As an Ohio homecare provider – in between managing scheduling, billing, payroll, and other daily challenges – you’re probably gearing up for one very important deadline: the Cures Act EVV mandate.
While the Cures Act federal deadline was set for January 1, 2020, Ohio was granted a Good Faith Effort (GFE) exemption by the Centers for Medicare and Medicaid Services (CMS), allowing the state to delay implementation of EVV for one year.
Though providers will not face penalties such as claim denials for non-compliance until January 2021, it’s critical to begin preparing for EVV now, as implementation does not come without its challenges. However, with the right approach, and the right tools, you can be well on your way to ensuring 100% compliance with the Cures Act.
Check out all of the details below to get up to speed on what’s happening in OH.
Signed into law in December 2016, the 21st Century Cures Act was designed to decrease fraud, waste, and abuse, and to help bring new innovations and medical advances faster to
patients who need them. Included in the Cures Act is a provision requiring the use of Electronic Visit Verification (EVV) for all personal care services, home health visits, and private duty nursing provided under Medicaid.
The Cures Act requires homecare visits to be electronically verified for the type, date, and location of the service being performed; the individual receiving the service; the caregiver or aide performing the service, and the time the service begins and ends.
The Ohio Department of Medicaid (ODM) began using an EVV system for many home and community-based services on January 8, 2018. EVV implementation for the state was broken up into three phases, based on the type of service performed.
Source: Ohio Department of Medicaid (ODM)
Training for Phase 3 of EVV is tentatively scheduled for fall 2020 and will include self-directed services, home health therapies, and any other services necessary to meet federal requirements.
Last year, Ohio was granted a Good Faith Effort exemption from CMS, delaying the state’s EVV deadline to January 1, 2021. While Phase 1 and 2 providers are already expected to be in compliance with the Cures Act, claims for payment for all relevant services provided without corresponding electronic visits will not be automatically denied until the 2021 deadline.
EVV is required for all home health services including home health visits, private duty nursing, and personal care services. According to ODM, providers must:
Verify delivery of services using an EVV system at the beginning and end of each home health 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.
If you’re contracted with one of Ohio’s five MCOs (United Healthcare, Molina, Buckeye, Paramount, or CareSource), you can continue to use your current EVV solution, as long as your vendor can send the correct information to the MCO’s visit confirmation and claims platform. Ohio’s MCOs will be responsible for collecting providers’ EVV data and submitting it to the state. If an agency is involved with the Consumer Directed program, the Fiscal/Employer Agent will provide an EVV system to collect EVV data.
ODM has contracted with Sandata Technologies to aggregate EVV data on behalf of the state. However, you do not need to directly contract with the state’s aggregator. There is no charge to your agency to send EVV data to the state, and in many cases, your EVV platform, including HHAeXchange, will send this data to the state’s aggregator on your behalf.
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 Ohio Medicaid program.
For news on EVV in Ohio and other important information regarding EVV requirements, we recommend you visit the Ohio Department of Medicaid website.
Since Ohio is an Open Model state, providers are free to choose the EVV solution that best meets the needs of their agency and complies with the Cures Act requirements. If you currently use HHAeXchange for EVV, you are in compliance with Ohio’s mandate since HHAeXchange has been approved by ODM as an Alternative EVV Solution Provider and meets all of ODM’s requirements. If you still need to find an EVV solution before the January 2021 deadline, contact us to learn more.
HHAeXchange is the industry leader in providing EVV solutions across the country with over 214 million visits confirmed annually through our platform, and we are actively providing solutions to meet EVV requirements for Ohio homecare agencies.
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