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Utah Administrative Code (Current through November 1, 2019) |
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R414. Health, Health Care Financing, Coverage and Reimbursement Policy |
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R414-522. Electronic Visit Verification Requirements for Personal Care and Home Health Care Services |
R414-522. Electronic Visit Verification Requirements for Personal Care and Home Health Care Services
| R414-522-1. Introduction and Authority |
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This rule implements the electronic visit verification requirements for personal care services and home health care services in accordance with Section 12006 of the 21st Century Cures Act. Electronic visit verification requirements apply to all personal care services or home health care services provided under the Medicaid State Plan or a waiver of the State Plan, which require an in-home visit by a provider. This rule is authorized by Section 26-18-3. |
| R414-522-2. Definitions |
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(1) "Electronic visit verification" (EVV) means the use of telephone or computer-based technology to verify the data elements related to the delivery of a Medicaid-covered service. (2) "EVV system" means the combination of the data collection component and the aggregator component used by a provider to comply with EVV requirements established by the Department. (3) "Home health care services" means services described in Subsection 1905(a)(7) of the Social Security Act, and provided under the Medicaid State Plan or under a 1915(c) waiver of the State Plan. (4) "Personal care services" means personal care services provided under the Medicaid State Plan or under a waiver of the State Plan. |
| R414-522-3. Electronic Visit Verification Requirements |
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EVV is required for all personal care services and home health care services effective July 1, 2019. A provider must select an EVV service vendor and have records available for review upon request. While a specific type of software is not mandated, an EVV system must comply with the provisions of the 21st Century Cures Act, and meet the standards of privacy set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Health Information Technology for Economic and Clinical Health (HITECH) Act. An EVV data system must 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 individual providing the service; (6) the time the service begins and ends; and (7) the date of creation of the electronic record. |
| R414-522-4. Evaluation of Provider Compliance with Electronic Visit Verification Requirements |
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(1) The Department shall conduct annual post-payment reviews of claims requiring EVV for all home health care service and personal care service providers to assess compliance with the requirements. (2) At random, and for each provider, the Department will select a calendar month within the previous 12-month period and will include as part of its audit, all claims for which a provider has service dates and has received reimbursement. The Department will also include in the audit, encounters paid through managed care within the selected month. (3) For any claims and encounters for which an associated EVV record cannot be located, or when the EVV record may not be sufficient to meet the requirements in Section R414-522-3, the Department shall present the findings to the provider and allow for an opportunity to refute the findings or request consideration through the fair-hearing process. (4) Claim and encounter disallowances for personal care services, which do not meet EVV requirements, shall become effective January 1, 2020. (5) Claim and encounter disallowances for home health care services, which do not meet EVV requirements, shall become effective January 1, 2023. (6) The Department shall recover funds for claims that do not comply with the provisions of Section 26-18-20. |