Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-522 - Electronic Visit Verification Requirements for Personal Care and Home Health Care Services
Section R414-522-5 - Evaluation of Provider Compliance with Electronic Visit Verification Requirements
Current through Bulletin 2024-06, March 15, 2024
(1) The Department shall conduct annual post-payment reviews of claims requiring EVV for home health care service and personal care service providers to assess compliance with the requirements.
(2) At random, and for each provider, the Department selects a calendar month within the previous 12-month period and includes as part of its audit, claims for which a provider has service dates and has received reimbursement in the selected month. The Department also includes in the audit, encounters paid through contracted managed care entities within the selected month.
(3) For any claims and encounters for which an associated EVV record cannot be located, or when the EVV record may not be sufficient to meet the requirements in Section R414-522-3, the Department shall present an audit report to the provider and allow for an opportunity to refute the findings.
(4)
(5) A provider may request an exemption from penalties if the provider makes a good faith effort, but could not implement an EVV solution in time due to circumstances beyond the provider's control. A provider must submit an exemption request to the EVV email within two weeks of being notified of the finding and recoupment. The Department reviews exemption requests and decides within two weeks of receiving the request whether the request meets exemption requirements. Exemption requests are handled on a case-by case basis.
(6) A provider may request consideration through the fair hearing process.