Section 12006(a) of the 21st Century Cures Act (Cures Act) mandated that states implement Electronic Visit Verification (EVV) for all Medicaid PCS by January 1, 2020. Missouri applied for and received a Good Faith Effort Exemption from the Centers for Medicare and Medicaid (CMS) to delay mandated use of EVV for one additional year.
Effective January 1, 2021, the use of EVV is mandatory for all Medicaid PCS in Missouri. This applies to PCS provided under sections 1905(a) (24), 1915(c), 1915(j), 1915(k), and Section 1115 of the Social Security Act.
Effective January 1, 2021, Medicaid participants cannot opt out of using the PCS provider’s EVV system. Providers must submit notice to MMAC of any participants who refuse to use EVV after the effective date.
Beginning January 30, 2021, Missouri Code of State Regulations (CSR) 13 70-3.320 will contain additional requirements for use of EVV for PCS services provided to Missouri Medicaid participants with a prior authorization, or care plan, as approved by the Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS); or the Department of Mental Health (DMH), Division of Developmental Disabilities (DD). The new regulation was posted in the Missouri Register on 12/15/2020. Although the new state regulation is not effective until January 30, 2021; the federal requirements under the Cures Act are effective January 1st and have not been waived or extended due to the COVID emergency.
In addition to the services authorized by DSDS and DMH, PCS authorized by the Bureau of Special Health Care Needs and the Bureau of HIV, STD and Hepatitis of DHSS must be verified through use of an EVV system in order to comply with the CURES Act.
In order to submit PCS claims, a provider’s EVV system must verify the following:
- Type of PCS performed with details specific to tasks
- Identity of the individual receiving the service
- Identity of the individual providing the service
- Date the service was provided
- Time delivery of PCS began and ended
- Location where the service was delivered
The Missouri Medicaid Audit & Compliance (MMAC) unit created a one page, fillable EVV Attestation Form, which is available at www.mmac.mo.gov. PCS providers can submit one form for all their enrolled National Provider Identifiers (NPIs), as long as all NPIs are using the same EVV system.
All PCS providers need to take the following actions:
- Prior to January 1, 2021, all PCS providers must submit an EVV Attestation Form to MMAC by emailing it to MMAC.EVV@dss.mo.gov
- Any PCS provider that will not be using an EVV system by January 1, 2021, must submit written notice to MMAC.EVV@dss.mo.gov that date. Failure to utilize EVV is a Medicaid program violation that will result in administrative sanctions.
- Any PCS provider that is unable to utilize their EVV system for a specific Medicaid participant(s) due to a technology issue, must submit written notice to MMAC.EVV@dss.mo.gov by January 1, 2021. DSDS will locate another PCS provider offering EVV technology that works for the participant.
- PCS providers must report to MMAC any Medicaid participant(s) who refuses to utilize the provider’s EVV system after January 1, 2021. The PCS provider should submit written notification to MMAC.EVV@dss.mo.gov. Medicaid claims submitted after January 1, 2021, for any participant that refuses to utilize EVV will be denied/recouped.
PCS providers who fail to submit an EVV Attestation Form to MMAC, or fail to provide notification of one of the circumstances listed above, will be subject to one or more administrative sanctions listed in 13 CSR 70-3.030(4).
MO HealthNet has an EVV website with additional information, including EVV Fact Sheets for providers and Medicaid participants. DMH also has an EVV website with more information for providers delivering PCS to DD participants.
Providers can email questions about EVV to Ask.EVV@dss.mo.gov