DHS Sandata EVV system is live. The system is free and available for use by Fee- For-Service (FFS) providers of ODP, OLTL, and OMAP programs. If FFS providers are intending to use this system, they must take the online training and receive a Welcome Kit which will provide their access to the system. 3/21/2025 48

DHS Sandata EVV System If you are a FFS provider and have completed training, but have not yet received a Welcome Kit for your agency, please contact PAC at 800-248- 2152 or papac1@dxc.com Reminder to check spam/junk folders for Welcome Kit and/or login credential emails If the Welcome Kit expired, call the PAC (EVV Prompt) to get Welcome Kit resent 800-248-2152 or papac1@dxc.com 3/21/2025 49

DHS Sandata EVV System DHS Sandata EVV Learning Management System (LMS) is a Train-the-Trainer Model. Agency Administrators and Supervisors should take training and then train their respective staffs. Self-paced, online training is still available for providers planning to use the DHS EVV system and Agency Administrators wanting to take a "refresher course" Registration Link: https://sandatalearn.com?KeyName=PAEVVAgency 662 unique provider agencies have completed training and received Welcome Kits to date 3/21/2025 50