Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter O - ELECTRONIC VISIT VERIFICATION
Section 354.4007 - EVV System

Universal Citation: 1 TX Admin Code ยง 354.4007

Current through Reg. 49, No. 38; September 20, 2024

(a) A program provider or FMSA must use one of the following EVV systems to electronically document the provision of a service described in § 354.4005 or § 354.4006 of this subchapter (relating to Personal Care Services that Require the Use of EVV and Home Health Care Services that Require the use of EVV):

(1) an EVV vendor system; or

(2) an EVV proprietary system.

(b) A CDS employer must use the EVV system selected by their FMSA.

(c) Except as provided in subsection (d) of this section, a program provider, an FMSA, and a CDS employer must ensure that a service provider uses an EVV system to electronically document the provision of a service described in § 354.4005 or § 354.4006 of this subchapter as described in the EVV Policy Handbook.

(d) If a service provider fails to use an EVV system to document the provision of a service described in § 354.4005 or § 354.4006 of this subchapter or if a service provider cannot use an EVV system because the EVV system is unavailable, a program provider, FMSA or a CDS employer must:

(1) ensure the data elements required by § 354.4009(a)(1) of this subchapter (relating to EVV Visit Transaction and EVV Claim) are accurate; and

(2) complete visit maintenance.

(e) If a program provider or an FMSA does not comply with subsections (a), (c), or (d) of this section, HHSC or an MCO may do one or more of the following:

(1) deny payment for a service;

(2) take enforcement action including:
(A) requiring a program provider or FMSA to complete a corrective action plan; or

(B) propose to terminate the contract of the program provider or FMSA.

(f) If a CDS employer does not comply with subsections (b), (c), or (d) of this section, HHSC or an MCO may:

(1) require the CDS employer to complete a corrective action plan; or

(2) propose to terminate the member's participation in the CDS option.

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