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 354.4017 - Process to Request Approval of a Proposed EVV Proprietary System and Additional Requirements for a PSO

Universal Citation: 1 TX Admin Code § 354.4017

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

(a) This section applies to a program provider or FMSA seeking HHSC's approval of a proposed EVV proprietary system. To request HHSC's approval of a proposed EVV proprietary system, a program provider or FMSA must comply with the onboarding process described in the EVV Policy Handbook, which includes:

(1) completing and submitting the EVV Proprietary System Request Form; and

(2) participating in an operational readiness review session.

(b) HHSC approves a proposed EVV proprietary system if a program provider or FMSA:

(1) demonstrates that the proposed EVV proprietary system complies with:

(A) the EVV Policy Handbook

(B) the EVV Business Rules for Proprietary Systems; and

(2) successfully completes the operational readiness review by receiving a score of 100% in the following methods, as described in the EVV Policy Handbook:

(A) certification;

(B) documentation;

(D) trading partner testing.

(1) ensure the EVV proprietary system complies with the HHSC EVV Policy Handbook, the EVV Business Rules for Proprietary Systems, and state and federal laws governing EVV;

(2) assume responsibility for the design, development, operation, and performance of the EVV proprietary system;

(3) cover all costs to develop, implement, operate, and maintain the EVV proprietary system;

(4) ensure the accuracy of EVV data collected, stored, and reported by the EVV proprietary system;

(5) assume all liability and risk for the use of the EVV proprietary system;

(6) maintain all data generated by the EVV proprietary system to demonstrate compliance with this subchapter and for general business purposes;

(7) develop training materials on the proprietary system and train HHSC staff and MCO staff;

(8) provide access to all HHSC-approved clock in and clock out methods offered by the PSO to a service provider at no cost to a member, HHSC, an MCO, or HHSC's designated contractor;

(9) ensure the functionality and accuracy of all clock in and clock out methods provided to a service provider;

(10) comply with the process in the HHSC EVV Policy Handbook if transferring EVV proprietary systems; and

(11) notify HHSC, in writing, if:

(A) the EVV proprietary system is not in compliance with the HHSC EVV Policy Handbook, the EVV Business Rules for Proprietary Systems, and state and federal laws governing EVV; or

(B) if the PSO plans to make significant changes to the EVV system.

(d) HHSC may, at its discretion, audit an EVV proprietary system. Such audit may be conducted by a contractor of HHSC.

(e) If HHSC determines that a PSO is not in compliance with subsection (c) of this section, HHSC may, in accordance with the HHSC EVV Policy Handbook:

(1) require the PSO to correct the non-compliance within a time frame specified by HHSC;

(2) reject EVV visit transactions from the proprietary system until HHSC determines the non-compliance is corrected;

(3) cancel the use of the EVV proprietary system if:

(A) the PSO fails to correct the non-compliance within the time frame specified by HHSC; or

(B) the PSO does not respond to a written communication from HHSC about the non-compliance within the time frame specified by HHSC; and

(4) cancel the use of an EVV proprietary system without giving the PSO the opportunity to correct the non-compliance:

(A) if the non-compliance is egregious, as determined by HHSC; or

(B) because of a substantiated allegation of fraud, waste, or abuse by the Office of Inspector General.

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