Electronic Visit Verification Updates

Statewide Implementation of EVV for Managed Care and NC Medicaid Direct

Beginning July 1, 2021, Electronic Visit Verification (EVV) must be used by all Managed Care Organizations including Prepaid Health Plans (PHPs), Local Management Entity/Managed Care Organizations (LME-MCOs) and NC Medicaid Direct (previously known as fee-for-service).

Provider organizations enrolled to render personal care-type services subject to EVV for NC Medicaid Direct must use Sandata, the state’s EVV solution or aggregator, defined in NC DHB Alt EVV Addendum. Provider organizations contracted by a health plan to render personal care services subject to EVV must use the plan’s EVV solution defined in NC DBH Alt EVV Addendum-PHP. Provider organizations contracted by an LME-MCO to render personal care services subject to EVV must use the LME-MCO’s EVV solution defined in NC DHB Alt EVV LME/MCO.

EVV full compliance was implemented for NC Medicaid Direct on June 1, 2021. All visits subject to EVV must have the required visit data information to assist with the adjudication of a claim.  

EVV compliance for managed care PHPs will have a soft-launch period from July 1, 2021 through Aug. 31, 2021.  After the soft-launch period, the PHPs shall ensure the collection of required EVV data per the 21st Century Cures Act for all claims subject to EVV that were paid for dates of service July 1, 2021 through August 31, 2021. EVV required data components are listed below:

• Type of service performed
• Individual receiving the service
• Date of the service
• Location of service delivery
• Individual providing the service
• Time the service begins and end

All contracted providers are required to comply with the EVV requirements when rendering personal care services subject to EVV. The health plan associated with the contracted provider(s) is responsible to determine how to address providers who are out of compliance and create an action plan for compliance. 

The health plans must collect all EVV data available for dates of service July 1, 2021 through Aug. 31, 2021, to submit to NC Medicaid at the specified time. NC Medicaid will provide additional information the week of July 5, 2021, on encounters and how to submit EVV data collected during the soft launch. 

EVV System Updates 

EVV enhancement through a release to a third-party alternative EVV system will deploy on July 9, 2021, as communicated during the May 21, 2021, stakeholder engagement webinar. The releases are described in the EVV Addendum v1.5.1. The releases are described below.

1. Update ClientQualified field from ClientOtherID to ClientMedicaidID
2. Update ClientIDQualified field to ClientOtherID to ClientMedicaidID
3. New exception codes and adding clarifying language around the exception ID
   • 5 Unscheduled visit
   • 21 No show
4. New program/service codes for PHP and LME-MCO
5. Clarification that employee segment is required

EVV Claim Issues and Resolution Guide

A new section called EVV Claim and Resolution Tips was added to the NC EVV webpage to provide helpful tips in troubleshooting and resolving claims submitted to the NCTracks provider portal or verifying visits in the Sandata solution or aggregator.

Outreach Technical Support Webinar - July 9, 2021

To ensure all enrolled NC Medicaid providers subject to the EVV requirements are 100% compliant with this mandate, a technical support webinar will be held on July 9, 2021, at 11 a.m. This technical support webinar is by invitation only and intended for agencies that have not logged visits or logged very few visits in the Sandata EVV solution or the Sandata aggregator to capture the six required EVV data points as specified in the 21st Century Cures Act.

Personal Care Services Rate Increase

NC Medicaid successfully implemented EVV as required by the 21st Century Cures Act with an effective date of Jan. 1, 2021. To ensure full compliance with this mandate and to compensate for the administrative oversight of capturing the six required EVV data points for personal care services (PCS) subject to EVV, the unit rates for PCS shall be increased by 10% above the $4.51 current rate in effect as described on the specified program’s Fee Schedule.

The new $4.96 rate will be retroactive to Jan. 1, 2021. Impacted providers do not need to make any changes to their previously submitted claims. NC Medicaid will work closely with NCTracks to reprocess non-COVID PCS claims submitted with a date of service on or after Jan. 1, 2021. The reprocessing of these claims will increase non-COVID unit rate by 10% and validate EVV data for those providers subject to the EVV requirements. The validation of the EVV data is to assist NC Medicaid in data collection of EVV key performance indicators. 

PCS included in the Community Alternatives Programs for Children and Disabled Adults (CAP/C and CAP/DA) will require an amendment to the 1915 (c) Home- and Community-based Services waiver application to demonstrate the rate expansion maintains the cost neutrality requirement of home- and community-based waiver planning. Because of the timeline to approve a 1915 (c) waiver application amendment, the reprocessing of the CAP/C and CAP/DA personal care rates may lag behind the reprocessing of the State Plan PCS rates.

The 10% increased unit rate applies to all personal care-type services to ensure parity across programs. The PCS are included in the table below.

State Plan PCS - 99509

Community Alternatives Programs (CAP)

Contact

Medicaid.EVV@dhhs.nc.gov