Ohio Admin. Code 5160-32-02 - Electronic visit verification (EVV) data collection
(A)
The Ohio department of medicaid (ODM) EVV system
collects and maintains data for medicaid programs and services subject to
participation in the EVV program.
(B)
Data collection
method option:
(1)
Application installed on one of the following
devices:
(a)
An
electronic device provided by ODM that is available at no cost to the service
provider. ODM's contracted entity is responsible for electronic device
distribution, collection, and ongoing maintenance activities.
(b)
A mobile
electronic device owned by the service provider or direct care worker.
(i)
ODM is not
responsible for any costs incurred.
(ii)
Data services
connected to the service provider or direct care worker owned device will be
used to transmit visit data from the application to the data aggregator in near
real time.
(iii)
The device used with the application will comply with
device qualifications found at
https://medicaid.ohio.gov/resources-for-providers/special-programs-and-initiatives/electronic-visit-verification
.
(2)
Telephony: The
use of a phone call to start or end a visit.
(3)
Manual entry:
Manual visit entry is only permissible in the event verification through a
device with an application or telephony is not available or appropriate based
on the immediate needs of the individual . It is not to be used for routine
visit verification.
(4)
Alternate vendor:
(a)
Agency providers
may utilize an alternate EVV system, as described in rule
5160-32-03 of the Administrative
Code.
(b)
Financial management service vendors contracted with
ODM, the Ohio department of aging, the Ohio department of developmental
disabilities, or their designees will obtain and maintain certification as an
alternate vendor.
(C)
Visit data
elements captured in accordance with Section 1093 of the Social Security Act
(42 U.S.C.
1396b) 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 direct care
worker providing the service; and
(6)
The time the
service begins and ends.
(D)
Data
aggregator:
(1)
Collects and stores visit data, regardless of method of
visit capture.
(2)
Confirms visit data present in the EVV system contains
all necessary elements.
(3)
Confirms claims submitted to the payor are supported by
the service provider's visit data.
(E)
Global
positioning system (GPS) functionality of any application or device may be used
only upon obtaining the signed consent of the individual receiving the service.
Signed consent will be obtained annually, and GPS functionality cannot be
activated if consent is not obtained for a respective annual period. The
provider will maintain a copy of that signed consent. An individual who has
provided consent for GPS functionality may revoke that consent at any
time.
(F)
The location of service delivery for each visit will be
recorded by some other means, such as drop-down menus indicating the location
of service in the home or community of the individual .
(G)
It is the
responsibility of the service provider to ensure accuracy of information
entered into the EVV system. Missing visit data or details needing additional
action by the service provider will result in a notification to the service
provider, otherwise known as an exception.
(H)
Claims cannot be
substantiated for payment until all exceptions are resolved by the service
provider and EVV visit data supports the claim. Unsubstantiated claims may
result in denial of payment or post payment review penalty. ODM will
communicate with affected service providers at least three months prior to
initiating the process of claims denial or post payment review penalty due to
EVV as set forth in this paragraph.
Replaces: 5160-1-40
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 01/01/2018, 09/26/2019, 06/12/2020 (Emer.), 02/07/2021
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