Public Law 114-255 (PDF), Minn. Stat. §256B.064

Electronic visit verification (EVV): An electronic system used to record data about the delivery of in-home or community-based services where people receive support with activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs).

All providers who deliver services subject to EVV must comply with federal and state EVV requirements, including financial management services (FMS) providers and managed care organization (MCO) network providers.

This page describes:

Failure to comply may result in corrective actions and payment sanctions under Minn. Stat. §256B.064.

Providers who deliver EVV services (including FMS providers) must:

The following sections provide more information about these responsibilities.

Providers must maintain accurate EVV enrollment, in accordance with EVV enrollment policy.

DHS uses EVV enrollment information as part of its compliance monitoring and determination process. Providers must ensure their EVV enrollment records remain accurate and current, including all required tax IDs and associated NPI and UMPI numbers.

Providers that do not maintain accurate EVV enrollment may be determined noncompliant.

Providers must submit all required EVV visits through HHAX, either:

Providers must submit all required EVV visits, including visits that are incomplete or noncompliant. Providers cannot exclude or withhold required visits because they do not meet EVV compliance requirements.

Comparison of confirmed and compliant visits

A visit may be confirmed but still be noncompliant (i.e., does not meet all EVV verification requirements).

A confirmed visit is a visit submitted to the provider's EVV system that contains the required EVV data and is available for claims review. A confirmed visit is not automatically considered compliant.

A compliant visit is a confirmed visit that also meets all applicable DHS EVV requirements, including real-time verification using an approved EVV verification method such as:

Providers must submit confirmed visits for claims review and billing purposes, even when the visits are noncompliant.

Manually entered visits and corrections

Manually entered visits, corrected visits and visits that were not verified when services were provided are considered noncompliant because they were not verified in real time (unless otherwise allowed under the policy for live-in caregivers; refer to CBSM – EVV live-in caregiver policy).

Signatures

Signatures are not required for EVV and do not affect EVV compliance. Some services that require EVV also require signatures. Providers can choose to gather signatures within the EVV system or use their existing processes.

Timeline

Providers must submit all required EVV data, including corrections, by the 14th of each month. DHS bases quarterly compliance determinations on the EVV data submitted by that deadline. DHS does not use EVV data submitted after the deadline to determine provider compliance.

On the 15th of each month, HHAX sends providers a compliance report for the previous month to the email address used during HHAX enrollment.

Providers must:

Providers should use monthly HHAX compliance reports to monitor and improve compliance throughout the quarter. However, these reports do not represent DHS compliance determinations. DHS uses these reports to monitor provider compliance, identify trends and support provider outreach.

When DHS determines a provider is noncompliant during a quarterly compliance review, DHS notifies the provider through their MN–ITS mailbox.

Note: Providers still must meet all applicable EVV requirements for services they deliver while they complete corrective actions and enforcement actions described in this section.

Corrective actions

DHS applies corrective actions progressively based on compliance history, previous corrective actions and response to corrective actions. Corrective actions give providers the opportunity to address noncompliance and return to compliance before DHS takes additional enforcement actions.

Increase compliance

Providers determined noncompliant for the first time must increase their EVV compliance by the next quarterly review.

Standard corrective action plan (CAP)

Providers that continue to be noncompliant during the next quarterly compliance review must:

Comprehensive interventions

Providers that continue to be noncompliant after completing a standard CAP must participate in comprehensive interventions identified by DHS.

DHS determines appropriate comprehensive interventions based on compliance history, previous corrective actions, response to corrective actions and individual circumstances. Comprehensive interventions may include, but are not limited to:

Timelines

Providers must complete all corrective actions within the timeframes established by DHS.

Enforcement actions

Providers that fail to complete required corrective actions or continue to remain noncompliant are subject to enforcement actions authorized under Minn. Stat. §256B.064.

Payment withholds

DHS will withhold payment when providers do not complete required corrective actions, including failure to:

A payment withhold remains in effect until DHS determines the provider met the requirements to lift it.

Additional enforcement actions

DHS may take one or more additional enforcement actions authorized under Minn. Stat. §256B.064, including:

Enrollment termination

If a provider continues to be noncompliant with EVV requirements, DHS may terminate their enrollment with Minnesota Health Care Programs (MHCP). DHS considers compliance history, previous outreach, corrective actions, response to corrective actions and other relevant information when determining whether termination is appropriate.

DHS can terminate provider enrollment for one or more of the following reasons:

If a provider meets any of these conditions, DHS may revoke their billing privileges and terminate their enrollment, per Minn. Stat. §256B.04, sub. 22 and Minn. Stat. §256B.064. If DHS terminates a provider’s enrollment, they will receive written notice of the termination decision. The notice will include appeal rights.

Live-in caregivers are exempt from the real-time EVV verification requirement, as described on CBSM – EVV live-in caregiver policy. Providers must ensure they identify live-in caregivers correctly in their EVV system and submit required EVV data in accordance with DHS EVV policy.

Properly identified live-in caregiver visits are excluded from compliance calculations. Manual entries that are not properly identified as live-in caregiver visits are included in compliance calculations.

MCOs must:

The following actions have the biggest impact on a provider’s compliance: