Section 686.1630  EVV Requirements for In-home Agency Providers

a)         In-home agency providers who provide homemaker services, maintenance home health services, and/or respite services shall utilize their choice of an Electronic Visit Verification (EVV) system that meets the requirements of this section when providing services to HSP Customers and shall:

1)         provide documentation to verify implementation and use of the EVV system that meets the requirements of this section;

2)         adopt internal policies and procedures regarding the EVV system;

3)         provide training and technical assistance to in-home agency field workers who use the EVV system; and

4)         submit monthly billing statements to the HSP local office or health plan managing the Customer case within 15 days of the end of the service period.

A)        Each statement must correspond to the providers EVV data, as defined in 686.1630(c)(3), for the same time period; and

B)        should not exceed the service hours or fees indicated on the active Vendor Authorization for Services form unless express written approval has been given by the HSP.

b)         In-home agency providers that employ fewer than 10 field workers may choose to utilize HSP’s EVV system at no cost to the agency provider; all other in-home agency providers must utilize an EVV system at the agency provider’s expense.

c)         In-home agency providers who utilize an alternative vendor EVV system shall require their alternative EVV vendor to submit all visit verification data to the HSP’s EVV aggregator component.

d)         Minimum EVV System Requirements:

1)         Technical Functionality

A)        System must capture, identify, and track all relevant service data, including:  the type of service performed, the Customer receiving the service, the date and precise time the service begins and ends, the location of the service delivery, and the agency worker providing the service.

B)        System must be accessible to agency workers for input 24 hours a day, 7 days a week.

C)        System must support changes in services, Customers, and agency workers.

D)        System must allow for multiple shifts per Customer and per agency worker per day including multiple sign in and sign out activities.

E)        System must allow for real time data capture.

F)         System must identify and track adjustments or edits made to EVV visits after the agency worker has input time worked.

2)         Data Storage, Security, and Recovery Standards

A)        System must retain all EVV data for up to seven years from the Customer’s last date of service with the agency.

B)        Archived data must be retrievable in a timely manner.

C)        System must comply with electronic data interchange standards under the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification regulations detailed in 45 CFR 160, 162, and 164.

D)        System must incorporate a disaster recovery plan, including offsite electronic and physical storage, recovery procedures, defined plan activation prompts, restart capabilities, and backup hardware and operating system software.

3)         Data Collection and Aggregator Interface Standards

A)        System must collect data in a manner consistent with the HSP EVV aggregator data collection specifications.

B)        System must submit all visit verification data to the HSP’s EVV aggregator in compliance with the approved interface and submission data specifications as provided by HSP.

(Source:  Added at 46 Ill. Reg. 20865, effective December 19, 2022)