Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.320 - Electronic Visit Verification (EVV)

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment clarifies the requirement to
				  identify direct care workers through entry of the caregiver's respective Family
				  Care Safety Registrant number. This amendment also specifies that the type of
				  service performed is identified through the collection of designated procedure
				  codes and associated modifiers.
(1) Definitions.
(A) "Agency Model Services" shall mean a
				service delivery option in which a contracted agency directs service
				delivery.
(B) "Aggregator Solution"
				shall mean the electronic system that supports the collection of electronic
				visit verification vendor data and stores the data for purposes of analysis and
				monitoring.
(C) "Direct Care
				Worker" shall mean the individual providing the Medicaid funded services to the
				MO HealthNet participant, either through an agency based or self-directed
				model.
(D) "Electronic Visit
				Verification (EVV)" shall mean electronic technology used for the purpose of
				recording the date, location, begin time, end time, type of service, and any
				related tasks. EVV also verifies the identity of the MO HealthNet participant
				and direct care worker in relation to Medicaid funded services authorized by
				the Department of Health and Senior Services (DHSS) or the Department of Mental
				Health (DMH).
(E) Exception" shall
				mean any manual adjustment or update to an EVV record, indicated within the EVV
				system and passed to the aggregator solution.
(F) "MO HealthNet Participant" shall mean an
				individual who the Family Support Division has determined eligible for MO
				HealthNet benefits who is receiving Medicaid funded services authorized by the
				Department of Health and Senior Services or the Department of Mental
				Health.
(G) "Fiscal Agent" shall
				mean a Person or Entity that provides financial management services to a
				self-directed employer.
(H) "Manual
				Visit Entry" shall mean the entry of a paper record, used in exigent
				circumstances for a provider visit to a participant, into the EVV solution. The
				paper record shall be maintained by the provider agency and made available upon
				request from state agency.
(I)
				"Provider Agency" shall mean an agency authorized to deliver Medicaid funded
				services or other Medicaid funded services as defined in this rule, or a fiscal
				agent, as authorized by the Department of Health and Senior Services or the
				Department of Mental Health.
(J)
				"Reason Codes" shall mean codes established by electronic visit verification
				vendors and utilized by personal care service providers to explain a manual
				visit entry/edit or an acknowledgement of exception; passed along to aggregator
				solution.
(K) "Self-Directed
				Services" shall mean a service delivery option in which a MO HealthNet
				participant employs a direct care worker and directs delivery of service
				themselves.
(L) "Services" shall
				mean all Medicaid-funded services, as identified by procedure code, or other
				service required by the state to use EVV including:
1. Advanced Personal Care;
2. Chore Services;
3. Consumer-Directed/Self-Directed Personal
				Care;
4. Homemaker
				Services;
5. In-Home Respite
				authorized by the Department of Health and Senior Services;
6. Personal Care;
7. Any of the above services reimbursed by a
				managed care organization; and
8.
				Any services where federal or state statute or rule requires EVV, but not
				specifically listed above.
(M) "Task" shall mean, as applicable,
				description of a service or services including, but not limited to, tasks
				authorized on the care plan.