Community First Health Plans would like to inform providers about two important Electronic Visit Verification (EVV) requirements. One is related to entering missing EVV visits and the other is for new EVV Texas Administrative Code (TAC) rules. Please see below for more details.
The Texas Health and Human Services Commission (HHSC) initiated a claim matching bypass from October 1, 2023, to December 31, 2023 for EVV claims to be paid without a matching EVV visit.
Program providers, Financial Management Services Agencies (FMSAs), and Consumer Directed Services (CDS) employers must enter missing EVV visits not submitted during the EVV claims matching bypass period within the 95-day visit maintenance timeframe.
Community First will not allow the entry of missing EVV visits after the 95-day visit maintenance timeframe has passed.
New EVV TAC Rules
HHSC has adopted new EVV TAC rules that include but are not limited to:
- The Home Health Care Services (HHCS) required by the 21st Century Cures Act, 1903(l) of the Social Security Act (42 U.S.C. §1396b(l)).
- The current policies regarding training, visit maintenance, and requests by program providers and FMSAs to become Proprietary System Operators (PSOs).
- The definitions related to the addition of the new TAC rules.
- The reorganized structure of the existing EVV required personal care services list for clarity.
For more details please reference the new EVV rules outlined in the TAC, Title 1, Part 15, Chapter 354, Subchapter O.
Next steps for Providers:
Providers should share this communication with their staff.
Community First Resources:
https://communityfirsthealthplans.com/provider-newsletter
https://communityfirsthealthplans.com/providers/
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.