Florida Electronic Visit Verification Information
The COVID-19 world pandemic has caused a ripple effect across the healthcare sector in the U.S and abroad. EVV, PDGM, and other regulatory changes which have recently gone into effect or were scheduled to go into effect have all been impacted.In this edition of the Home Health blog, we take a look at the latest on EVV in the state of Florida.
Florida is considered an “Open Model” state, which essentially mean that care agency providers are free to select any system for EVV they choose, as long as the Florida Evv system they select collects the six data elements as required by the 21st Century CURES Act. AHCA Florida requires that agencies must verify the delivery of personal care and home health services using an Electronic Visit Verification (EVV) system.
Florida EVV Requirements
EVV is required for all home health services rendered in the state of Florida including home health visits, private duty nursing, and personal care services. According to AHCA, providers are required to:
- Verify delivery of services using an Electronic Visit Verification system at the start and end of each home health service visit
- Submit claims through the vendor’s system to verify that all rendered services comply with prior authorizations prior to any claims being processed for payment.
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When Does Florida EVV Start?
Originally AHCA directed SMCC health plans to require all impacted providers to electronically verify visits for all home health care and personal care services conducted in the state of Florida beginning on December 1, 2019. As of March, 2020.
COVID-19 EFFECT ON FLORIDA EVV
Official Update, May 2020: Due to the COVID-19 pandemic, the Medicaid health plans will not require providers to submit claims through the EVV system. Providers can continue to submit claims through the EVV system if they wish, but they are not required to do so. Providers are required to continue to verify the delivery of services (checking in at the start of a visit and checking out at its conclusion) using EVV technology, to the fullest extent possible.
Florida requires that SMCC health plans must ensure that at least 85% of all visits paid are verified using Electronic Visit Verification and has established monthly targets to ensure compliance. AHCA has established these targets as well as several provider guidelines which were communicated official in January 2020 stating that:
- Providers utilize the MCOs’ EVV system and a valid, compliant EVV method.
- Providers are required to submit a valid exception reason (override) for all visits not submitted with a valid EVV method.
- Providers must report any technical difficulties experienced with MCOs’ EVV system to the specific EVV vendor and to the MCO.
Request information on Home Health Software for Florida with integrated EVV
About Telus and HHA Exchange
AHCA has contracted with Centric Consulting, LLC (Tellus) to aggregate EVV data on behalf of the state of Florida. There is no requirement for agencies to directly contract with the State’s aggregator. There is no additional charge or fees to an agency to send EVV data to the State. In most cases, your chosen EVV platform (including HHAeXchange) will send this data to the State’s aggregator on behalf of your agency.
AHCA and the Statewide Medicaid Managed Care (SMMC) health plans require agencies to utilize an EVV vendor. With the state being “Open Model” for EVV, agency simply need a Florida EVV system that can successfully collect all six data elements outlined in the 21st Century CURES Act. EVV data captured needs to be transmitted to the chosen data aggregator:
HHAeXchange is the aggregator for the following health plans:
- Children’s Medical Services Health Plan
- Humana Medical Plan
- Molina Healthcare
- Staywell
- Sunshine Health
Tellus is the EVV data aggregator for the following payers:
- Medicaid fee-for-service
- Aetna Better Health
- Florida Community Care
- Magellan Complete Care
- Simply Healthcare
- UnitedHealthcare
Learn more about Home Health Software for Florida
Florida EVV Compliance
If a provider fails to comply with Florida EVV rules, they may be subject to denial or non-payment of claims, sanctions, fines and suspension, or termination, from the Florida Medicaid program per Rule 59G-9.070
Providers should be certain their selected EVV solution can transmit data electronically to both the MCO’s vendors and the State’s Aggregator. Agencies should consider seeking a Florida EVV Software system capable of transmitting EVV data captured for these health plans directly to both Tellus and HHAeXchange.
Visit the Florida AHCA Website for more information
The Alora Home Health Blog
Read the Alora blog for industry news, including recent news, articles and commentaries, as well as other issues that pertain to Homecare in the U.S and beyond. For more information on Florida EVV or on Home Health Software, COVID-19 homecare, or other blog topics, questions and feedback, please send us an email to [email protected]
