DAR File No. 43689

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-522

Electronic Visit Verification Requirements for Personal Care and Home Health Care Services

Notice of Proposed Rule

(New Rule)

DAR File No.: 43689
Filed: 05/01/2019 03:59:26 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule is to implement the electronic visit verification (EVV) requirements for personal care services and home health care services in accordance with Section 12006 of the 21st Century Cures Act.

Summary of the rule or change:

This rule outlines EVV provisions for personal care services and home health care services that require an in-home visit by a provider. Specifically, the rule requires record availability upon request, lists the types of data that an EVV system must include, ensures the system complies with federal privacy standards, sets forth Department audit procedures, and spells out provisions for disallowances.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

Due to post-payment audit requirements, the state may see costs associated with increased staffing necessary to perform audit work should existing resources not be sufficient. Post-payment review costs and other state costs may reach $314,000 in total funds by state fiscal year (SFY) 2021.

local governments:

There is no impact to local governments because they do not furnish the types of services identified in the rule.

small businesses:

Small businesses incur additional costs if they perform the personal care and home health care services described in the rule, and need to develop or purchase software or equipment to meet the EVV requirements to contract with another entity. Small businesses would incur a share of the $627,000 estimated impact by SFY 2021.

persons other than small businesses, businesses, or local governmental entities:

Businesses and Medicaid providers incur additional costs if they perform the personal care and home health care services described in the rule, and need to develop or purchase software or equipment to meet the EVV requirements to contract with another entity. These businesses would incur a share of the $627,000 estimated impact by SFY 2021.

Compliance costs for affected persons:

A single person, organization, or business may see a share of the estimated impact of $627,000 in total funds by SFY 2021.

Comments by the department head on the fiscal impact the rule may have on businesses:

This unfunded federal mandate is estimated to increase costs for the State and for businesses by $941,000 by FY 2021.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

06/14/2019

This rule may become effective on:

07/01/2019

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2020	FY 2021	FY 2022
State Government	$156,825	$156,825	$0
Local Government	$0	$0	$0
Small Businesses	$47,055	$47,055	$0
Non-Small Businesses	$109,795	$109,795	$0
Other Persons	$156,825	$156,825	$0
Total Fiscal Costs:	$470,500	$470,500	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	$-470,500	$-470,500	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non-Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non-Small Businesses

About 265 non-small business agencies and providers of home health care and personal care services, will share an estimated cost of $627,000, to implement electronic visit verification (EVV) requirements in accordance with federal law.

 

 

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-522. Electronic Visit Verification Requirements for Personal Care and Home Health Care Services.

R414-522-1. Introduction and Authority.

This rule implements the electronic visit verification requirements for personal care services and home health care services in accordance with Section 12006 of the 21 ^st Century Cures Act. Electronic visit verification requirements apply to all personal care services or home health care services provided under the Medicaid State Plan or a waiver of the State Plan, which require an in-home visit by a provider. This rule is authorized by Section 26-18-3.

 

R414-522-2. Definitions.

(1) "Electronic visit verification" (EVV) means the use of telephone or computer-based technology to verify the data elements related to the delivery of a Medicaid-covered service.

(2) "EVV system" means the combination of the data collection component and the aggregator component used by a provider to comply with EVV requirements established by the Department.

(3) "Home health care services" means services described in Subsection 1905(a)(7) of the Social Security Act, and provided under the Medicaid State Plan or under a 1915(c) waiver of the State Plan.

(4) "Personal care services" means personal care services provided under the Medicaid State Plan or under a waiver of the State Plan.

 

R414-522-3. Electronic Visit Verification Requirements.

EVV is required for all personal care services and home health care services effective July 1, 2019. A provider must select an EVV service vendor and have records available for review upon request. While a specific type of software is not mandated, an EVV system must comply with the provisions of the 21 ^st Century Cures Act, and meet the standards of privacy set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Health Information Technology for Economic and Clinical Health (HITECH) Act. An EVV data system must include:

(1) the type of service performed;

(2) the individual receiving the service;

(3) the date of the service;

(4) the location of service delivery;

(5) the individual providing the service;

(6) the time the service begins and ends; and

(7) the date of creation of the electronic record.

 

R414-522-4. Evaluation of Provider Compliance with Electronic Visit Verification Requirements.

(1) The Department shall conduct annual post-payment reviews of claims requiring EVV for all home health care service and personal care service providers to assess compliance with the requirements.

(2) At random, and for each provider, the Department will select a calendar month within the previous 12-month period and will include as part of its audit, all claims for which a provider has service dates and has received reimbursement. The Department will also include in the audit, encounters paid through managed care within the selected month.

(3) For any claims and encounters for which an associated EVV record cannot be located, or when the EVV record may not be sufficient to meet the requirements in Section R414-522-3, the Department shall present the findings to the provider and allow for an opportunity to refute the findings or request consideration through the fair-hearing process.

(4) Claim and encounter disallowances for personal care services, which do not meet EVV requirements, shall become effective January 1, 2020.

(5) Claim and encounter disallowances for home health care services, which do not meet EVV requirements, shall become effective January 1, 2023.

(6) The Department shall recover funds for claims that do not comply with the provisions of Section 26-18-20.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: 2019

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3