Common use of Electronic Visit Verification Clause in Contracts

Electronic Visit Verification. (EVV) a. The Contractor shall develop or purchase and implement an electronic visit verification system to monitor member receipt and utilization of personal care services including at a minimum, personal care assistance, home based supportive care and in-home respite. This includes all applicable self-directed personal care services. b. The Contractor shall oversee its selected EVV vendor to ensure the EVV system operates in compliance with this Contract, with policies and protocols established by DMAHS, and with the requirements of the 21st Century Cures Act. The 21st Century Cures Act requires electronic (not manual) verification of the type of service performed, the individual receiving the service, the date of the service, location of service delivery, the individual providing the service, and time the service begins and ends. The Contractor shall notify DMAHS within five (5) business days of the identification of any issue affecting EVV system operation which impacts the Contractor’s performance of this Contract, including actions that will be taken by the Contractor to resolve the issue and the specific timeframes within which such actions shall be completed. c. At a minimum, recredentialing of providers shall include verification of continued licensure and/or certification (as applicable); compliance with policies and procedures identified during credentialing, including background checks and training requirements, use of the EVV; and compliance with the HCBS Settings Rule detailed in 42 C.F.R. § 441.301(c)(4)-(5). d. The Contractor shall monitor all manual confirmations and take action to eliminate manual confirmations to ensure compliance with 21st Century Cures Act EVV system requirements by January 1, 2022. i. Contractor shall pay claims for visits recorded in an EVV system which may require manual intervention. ii. The Contractor shall utilize an exceptions process as specified by DMAHS for visits recorded manually and outside the EVV system. e. The Contractor shall generate reports and conduct audits according to DMAHS specification to ensure members are receiving necessary services. The Contractor shall take appropriate remedial action against providers and workers who repeatedly fail to use the EVV system as required. f. The Contractor shall select its own electronic visit verification vendor, as applicable, and shall ensure, in the development of its EVV system, the following minimal functionality: i. The ability to effectively connect with the state procured contracted EVV aggregator; ii. The ability to receive and store service authorizations for individual members; iii. The ability to log the arrival and departure of an individual provider staff person or worker, through the use of a mobile device, member landline telephone or a static GPS device, when mobile and landline service is not available; iv. Contractor shall maintain records of unique staff identifier to allow for auditing and reporting for program integrity; v. The ability to verify in accordance with business rules that services are being delivered in the correct location (e.g., the member’s home); vi. The ability to match services provided to a member with services authorized in the plan of care; vii. The ability to ensure that the provider/worker delivering the service is authorized to deliver such services; viii. The ability to create a schedule of services from the service authorizations entered for each member which identifies the amount, frequency, duration and scope of each service, and any schedule specified in which services are needed or preferred by the member; ix. Ensure that workers are scheduled by providers in accordance with such authorization, including any schedule of services specified; and to ensure providers’ adherence to the established schedule; x. The ability to distinguish between electronic confirmation versus manual confirmation. g. The EVV system shall have the ability to receive and store service authorizations and service schedules as required. Schedule data must be used to compare to visit verification. i. The ability to identify gaps in care and provide system-generated reporting regarding each provider’s compliance with scheduling requirements, late and missed visits, and other data specified by DMAHS; ii. The ability to allow more flexible scheduling options, including the option for open scheduling while still performing all remaining system functions; iii. The ability to receive and store updated authorizations and provide timely notification to the provider of the updates; iv. Outline the process for provider to update schedules based on changes in authorization information. v. The ability to capture worker notes per service provided and provide such notes to the provider, MCO and DMAHS as appropriate, upon request; vi. Access to the EVV system and a dashboard for DMAHS to conduct monitoring of the Contractor’s performance with the requirements detailed above; h. The Contractor shall establish business processes regarding EVV and ensure efficient operation of EVV. The Contractor must ensure the following: i. Timely as defined by 4.6.4B of this Contract. ii. Consistency between MCO authorizations, and the authorizations reflected in the EVV system. iii. Timely remediation of issues associated with claims rejections or denials in order to provide appropriate claims adjudication for services delivered. iv. Ongoing monitoring of the total volume of rejected or denied claims due to issues with the EVV system. v. In instances where systems outages, breakdowns, etc. are identified, the Contractor shall notify DMAHS and providers immediately. vi. Contractor shall collaborate with the Fiscal Intermediary for Self- Direction to determine root cause for rejections or denials.

Electronic Visit Verification. (EVV) a. The Contractor shall develop or purchase and implement an electronic visit verification system to monitor member receipt and utilization of personal care services including at a minimum, personal care assistance, home based supportive care and in-home respite. This includes all applicable self-directed personal care services. b. The Contractor shall oversee its selected EVV vendor to ensure the EVV system operates in compliance with this Contract, with policies and protocols established by DMAHS, and with the requirements of the 21st Century Cures Act. The 21st Century Cures Act requires electronic (not manual) verification of the type of service performed, the individual receiving the service, the date of the service, location of service delivery, the individual providing the service, and time the service begins and ends. The Contractor shall notify DMAHS within five (5) business days of the identification of any issue affecting EVV system operation which impacts the Contractor’s 's performance of this Contract, including actions that will be taken by the Contractor to resolve the issue and the specific timeframes within which such actions shall be completed. c. At a minimum, recredentialing of providers shall include verification of continued licensure and/or certification (as applicable); compliance with policies and procedures identified during credentialing, including background checks and training requirements, use of the EVV; and compliance with the HCBS Settings Rule detailed in 42 C.F.R. § 441.301(c)(4)-(5). d. The Contractor shall monitor all manual confirmations and take action to eliminate manual confirmations to ensure compliance with 21st Century Cures Act EVV system requirements by January 1, 2022. i. I. Contractor shall pay claims for visits recorded in an EVV system which may require manual intervention. iiII. The Contractor shall utilize an exceptions process as specified by DMAHS for visits recorded manually and outside the EVV system. e. The Contractor shall generate reports and conduct audits according to DMAHS specification to ensure members are receiving necessary services. The Contractor shall take appropriate remedial action against providers and workers who repeatedly fail to use the EVV system as required. f. The Contractor shall select its own electronic visit verification vendor, as applicable, and shall ensure, in the development of its EVV system, the following minimal functionality: i. I. The ability to effectively connect with the state procured contracted EVV aggregator; iiII. The ability to receive and store service authorizations for individual members; iiiIII. The ability to log the arrival and departure of an individual provider staff person or worker, through the use of a mobile device, member landline telephone or a static GPS device, when mobile and landline service is not available; ivIV. Contractor shall maintain records of unique staff identifier to allow for auditing and reporting for program integrity; v. V. The ability to verify in accordance with business rules that services are being delivered in the correct location (e.g., the member’s 's home); viVI. The ability to match services provided to a member with services authorized in the plan of care; viiVII. The ability to ensure that the provider/worker delivering the service is authorized to deliver such services; viiiVIII. The ability to create a schedule of services from the service authorizations entered for each member which identifies the amount, frequency, duration and scope of each service, and any schedule specified in which services are needed or preferred by the member; ixIX. Ensure that workers are scheduled by providers in accordance with such authorization, including any schedule of services specified; and to ensure providers’ ' adherence to the established schedule; x. X. The ability to distinguish between electronic confirmation versus manual confirmation. g. The EVV system shall have the ability to receive and store service authorizations and service schedules as required. Schedule data must be used to compare to visit verification. i. I. The ability to identify gaps in care and provide system-generated reporting regarding each provider’s 's compliance with scheduling requirements, late and missed visits, and other data specified by DMAHS; iiII. The ability to allow more flexible scheduling options, including the option for open scheduling while still performing all remaining system functions; iiiIII. The ability to receive and store updated authorizations and provide timely notification to the provider of the updates; ivIV. Outline the process for provider to update schedules based on changes in authorization information. v. V. The ability to capture worker notes per service provided and provide such notes to the provider, MCO and DMAHS as appropriate, upon request; viVI. Access to the EVV system and a dashboard for DMAHS to conduct monitoring of the Contractor’s 's performance with the requirements detailed above; h. The Contractor shall establish business processes regarding EVV and ensure efficient operation of EVV. The Contractor must ensure the following: i. I. Timely as defined by 4.6.4B of this Contract. iiII. Consistency between MCO authorizations, and the authorizations reflected in the EVV system. iiiIII. Timely remediation of issues associated with claims rejections or denials in order to provide appropriate claims adjudication for services delivered. ivIV. Ongoing monitoring of the total volume of rejected or denied claims due to issues with the EVV system. v. a. In instances where systems outages, breakdowns, etc. are identified, the Contractor shall notify DMAHS and providers immediately. vi. V. Contractor shall collaborate with the Fiscal Intermediary for Self- Self-Direction to determine root cause for rejections or denials. VI. Contractor shall perform monthly program integrity audits of rendering provider credentials (certified home health aide, registered nurse, licensed practical nurse, physical therapist, cognitive therapist, occupational therapist, speech therapist) to verify services were provided by the authorized provider for such service. If it is determined that the credentials are incorrect, expired, or missing the Contractor shall adhere to A.7.2.1A and 7.36.5 et al (RECOVERIES AND OVERPAYMENTS) of the MCO contract.”

Electronic Visit Verification. (EVV) a. The Contractor shall develop or purchase and implement an electronic visit verification system to monitor member receipt and utilization of personal care services including at a minimum, personal care assistance, home based supportive care and in-home respite. This includes all applicable self-directed personal care services. b. The Contractor shall oversee its selected EVV vendor to ensure the EVV system operates in compliance with this Contract, with policies and protocols established by DMAHS, and with the requirements of the 21st Century Cures Act. The 21st Century Cures Act requires electronic (not manual) verification of the type of service performed, the individual receiving the service, the date of the service, location of service delivery, the individual providing the service, and time the service begins and ends. The Contractor shall notify DMAHS within five (5) business days of the identification of any issue affecting EVV system operation which impacts the Contractor’s performance of this Contract, including actions that will be taken by the Contractor to resolve the issue and the specific timeframes within which such actions shall be completed. c. At a minimum, recredentialing of providers shall include verification of continued licensure and/or certification (as applicable); compliance with policies and procedures identified during credentialing, including background checks and training requirements, use of the EVV; and compliance with the HCBS Settings Rule detailed in 42 C.F.R. § 441.301(c)(4)-(5). d. The Contractor shall monitor all manual confirmations and take action to eliminate manual confirmations to ensure compliance with 21st Century Cures Act EVV system requirements by January 1, 2022. i. Contractor shall pay claims for visits recorded in an EVV system which may require manual intervention. ii. The Contractor shall utilize an exceptions process as specified by DMAHS for visits recorded manually and outside the EVV system. e. The Contractor shall generate reports and conduct audits according to DMAHS specification to ensure members are receiving necessary services. The Contractor shall take appropriate remedial action against providers and workers who repeatedly fail to use the EVV system as required. f. The Contractor shall select its own electronic visit verification vendor, as applicable, and shall ensure, in the development of its EVV system, the following minimal functionality: i. The ability to effectively connect with the state procured contracted EVV aggregator; ii. The ability to receive and store service authorizations for individual members; iii. The ability to log the arrival and departure of an individual provider staff person or worker, through the use of a mobile device, member landline telephone or a static GPS device, when mobile and landline service is not available; iv. Contractor shall maintain records of unique staff identifier to allow for auditing and reporting for program integrity; v. The ability to verify in accordance with business rules that services are being delivered in the correct location (e.g., the member’s home); vi. The ability to match services provided to a member with services authorized in the plan of care; vii. The ability to ensure that the provider/worker delivering the service is authorized to deliver such services; viii. The ability to create a schedule of services from the service authorizations entered for each member which identifies the amount, frequency, duration and scope of each service, and any schedule specified in which services are needed or preferred by the member; ix. Ensure that workers are scheduled by providers in accordance with such authorization, including any schedule of services specified; and to ensure providers’ adherence to the established schedule; x. The ability to distinguish between electronic confirmation versus manual confirmation. g. The EVV system shall have the ability to receive and store service authorizations and service schedules as required. Schedule data must be used to compare to visit verification. i. The ability to identify gaps in care and provide system-generated reporting regarding each provider’s compliance with scheduling requirements, late and missed visits, and other data specified by DMAHS; ii. The ability to allow more flexible scheduling options, including the option for open scheduling while still performing all remaining system functions; iii. The ability to receive and store updated authorizations and provide timely notification to the provider of the updates; iv. Outline the process for provider to update schedules based on changes in authorization information. v. The ability to capture worker notes per service provided and provide such notes to the provider, MCO and DMAHS as appropriate, upon request; vi. Access to the EVV system and a dashboard for DMAHS to conduct monitoring of the Contractor’s performance with the requirements detailed above; h. The Contractor shall establish business processes regarding EVV and ensure efficient operation of EVV. The Contractor must ensure the following: i. Timely as defined by 4.6.4B of this Contract. ii. Consistency between MCO authorizations, and the authorizations reflected in the EVV system. iii. Timely remediation of issues associated with claims rejections or denials in order to provide appropriate claims adjudication for services delivered. iv. Ongoing monitoring of the total volume of rejected or denied claims due to issues with the EVV system. v. a. In instances where systems outages, breakdowns, etc. are identified, the Contractor shall notify DMAHS and providers immediately. vi. v. Contractor shall collaborate with the Fiscal Intermediary for Self- Direction to determine root cause for rejections or denials. vi. Contractor shall perform monthly program integrity audits of rendering provider credentials (certified home health aide, registered nurse, licensed practical nurse, physical therapist, cognitive therapist, occupational therapist, speech therapist) to verify services were provided by the authorized provider for such service. If it is determined that the credentials are incorrect, expired, or missing the Contractor shall adhere to A.7.2.1A and

Electronic Visit Verification. (EVV) a. The Contractor shall develop or purchase and implement an electronic visit verification system to monitor member receipt and utilization of personal care services including at a minimum, personal care assistance, home based supportive care and in-home respite. This includes all applicable self-directed personal care services. b. The Contractor shall oversee its selected EVV vendor to ensure the EVV system operates in compliance with this Contract, with policies and protocols established by DMAHS, and with the requirements of the 21st Century Cures Act. The 21st Century Cures Act requires electronic (not manual) verification of the type of service performed, the individual receiving the service, the date of the service, location of service delivery, the individual providing the service, and time the service begins and ends. The Contractor shall notify DMAHS within five (5) business days of the identification of any issue affecting EVV system operation which impacts the Contractor’s performance of this Contract, including actions that will be taken by the Contractor to resolve the issue and the specific timeframes within which such actions shall be completed. c. At a minimum, recredentialing of providers shall include verification of continued licensure and/or certification (as applicable); compliance with policies and procedures identified during credentialing, including background checks and training requirements, use of the EVV; and compliance with the HCBS Settings Rule detailed in 42 C.F.R. § 441.301(c)(4)-(5). d. The Contractor shall monitor all manual confirmations and take action to eliminate manual confirmations to ensure compliance with 21st Century Cures Act EVV system requirements by January 1, 2022. i. Contractor shall pay claims for visits recorded in an EVV system which may require manual intervention. ii. The Contractor shall utilize an exceptions process as specified by DMAHS for visits recorded manually and outside the EVV system. e. The Contractor shall generate reports and conduct audits according to DMAHS specification to ensure members are receiving necessary services. The Contractor shall take appropriate remedial action against providers and workers who repeatedly fail to use the EVV system as required. f. The Contractor shall select its own electronic visit verification vendor, as applicable, and shall ensure, in the development of its EVV system, the following minimal functionality: i. The ability to effectively connect with the state procured contracted EVV aggregator; ii. The ability to receive and store service authorizations for individual members; iii. The ability to log the arrival and departure of an individual provider staff person or worker, through the use of a mobile device, member landline telephone or a static GPS device, when mobile and landline service is not available; iv. Contractor shall maintain records of unique staff identifier to allow for auditing and reporting for program integrity; v. The ability to verify in accordance with business rules that services are being delivered in the correct location (e.g., the member’s home); vi. The ability to match services provided to a member with services authorized in the plan of care; vii. The ability to ensure that the provider/worker delivering the service is authorized to deliver such services; viii. The ability to create a schedule of services from the service authorizations entered for each member which identifies the amount, frequency, duration and scope of each service, and any schedule specified in which services are needed or preferred by the member; ix. Ensure that workers are scheduled by providers in accordance with such authorization, including any schedule of services specified; and to ensure providers’ adherence to the established schedule; x. The ability to distinguish between electronic confirmation versus manual confirmation. g. The EVV system shall have the ability to receive and store service authorizations and service schedules as required. Schedule data must be used to compare to visit verification. i. The ability to identify gaps in care and provide system-generated reporting regarding each provider’s compliance with scheduling requirements, late and missed visits, and other data specified by DMAHS; ii. The ability to allow more flexible scheduling options, including the option for open scheduling while still performing all remaining system functions; iii. The ability to receive and store updated authorizations and provide timely notification to the provider of the updates; iv. Outline the process for provider to update schedules based on changes in authorization information. v. The ability to capture worker notes per service provided and provide such notes to the provider, MCO and DMAHS as appropriate, upon request; vi. Access to the EVV system and a dashboard for DMAHS to conduct monitoring of the Contractor’s performance with the requirements detailed above; h. The Contractor shall establish business processes regarding EVV and ensure efficient operation of EVV. The Contractor must ensure the following: i. Timely as defined by 4.6.4B of this Contract. ii. Consistency between MCO authorizations, and the authorizations reflected in the EVV system. iii. Timely remediation of issues associated with claims rejections or denials in order to provide appropriate claims adjudication for services delivered. iv. a. Ongoing monitoring of the total volume of rejected or denied claims due to issues with the EVV system. v. iv. In instances where systems outages, breakdowns, etc. are identified, the Contractor shall notify DMAHS and providers immediately. vi. v. Contractor shall collaborate with the Fiscal Intermediary for Self- Self-Direction to determine root cause for rejections or denials. vi. Contractor shall perform monthly program integrity audits of rendering provider credentials (certified home health aide, registered nurse, licensed practical nurse, physical therapist, cognitive therapist, occupational therapist, speech therapist) to verify services were provided by the authorized provider for such service. If it is determined that the credentials are incorrect, expired, or missing the Contractor shall recoup payment from the provider.