If you’re unsure about what you need to do to prepare for Pennsylvania’s Department of Human Services (DHS) EVV mandate, you’re not alone.
With the passing of the 21st Century CURES Act, EVV is now a requirement for all Medicaid homecare providers.
While the CURES Act is a federal mandate with a deadline of January 1, 2020, many states, including Pennsylvania, have implemented a phased rollout to require EVV in advance of the federal deadline in order to ensure compliance and give providers time to transition.
In this post, we’ll cover Pennsylvania’s move to managed care and what you need to know to be ready for the State’s upcoming EVV deadline.
How Pennsylvania Began Its Move to Managed Care
In 2018, Pennsylvania’s DHS began to terminate all of its home and community-based services from Medicaid waivers (Aging Waiver, Attendant Care Waiver, Independence Waiver, OBRA Waiver, and COMMCARE Waiver), replacing them with one comprehensive program called Community HealthChoices (CHC).
Together with CHC, the MCOs rolled out Phase 1 in January 2018 in the Southwest region, Phase 2 in the Southeast in January 2019, and are preparing to roll out Phase 3 for the rest of the state in January 2020.
In this post, we’ll walk you through the key things to know about what’s happening with EVV in Pennsylvania.
When is Pennsylvania’s EVV Deadline?
Pennsylvania’s Department of Health Services (DHS) has set a soft launch date of October 7th, 2019 for providers to begin collecting homecare visits via EVV.
Who does this impact?
EVV is required for all home health services including home health visits, private duty nursing, and personal care services. According to DHS, providers must:
- Verify delivery of services using an EVV system at the beginning and end of each home health care service visit.
- Submit claims through the vendor’s system to verify that delivered services comply with prior authorizations before claims can be processed for payment.
What is the status of EVV in Pennsylvania?
Pennsylvania is an Open Model state. This means providers are free to choose any EVV solution that best meets the needs of their agency. The only requirement is that the selected EVV solution must collect all six data elements as required by the CURES Act.
What if I’m connected with an MCO?
If you’re contracted with any of the MCOs (Amerihealth Caritas, Keystone First, PA Health & Wellness, or UPMC for You) – you’ll submit your visit confirmations and send claims through the HHAeXchange Platform or through your current EVV tool. These options are explained below:
- Use the MCOs’ chosen vendor, HHAeXchange, to process EVV and claims. Visit the HHAeXchange Provider Info Center to get started.
- Continue to use your existing EVV solution. It’s simple to connect your existing EVV system to the MCOs through the HHAeXchange Portal. Email the HHAeXchange Integration Team to get started.
What about the State’s aggregator?
DHS has contracted with DXC and Sandata to aggregate EVV data on behalf of the State. However, since Pennsylvania is an Open Model state, there is no charge to your agency to use the MCOs’ chosen platform, HHAeXchange, or your existing EVV tool, to send EVV data to the State’s aggregator.
What are the penalties?
If a provider fails to comply with these rules, they are subject to denial or non-payment of claims, sanctions, fines and suspension, or termination from the Pennsylvania Medicaid program.
What are my next steps?
Since Pennsylvania is an Open Model state, you are free to choose the EVV solution that best meets the needs of your agency and complies with the CURES Act requirements. If you currently use HHAeXchange to submit visits to any of the MCOs, HHAeXchange will automatically send the required EVV information to the State’s aggregator.
Want to learn more about EVV in Pennsylvania? Contact us today.
HHAeXchange is the industry leader in providing EVV solutions across the country with over 91 million visits confirmed annually through our platform, and we are actively providing solutions to meet EVV requirements for Pennsylvania homecare agencies as the exclusive vendor of choice to the MCOs. Since the launch of Community HealthChoices (CHC), we’ve helped PA agencies log more than 13 million confirmed homecare visits through HHAeXchange’s EVV platform, and we support 1,600+ agencies on the free HHAeXchange Portal.