Ohio Admin. Code 5160-32-04 - Electronic visit verification (EVV) program providers

(A) This rule establishes Ohio medicaid service provider requirements for services subject to EVV as described in rule 5160-32-01 of the Administrative Code.

(B) All providers and financial management service vendors will:

(1) Complete initial and ongoing training per Ohio department of medicaid (ODM) instructions published on the ODM website https://medicaid.ohio.gov/resources-for-providers/special-programs-and-initiatives .

(2) Create and maintain updated and accurate records of individuals receiving EVV subject services. Needed data elements in the EVV system include:

(a) First and last name.

(b) A minimum of one known address at which the individual may routinely receive services. For individuals participating in the address confidentiality program, in accordance with section 111.42 of the Revised Code, the address documented will be according to program policy and may include a post office box.

(c) Telephone number.

(d) Program billing identifier of the individual receiving the service:

(i) Medicaid identification number, otherwise known as medicaid ID: the unique billing number assigned by ODM. The individual's medicaid ID is necessary for claims validation;

(ii) PASSPORT information management system ID assigned by the Ohio department of aging for individuals temporarily enrolled in the state funded preadmission screening system providing options and resources today (PASSPORT) waiver program. When the individual receiving the service has been assigned a medicaid ID, the provider should update the EVV system with the individual's medicaid ID. Billed claims will not be validated unless the individual receiving the service has an active and valid medicaid ID entered into the system; or

(iii) An indicator that the individual receiving the service is a newborn, not yet assigned a medicaid ID. When the newborn receiving the service has been assigned a medicaid ID, the provider should update the EVV system with the individual's medicaid ID. Billed claims will not be validated unless the newborn receiving the service has an active and valid medicaid ID entered into the system.

(e) Payer, program, and service provided. Valid values accepted are found on ODM's website https://medicaid.ohio.gov/INITIATIVES/Electronic-Visit-Verification/ .

(3) Utilize EVV for all services described in rule 5160-32-01 of the Administrative Code.

(4) Report known or suspected tampering of devices to ODM upon discovery.

(5) Report any known or suspected falsification of EVV data to ODM upon discovery.

(C) Providers and financial management service vendors will create and maintain updated and accurate records of direct care workers providing services. Needed data elements in the EVV system include:

(1) First and last name.

(2) Social security number.

(3) Email address.

(D) State provided electronic device.

(1) A provider electing to request an electronic device provided by ODM will complete EVV training and submit the device request using https://etraconline.net/login .

(2) When a provider is no longer providing services requiring EVV or determines use of the state provided electronic device is no longer desired, the provider will initiate the return process. The return process can be found on ODM's website, https://medicaid.ohio.gov/INITIATIVES/Electronic-Visit-Verification/ .

Replaces: 5160-1-40

Notes

Ohio Admin. Code 5160-32-04

Effective: 7/1/2024
Five Year Review (FYR) Dates: 07/01/2029
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