Electronic Visit Verification System. 4.4.14.1 The CONTRACTOR, together with the other Centennial Care MCOs, shall contract with the existing EVV vendor to continue the statewide electronic visit verification (EVV) system to monitor Member receipt and utilization of the Community Benefit. The CONTRACTOR shall maintain an EVV system capable of leveraging up-to-date technology as it emerges to improve functionality in all areas of the State including rural areas. The CONTRACTOR is responsible for issuing devices to its Providers, as needed, and shall ensure that all contracted personal care service Providers and respite Providers are participating in the EVV system unless granted an HSD approved written exception. 4.4.14.2 The CONTRACTOR shall ensure the following system functionality, including the ability to: 4.4.14.2.1 Log the arrival and departure of t he Pro vid er d e l iver ing t he service ; 4.4.14.2.2 Verify, in accordance with business rules, that services are being delivered in the correct location (e.g., the Member’s home); 4.4.14.2.3 Verify the identity of the individual Provider providing the service to the Member; 4.4.14.2.4 Match services provided to a Member with services authorized in the Member’s Individualized Plan of Care (IPoC); 4.4.14.2.5 Ensure that the Provider delivering the service is authorized to deliver such services; 4.4.14.2.6 Establish a schedule of services for each Member identifying the time at which each service is needed, as well as the amount, frequency, duration and scope of each service, and to ensure adherence to the established schedule; 4.4.14.2.7 Provide reasonable notification to care coordinators if a Provider does not arrive as scheduled or otherwise deviates from the authorized schedule so that service gaps and the reason the service was not provided as scheduled, are immediately identified and addressed, including through the implementation of back-up plans, as appropriate; 4.4.14.2.8 Permit the Provider to submit Claims to the CONTRACTOR (claims from self-directed Providers shall be submitted initially to the FMA, and the FMA shall provide Claims information to the CONTRACTOR as specified in the subcontract with the FMA); and 4.4.14.2.9 Reconcile paid Claims with service authorizations. 4.4.14.3 The CONTRACTOR shall monitor and use information from the electronic visit verification system to verify that services are provided as specified in the IPoC, and in accordance with the established schedule, including the amount, frequency, duration, and scope of each service, and that services are provided by the authorized provider; and to identify and immediately address service gaps, including late and missed visits. The CONTRACTOR shall monitor services anytime a Member is receiving services, including after the CONTRACTOR’s regular business hours. 4.4.14.4 The CONTRACTOR shall submit reports on its EVV system as directed by HSD. 4.4.14.5 The CONTRACTOR shall employ a dedicated full-time staff person who is responsible for managing and overseeing all EVV system functions and requirements.
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Electronic Visit Verification System. 4.4.14.1 The CONTRACTOR, together with the other Centennial Care MCOs, shall contract with the existing EVV vendor to continue the statewide electronic visit verification (EVV) system to monitor Member receipt and utilization of the Community Benefit. The CONTRACTOR shall maintain an EVV system capable of leveraging up-to-date technology as it emerges to improve functionality in all areas of the State including rural areas. The CONTRACTOR is responsible for issuing devices to its Providers, as needed, and shall ensure that all contracted personal care service Providers and respite Providers are participating in the EVV system unless granted an HSD approved written exception.
4.4.14.2 The CONTRACTOR shall ensure the following system functionality, including the ability to:
4.4.14.2.1 Log the arrival and departure of t he Pro vid er d e l iver vider deliver ing t he service ser vice ;
4.4.14.2.2 Verify, in accordance with business rules, that services are being delivered in the correct location (e.g., the Member’s home);
4.4.14.2.3 Verify the identity of the individual Provider providing the service to the Member;
4.4.14.2.4 Match services provided to a Member with services authorized in the Member’s Individualized Plan of Care (IPoC);
4.4.14.2.5 Ensure that the Provider delivering the service is authorized to deliver such services;
4.4.14.2.6 Establish a schedule of services for each Member identifying the time at which each service is needed, as well as the amount, frequency, duration and scope of each service, and to ensure adherence to the established schedule;
4.4.14.2.7 Provide reasonable notification to care coordinators if a Provider does not arrive as scheduled or otherwise deviates from the authorized schedule so that service gaps and the reason the service was not provided as scheduled, are immediately identified and addressed, including through the implementation of back-up plans, as appropriate;
4.4.14.2.8 Permit the Provider to submit Claims to the CONTRACTOR (claims from self-directed Providers shall be submitted initially to the FMA, and the FMA shall provide Claims information to the CONTRACTOR as specified in the subcontract with the FMA); and
4.4.14.2.9 Reconcile paid Claims with service authorizations.
4.4.14.3 The CONTRACTOR shall monitor and use information from the electronic visit verification system to verify that services are provided as specified in the IPoC, and in accordance with the established schedule, including the amount, frequency, duration, and scope of each service, and that services are provided by the authorized provider; and to identify and immediately address service gaps, including late and missed visits. The CONTRACTOR shall monitor services anytime a Member is receiving services, including after the CONTRACTOR’s regular business hours.
4.4.14.4 The CONTRACTOR shall submit reports on its EVV system as directed by HSD.
4.4.14.5 The CONTRACTOR shall employ a dedicated full-time staff person who is responsible for managing and overseeing all EVV system functions and requirements.
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