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Beginning July 1, 2024, Ohio Administrative Code rule 5160-32-01 Electronic Visit Verification program, permits an exemption to visit capture requirements when the direct care worker is a resident of the same household as the individual receiving services.
Ohio Medicaid is now accepting submission of the Electronic Visit Verification Exemption Request form. Please submit all required documents through an encrypted email to evv@medicaid.ohio.gov or fax to 614-318-4956. Forms should not be sent to any other email. Ohio Medicaid will not accept requests through any other submission method. Decisions regarding approval will be sent via email after July 1, 2024. Forms can be submitted now and Ohio Medicaid’s approval or request for more information will occur after July 1.
Forms should be filled out with all requested information. Missing elements such as payor, program account number and EVV account number will cause processing delays.
Prior to submitting the exemption request form, the provider must ensure the direct care worker/employee record and recipient record are in the Sandata EVV system. For those providers using an Alternate EVV vendor and/or Fiscal Management Service (FMS) entity, the direct care worker/employee record and recipient record must be documented in the State’s Aggregator system.
Direct care workers must continue to log all services subject to EVV until the submitted EVV exemption request is approved by ODM.
Ohio Medicaid state plan home health and nursing services provided through telehealth and billed with a place of service code indicating it is a telehealth visit are not required to be logged for EVV.
Effective July 1, ODM is making policy updates and system enhancements to the EVV program that will include a claims adjudication process introduced in phases, by service type.
Phase 1
The first phase of the claims adjudication process begins with home health services claims billed through State Plan Fee for Service (FFS).
Beginning October 1, claims for these services only will require complete EVV visit data in order to receive payment. If the information submitted does not match visit records, claims may be denied. For a list of services subject to EVV, please find the ODM EVV Program and Service Code Guide here.
Additional services subject to program participation will be announced in future phase(s). In accordance with OAC Rule 5160-32-02 Electronic Visit Verification data collection, Ohio Medicaid will communicate with affected service providers at least three months prior to initiating the process of claims denial or post payment penalty review.
To support this process, data will be made available in the coming weeks to support efforts to comply with EVV requirements. Ohio Medicaid will provide information to all providers when this is available.
Steps Providers Can Take to Prepare
- Review compliance requirements and, if needed, take steps to come into compliance with EVV program requirements.
- Visit ODM’s EVV website to learn more about what EVV is, what services require EVV, and what providers need to know about EVV.
- Subscribe to the EVV listserv to receive the EVV newsletter.
To stay updated on Ohio Medicaid EVV program communications you can sign up for notifications by clicking Subscribe to Medicaid News on the Ohio Medicaid website.
Electronic Visit Verification Enhancement System Training
Register for the Ohio Department of Medicaid EVV Enhanced System training. This training will guide you through EVV system enhancements that will become available to ODM provider agencies and independent providers effective July 1. We highly recommend attending training to help you effectively use the enhancements.
Complete self-paced training through Sandata Learn, the new learning management system. To access Sandata Learn, you will have to complete a log-in process and update your Sandata Learn profile. If you are new to Sandata Learn, you will need to enroll using the Profile Form under Sign Up.
Sandata Bridge Training: This course will guide agencies and independent providers through the enhancements made to the EVV system. We recommend that all current Sandata EVV system agencies and independent providers attend this two-hour training. Intended audience: Agency administrative staff and independent providers using the Sandata system. This training is not intended for agency-employed direct care workers or participant-directed only providers who receive payment through a financial management service.
Aggregator Bridge Training: This one-hour course will guide agency providers using an alternate vendor through the changes that will be coming to reporting and sign-in. Intended Audience: Agency provider administrative staff using an alternate vendor.
Scheduling: This optional scheduling feature for agency providers will be added to help direct care workers with capturing visits. This course will show how to create and manage schedules. Intended Audience: Agency provider administrative staff intending to use the Sandata scheduling solution.
Instructions for Current Sandata Learn Users
- Visit the new Sandata Learn
- Select Forgot Password. Do not enter your email address, password, or click on the Sign In
- When prompted on the next screen, enter the email address you currently use for Sandata Learn and click Send Password Reset Instructions.
- If your email exists in our system, you will receive an activation email. In your email, click on Activate Account.
Note: If your email does not exist in the new learning management system (LMS) platform, use the Profile Form to create your account. After you have done that, click Save Profile.
- You will arrive at the new LMS dashboard. Take the short Mastering Your Learning Journey course to explore the new platform.
- Sign up for your available self-paced training and start learning!
Instructions for New Sandata Learn Users
- Go to Sandata Learn. Make sure to update your bookmarks to save this site for quick access.
- On the Create an Account screen, fill in your name and email address. Create a password and select Sign Up.
- Complete the Profile Form with your Agency Name, Agency ID number (optional), and your Provider ID number.
- Click Select a Role and choose from the dropdown menu. Only Agency Admins should select the first option, Agency Admin/Manager.
- Select the State out of which your agency is based. Note: This may not be the state in which you work.
- Select Agency EVV, Non-Agency EVV, or Alt EVV Aggregator.
- After you have done that, click Save Profile.
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