A.
Definitions. The following words and terms when used in this section shall have
the following meanings unless the context clearly indicates otherwise:
"Aide" means the person who is employed by an agency to
provide hands-on care.
"Agency-directed services" means a model of service delivery
where an agency is responsible for providing direct support staff, for
maintaining an individual's records, and for scheduling the dates and times of
the direct support staff's presence in the individual's home for personal care
services, respite care services, and companion services.
"Attendant" means the person who is hired by the individual
consumer to provide hands-on care.
"Companion services" means nonmedical care, supervision, and
socialization provided to an adult individual (ages 18 years and older). The
provision of companion services shall not entail hands-on care but shall be
provided in accordance with a therapeutic goal in the individual support plan
and is not purely diversional in nature.
"Consumer-directed attendant" means a person who provides
consumer-directed personal care services, respite care services, companion
services, or any combination of these three services, who is also exempt from
workers' compensation.
"Consumer-directed services" or "CD services" means the model
of service delivery for which the individual enrolled in the waiver or the
individual's employer of record, as appropriate, is responsible for hiring,
training, supervising, and firing of an attendant who renders the services that
are reimbursed by DMAS.
"DMAS" means the Department of Medical Assistance
Services.
"Electronic visit verification" or "EVV" means a system by
which personal care services, companion services, or respite care services home
visits are electronically verified with respect to (i) the type of service
performed, (ii) the individual receiving the service, (iii) the date of the
service, (iv) the location of service delivery, (v) the individual providing
the service, and (vi) the time the service begins and ends.
"Individual" means the person who has applied for and been
approved to receive services for which EVV is required.
"Personal care services" means a range of support services
that includes assistance with activities of daily living and instrumental
activities of daily living, access to the community, and self-administration of
medication or other medical needs and the monitoring of health status and
physical condition provided through the agency-directed or consumer-directed
model of service. Personal care services shall be provided by a personal care
attendant or aide within the scope of the attendant's or aide's license or
certification, as appropriate.
"Respite care services" means services provided to waiver
individuals who are unable to care for themselves that are furnished on a
short-term basis because of the absence of or need for the relief of the unpaid
primary caregiver who normally provides the care.
B. Applicable services. All of the
requirements for an electronic visit verification system shall apply to all
providers, both agency-directed and consumer-directed, of personal care
services, respite care services, and companion services unless exempt under
subsection C of this section.
1. Agency
providers shall choose the EVV system that best suits the provider business
model, meets regulatory requirements established in this section, and provides
reliable functionality for the geographic area in which it is to be
used.
2. For consumer-directed
services, the DMAS designee (the fiscal employer agent) shall select and
operate an EVV system to support an individual, or the employer of record, in
managing the individual's care, meeting regulatory requirements established in
this section, and providing reliable functionality for the geographic area in
which it is to be used.
3.
Providers of consumer-directed personal care services, respite care services,
and companionservices shall comply with all EVV requirements.
4. Providers of agency-directed personal care
services, respite care services, and companion services shall comply with all
EVV requirements.
5. Individuals
shall not be restricted from receiving a combination of agency-directed and
consumer-directed services. Nothing in this section shall be construed to limit
personal care, respite care, or companion services; an individual's selection
of a provider attendant or aide; or impede the manner or location in which
services are delivered subject to subsection C of this section.
C. The following entities and
individuals shall be exempt from EVV requirements:
1. A DBHDS-licensed provider in a
DBHDS-licensed program site, such as a group home or sponsored residential home
or a supervised living, supported living, or similar facility or location
licensed to provide respite care services;
2. The Regional Educational Assessment Crisis
Response and Habilitation (REACH) Program;
3. Schools where personal care services are
rendered under the authority of an individual education program; and
4. Live-in caregivers.
D. System requirements.
1. The EVV system shall be capable of
capturing required data in real time and producing such data as requested by
DMAS in electronic format. The following information shall be retained:
a. The type of the service being
performed;
b. The individual who
receives the service;
c. The date
of the service, including month, day, and year;
d. The time the service begins and
ends;
e. The location of the
service delivery at the beginning and the end of the service. EVV systems shall
not restrict locations where individuals may receive services; and
f. The attendant or aide who provides the
service.
2. In the event
the time of service delivery needs to be adjusted, the start or end time may be
modified by someone who has the provider's authority to adjust the aide's or
attendant's hours.
a. For agency-directed
providers, this may be a supervisor or the agency owner or a designee who has
authority to make independent verifications. In no case shall workers be
allowed to adjust a peer worker's reported time.
b. For consumer-directed attendants, the
fiscal employer agent shall have this authority.
3. All EVV systems shall be compliant with
the requirements of the American with Disabilities Act (42 USC
§
12101 et seq.) and Health Insurance
Portability and Accountability Act of 1996 (
P.L.
104-191).
4. All EVV systems shall employ electronic
devices that are capable of recording the required data described in
subdivision D 1 of this section, producing it upon demand, and safeguarding the
data both physically and electronically.
5. All EVV systems shall be accessible for
input or service delivery 24 hours per day, seven days per week.
6. All EVV systems shall provide for data
backups in the event of emergencies; disasters, natural or otherwise; and
system malfunctions, both in the location services are being delivered and the
backup server location.
7. All EVV
systems shall be capable of handling:
a.
Multiple work shifts per day per individual or aide or attendant
combination;
b. Aides or attendants
who work for multiple individuals;
c. Individuals who use multiple aides or
attendants;
d. Multiple individuals
and multiple aides or attendants or both in the same location at the same time
and date. In such situations, the EVV shall be capable of separately
documenting the services, as well as the other elements set out in subdivision
D 1 of this section, that are provided to each individual; and
e. At minimum, daily backups of the most
recent data that has been entered.
8. All EVV systems shall be capable of
electronically transmitting information to DMAS in the required format or
electronically transferring it to the provider's billing system.
E. EVV data shall be submitted to
DMAS with the provider's billing claim in a manner that conforms with agency
specifications.
F. Agency-directed
provider records, audits, and reports.
1.
Providers shall select and obtain an EVV system that meets the functional
requirements of DMAS or its designee.
2. All providers shall retain EVV data for at
least six years from the last date of service or as provided by applicable
federal and state laws, whichever period is longer. However, if an audit is
initiated within the required retention period, the records shall be retained
until the audit is completed and every exception is resolved. Policies
regarding retention of records shall apply even if the provider discontinues
operation.
a. In the event a provider
discontinues services, DMAS shall be notified in writing of the storage
location and procedures for obtaining records for review should the need
arise.
b. The location, agent, or
trustee shall be within the Commonwealth.
3. All providers shall retain records of
minor individuals for at least six years after such minor individual has
reached 18 years of age.
4. All
providers shall produce their archived EVV data in a timely manner and in an
electronic format when requested by DMAS or its designee.
5. In the event that a telephone or other
verification option that the provider uses is not available or accessible in
the individual's home or location, and delayed data input is utilized, the
provider shall have information on file documenting the reason that the aide or
attendant did not use EVV for the service delivered.
