Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 60 - STANDARDS ESTABLISHED AND METHODS USED TO ASSURE HIGH QUALITY CARE › Section 12VAC30-60-65 - Electronic visit verification

Current through Register Vol. 40, No. 24, July 15, 2024
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.