Electronic Visit Verification Program Manual

Official guidance for the Illinois Division of Developmental Disabilities (DDD) Electronic Visit Verification (EVV) Program

Effective: 09/01/2023

The purpose of this manual is to provide a guide for all agencies and individual service providers who are required to comply with the DDD EVV program.

EVV Program Glossary

EVV Program Glossary

EVV Program Glossary

  1. EVV Program Glossary
    1. Participants
    2. General
    3. Operational Use
    4. Program Integration
    5. Technical Definitions
  2. EVV Program Overview
    1. Illinois DDD EVV
    2. Illinois DDD EVV Exclusions
    3. Illinois DDD EVV Restrictions
  3. Enrollment
    1. Customer Enrollment
    2. PSW Enrollment
    3. Provider Enrollment
  4. Provider Guidance, Policy, and Procedures
    1. Alternate Locations
    2. Billing Integration
    3. Compliance Timeline
    4. Live-in Caregivers
    5. Student/Observational Caregivers
    6. Manual Entry Guidance
    7. Minimum Necessary
    8. Modification Thresholds
    9. Telemedicine/Telehealth and EVV
    10. Consumer Directed Attendant Support Services
    11. Overtime (OT)
    12. 16-hour Rule
    13. Correcting Customer IDs
    14. Data Storage and Security
    15. Disaster Recovery
  5. EVV Types of Service
    1. Illinois DDD EVV Types of Service Summary Table
    2. Illinois DDD EVV Types of Service Billing Conditions and Code Inclusions
  6. Appendix A: Alternate Location Guidance for State EVV Solution
  7. Appendix B: EVV Live-in Caregiver Attestation
  8. Version History

EVV Program Glossary

A. Participants

Customer
Customer is an actively enrolled Illinois Medicaid and Home and Community Based Services (HCBS) Waiver recipient of EVV-required services. The waiver participant is referred to as the 'Customer'.

  • Personal Support Worker
    Personal Support Worker (PSW), also known as Caregiver, is the person providing a service to a customer. The Personal Support Worker may be an employee of a Provider or directly hired by the customer.
  • Provider
    Provider is a personal care service (PCS) provider (Personal Support Worker (PSW)) or home health care service (HHCS) provider (Physical Therapist, Occupational Therapist, Speech Therapist, Licensed Practical Nurse, or Registered Nurse) who is actively enrolled in IMPACT and with the Division of Developmental Disabilities (DDD) and who is billing DDD for PCS or HHCS services.
  • ACES$
    ACES$ is the Financial Management Services (FMS) entity contracted with the Division of Developmental Disabilities (DDD) to assist customers who self-direct their services through employer authority to complete their employer responsibilities. ACES$ is considered a Provider (defined above) throughout the EVV Program Manual.

B. General

  • The 21st Century Cures Act
    The 21st Century Cures Act, also known as the Cures Act, is a Federal statute "to accelerate the discovery, development, and delivery of 21st century cures, and for other purposes." Section 12006 of the Cures Act mandates State Medicaid agencies to use Electronic Visit Verification.
  • Electronic Visit Verification (EVV)
    An electronic visit verification (EVV) system is a method designed to verify in-home visits for personal care services (PCS) and home health care services (HHCS).
  • Illinois "Open Choice" Model
    An Open Choice EVV model means that in Illinois a DDD provider agency may choose to use the State EVV Solution at no cost or utilize an EVV Provider Choice System at their own cost. Providers who choose to utilize the Provider Choice System must ensure their system is configured to Illinois EVV rules and requirements and the system meets the Electronic Data Interface (EDI) requirements.
  • Implementation Date
    The implementation date is the date Personal Care Services (PCS) and/or Home Health Care Services (HHCS) providers were required to begin using EVV. The implementation date also refers to the date a new PCS or HHCS provider is enrolled to become a new DDD service provider.
  • Provider Choice System
    Provider Choice System means the portion of the Illinois Open Choice Model chosen by providers to submit EVV data through an EVV contracted provider that is secured independently by the provider. All contracted technologies must complete interface testing with HHAeXchange, and providers must complete Data Aggregator training. Provider Choice Systems are paid for by the Provider, satisfy all requirements as defined in rule, are compatible with the State EVV Solution interfacing, and are consistent with Federal and State law.
  • State EVV Solution
    State EVV Solution means the portion of the Illinois Open Choice model that is made available by the State at no cost to the provider. The State EVV Solution includes the Mobile Visit Verification (MVV) Application, Telephonic Visit Verification (TVV) System, and the Provider EVV Portal. The State utilizes HHAeXchange for the State EVV Solution, and the solution is offered at no cost to providers.
  • Threshold
    Threshold means the State-defined acceptable limit of modified and manual EVV records. This is calculated as a percent of paid claims.
  • Verification Data Points
    Verification Data Points mean the essential points of data that all EVV records must have to be considered a viable EVV system. The federally required points and their corresponding definitions in Illinois are:
Federally Required Point of Data Corresponding Definition in Illinois
The type of service performed EVV Type of Service is a designation given to codes for the type of service delivered. Full information is in the EVV Type of Service section of this manual.
The individual receiving the service The individual receiving the service is the Customer, as clarified in the Participant Definitions of this manual.
The date of the service The date of the service.
The location of service delivery A home or community address where PCS or HHCS services are conducted, accompanied by a GPS location. It is expected HHCS services are provided at the Customer's home.
The individual providing the service The PCS or HHCS provider as clarified in the Participant Definitions of this manual. Personal Support Workers (PSWs) may be affiliated with a Provider, as clarified in the Participant Definitions of this manual, or directly hired by a Customer.
The time the service begins and ends The time a service begins and the time a service ends, as recorded utilizing EVV technology at the time of service.

C. Operational Use

  • Welcome Letter
    A Welcome Letter from the Division of Developmental Disabilities is sent to the Provider's service e-mail address or mailed to the Provider's mailing address to initiate the contact between HHAeXchange and the Provider. The Welcome Letter includes HHAeXchange credentials for entry into the State EVV Solution Provider EVV Portal or Provider Choice EVV Solution Data Aggregator.
  • Unmodified EVV
    Unmodified EVV is an EVV captured by a PCS or HHCS provider with all Verification Data Points at the time of service and not manually modified in any way.
  • Modified EVV
    Modified EVV is an EVV record with one or more of the Verification Data Points captured or modified by the PCS or HHCS provider after the time-of-service delivery. Modifications could include a change to the start/stop time, location, etc.
  • Exception
    Exception means an alert identifying a missing Verification Point of Data. All Exceptions must be fixed for an EVV record to be a verified visit.
    Exceptions may be fixed in the Call Dashboard and Pre-billing modules of the State EVV Solution. For Provider Choice functionality contact your vendor or ACES$.
  • Alternate Location
    An Alternate Location means a modification that corrects the location recorded at the time of service or enters an otherwise unrecorded location. See Managing Customer Addresses Job Aid for more information about the State EVV Solution.
  • Manual Visit Entry (Manual EVV)
    Manual Visit Entry means an EVV record input by the PCS or HHCS provider in the Provider EVV Portal after the time of service delivery by administratively entering all Verification Points of Data.
  • Verified Visit
    A verified visit does not contain any exceptions, meaning either no exceptions exist, or they have been fixed, making the visit eligible for claim submission.
  • Incomplete
    A visit is considered Incomplete if it requires manual intervention before it can be considered closed, completed, or verified.
  • In Process
    A visit is considered in process if a "clock in" is received and visit will remain in process until a "clock out" is received, or 16 hours has passed. After 24 hours, the visit will become Incomplete, assuming the Clock Out was not received.

D. Program Integration

  • Provider Email Address
    Email contact located in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) Provider Enrollment System titled "Provider Email Address". The Provider Email Address is utilized for communicating with the Provider

E. Technical Definitions

  • Your Assignment ID
    Your Assignment ID, or Employee ID, identifies the Personal Support Worker, Occupational Therapist, Physical Therapist, Speech Therapist, Licensed Practical Nurse, or Registered Nurse providing services and is automatically generated for the State EVV Solution
  • Exception ID
    Exception IDs identify Exceptions that are created in the EVV systems. Specific Exception IDs are located in the Support Center for the State EVV Solution.
  • HHAeXchange Client Support Portal
    The web-based administrative tool used to manage EVV activity, to add Manual Visit Entry data elements, and to monitor all activity recorded in the State EVV Solution.
  • Data Aggregator
    The State EVV Solution is also the State's EVV Data Aggregator. The system collects and normalizes visit data from all providers, regardless of whether using the State EVV Solution or a provider choice system. The State and Operating Agency utilize this portal for visit data oversight.
  • Mobile Visit Verification (HHAeXchange +)
    Mobile Visit Verification is a smart phone or mobile device application used by the Personal Support Worker, Occupational Therapist, Physical Therapist, Speech Therapist, Licensed Practical Nurse, or Registered Nurse to record visit data at the start and end of the visit.
  • Reason Code
    Reason Codes are standard codes established by the State used to explain (or, as stated in the HHAeXchange training manuals, "acknowledge") an Exception. Reason Codes are located in the Support Center for the State EVV Solution.
  • Telephonic Visit Verification/Interactive Voice Recognition (TVV/IVR)
    TVV/IVR is a functionality for the Personal Support Worker, Occupational Therapist, Physical Therapist, Speech Therapist, Licensed Practical Nurse, or Registered Nurse to record an EVV visit calling in with a telephone. Each provider agency using the State EVV Solution is provided with one toll- free telephone number for use by the Personal Support Worker, Occupational Therapist, Physical Therapist, Speech Therapist, Licensed Practical Nurse, or Registered Nurse to record visit data at the start and end of a visit. For Provider Choice System functionality, please contact your vendor.
    Illinois only allows the use of landlines to submit TVV records. EVV systems (either State Solution or Provider Choice System) must automatically record a specific address as the telephone is used, and locations must be updated to reflect the actual location of service delivery as needed.

EVV Program Overview

A. Illinois DDD EVV

Electronic Visit Verification (EVV) is mandated (effective September 1, 2023) in the Illinois DDD HCBS Waiver system by Section 12006(a) of the 21st Century Cures Act. Federal guidance requires EVV for Home and Community Based Services (HCBS) that include an element of Personal Care Services and Home Health Care Services. Effective September 1, 2023, Illinois DDD required EVV for Personal Support Worker services (55D), including PSW services approved through Temporary Assistance (53C). Effective January 1, 2024, Illinois DDD required EVV for Occupational Therapist (52O), Physical Therapist (52P), Speech Therapist (52S), Licensed Practical Nurse (55P), and Registered Nurse (55N) services.
EVV requirements are the responsibility of providers billing PCS and HHCS services to the DDD through the Reporting of Community Services (ROCS) system. The impact to most customers is minimal.
The Illinois DDD EVV Program has implemented an Open Choice Model, meaning that providers may use the State EVV Solution or a Provider Choice EVV System.
The DDD established an Electronic Visit Verification web page to share policy and system updates and recordings of Kick Off Meetings and stakeholder Listening Sessions held in April 2023.

  • State EVV Solution: The State offers an EVV system for provider use at no cost to the provider. The State EVV Solution is built specifically to collect EVV records. HHAeXchange is the State's EVV solution contracted provider.
  • Provider Choice EVV System: Providers may choose to contract with a Provider Choice EVV system of their own that interfaces their choice of technology with the State EVV Solution. This is especially useful for providers that already use an administrative suite of technology that can incorporate EVV records into existing records and practices. Any costs associated with using a different EVV system will be borne by the provider, and it is the responsibility of the provider to work with the State EVV Solution provider to ensure timely and accurate transmission of EVV data to the State

B. Illinois DDD EVV Exclusion
EVV is intended to be used for PCS and HHCS services when providing face-to-face support in a visit-based fee-for service setting. While EVV records may still be collected (meaning the State does not prohibit the collection of records in these circumstances), EVV records are not required when services are delivered through the following way:

  • Live-in Caregivers: The DDD recognizes the unique nature of service delivery for Live-in Caregivers. For an EVV exemption, Live-in Caregivers, who provide personal care services, must meet all requirements as stated in the Live in Caregiver section of this EVV Program Manual.

C. Illinois DDD EVV Restrictions
EVV assures that care is delivered at the time of service by collecting six points of data. DDD, in coordination with stakeholder feedback, has developed restrictions enforced in both the State EVV Solution and Provider Choice Systems and policy. The following practices are prohibited in the DDD EVV Program:

  • DDD will not allow or accept biometric data, pictures, video, or voice recordings to identify customers.
  • DDD will not allow or accept pictures, video, or voice recordings to substantiate PCS or HHCS visit data.
  • DDD will not allow or accept visit data that includes continual GPS tracking during a visit and will only accept location information at the beginning and/or end of a PCS or HHCS visit. It is expected HHCS services are provided at the Customer's home.
  • DDD will not utilize geo-fencing to restrict the location of PCS service delivery. Geo-fencing will be used to determine when a customer is receiving PCS services in the community versus the home. Geo-fencing will be used to notify the DDD when services are provided outside the State of Illinois to ensure policies concerning out of state services are appropriately followed.

Enrollment

A. Customer Enrollment
Customers receiving services that require EVV must be administratively entered into the Provider EVV Portal for each Provider Agency collecting EVV records. Customers and Providers must work together to ensure information is correct and viable. Provider Agencies are responsible for the maintenance of all Personal Support Worker, Occupational Therapist, Physical Therapist, Speech Therapist, Licensed Practical Nurse, and Registered Nurse information. Self-direction customers should work directly with ACES$.

B. PSW, PT, OT, ST, LPN, and RN Enrollment
Personal Support Workers (PSWs), Occupational Therapists (OTs), Physical Therapists (PTs), Speech Therapists (STs), Licensed Practical Nurses (LPNs), and Registered Nurses (RNs) utilizing EVV must be administratively entered into the Provider EVV Portal by each Provider collecting EVV records for services rendered. PSWs, OTs, PTs, STs, LPNs, RNs and Providers must work together to assure information is correct and viable. Providers are responsible for the maintenance of all caregiver information.

C. Provider Enrollment
Providers billing for EVV services must be enrolled with the EVV program. EVV enrollment may be automatically included through your Medicaid IMPACT enrollment depending on the provider type and specialty.

  • Training
    Providers enrolled in the EVV program must complete necessary training to receive EVV credentials. Training must be completed for both the State EVV Solution and Provider Choice EVV Solution (if/when applicable). For more information on training on the State EVV Solution, visit the Client Support Portal on HHAeXchange's EVV Website.

Provider Guidance, Policy and Procedures

  • The following guidance may be used to implement EVV successfully:

A. Alternate Location
A modification that corrects the location recorded at the time of service or enters an otherwise unrecorded location is defined as an Alternate Location. Providers may refer to Appendix A: Alternate Location Guidance for additional information. Alternate Locations are used in the following situations:
Provider Responsibilities
Provider agencies must ensure the location for an EVV record is correct. A location may be a home address or community location, accompanied by GPS coordinates.
Provider agencies must maintain records supporting both the validity and appropriate use of an Alternate Location.
Alternate Location in State EVV Solution
Providers utilizing the State EVV Solution can find information on entering an Alternate Location in the Client Support Portal in the Learning Management System (LMS) on the EVV Solution Information web page.
Alternate Location in Provider Choice EVV Solutions
Providers utilizing a Provider Choice EVV Solution must ensure a correct location of service delivery is submitted to the State. Providers should ask their EVV vendor how to correct or input location of service delivery within their EVV system. Providers are responsible for reviewing and ensuring accuracy of EVV data submitted to the State through the Data Aggregator

  • Correcting any method of EVV collection that recorded the location incorrectly.
  • Modifying an existing EVV record to update a previously entered location.
  • Entering a Manual Visit into the Provider EVV Portal

B. Billing Integration
EVV records do not initiate billing requests to DDD directly. Claims must still be submitted to DDD through the ROCS Billing System. EVV records collected by the State Solution or transmitted to the State Solution by a Provider Choice system will be used to match claims against visits during a post payment review process.
If an EVV record is modified after a claim has been submitted for payment and paid, the provider is responsible for correcting the submitted claim to ensure it matches the modified record.
Please be aware that claims must be billed after service has been completed and a visit has been recorded to ensure there is an EVV record to match a claim against.
If, as a billing provider, your claim requires an EVV visit but doesn't have an EVV record to match against, this means you are incorrectly entering one of the points of data being captured in the EVV system, or you submitted your claim prior to having a visit available for matching. Next, you will need to log into the HHAeXchange provider portal (for State Solution users) or the HHAeXchange Aggregator (for Provider Choice systems) and find the visits that were logged for those claim lines. Next, check the following points of data to see which is the cause of the missing visit(s)

  • Client Medicaid ID - does the Client Medicaid ID on the claim match the Client Medicaid ID on the visit? If the Client Medicaid ID on the visit is mistyped, the visit will not match to the claim.
  • Dates of Service - does the first and last dates of service match the visit's start and end dates?

C. Compliance Timeline
Beginning on September 1, 2023, customers and providers of Personal Care Services (PCS) are required to begin utilizing either the State EVV Solution or their Provider Choice Systems to submit EVV records.
Beginning on January 1, 2024, customers and providers of Home Health Care Services are required to begin utilizing either the State EVV Solution or their Provider Choice Systems to submit EVV records.
Six (6) months after the implementation date, the minimum agency compliance threshold of 50% of EVV submissions must meet visit compliance requirements as outlined below.
Twelve (12) months after the implementation date, the minimum agency compliance threshold of 75% of EVV submissions must meet visit compliance requirements as outlined below.
Non-compliance occurs if one or more of the following applies when an EVV visit is submitted:

  • No EVV data is entered in the EVV system for a visit that was billed. For example, PCS or HHCS provider is NOT using EVV at all to clock in/out.
  • At least 1 data point is altered or missing at the time the visit is submitted. Examples include:
    • Missing call in
    • Missing call out
    • Missing call in/out
    • If visit confirmed by mobile but is missing GPS coordinates
    • If visit is confirmed by IVR but is missing Caller ID
    • Manual edit to the visit (i.e., visit times billed do not match EVV times entered)
  • Call in/out takes place from an unregistered EVV telephone number. Visits in the EVV system are from a Non-Registered EVV telephone number. For example, PSW is calling in/out from an unregistered EVV telephone number
  • Service is provided by a temporary/unregistered PCS or HHCS provider.
  1. Provider Options for Compliance
    Providers may utilize multiple strategies to assure compliance to meet these thresholds and are advised of options that may be useful in implementing EVV in a timely manner.
    • The DDD will begin monitoring for compliance on a quarterly basis to ensure providers are utilizing the State EVV Solution or Provider Choice system. The DDD will work with the PCS or HHCS Provider Agency to assist with compliance requirements.
    • Providers that fail to meet the 50% compliance threshold six (6) months after the implementation date will be subject to Compliance Monitoring and Request for Written Response. Providers may be subject to Payment Recoupment. Beginning March 1, 2024, a selection of claims submitted to the DDD that require EVV records will be reviewed for corresponding EVV. All claims subject to EVV requirements will pay initially, even if no EVV record is on file to match to the claim. Paid claims that do not have valid matching EVV records may be subject to DDD review and Payment Recoupment.
    • Providers that fail to meet the 75% compliance threshold twelve (12) months after the implementation date will be subject to Compliance Monitoring and Request for Written Response. Additionally, providers may be subject to Overpayment Recovery, Denial of Claims, Suspension, or Termination of their Illinois Medicaid Provider Agreement in accordance with the IMPACT Agreement and Attachment A of the Community Services Agreement (CSA).

Switching to a different EVV vendor: If a Provider Choice System is not fully interfaced with HHAeXchange to transmit EVV records to the Department before September 1, 2023, when the implementation of EVV for PCS services officially began, providers may continue using their Provider Choice System until the interface is complete to ensure compliance. Providers will not be exempt from using EVV while going through the interface process with HHAeXchange so the Provider Choice System should continue to gather EVV data during the development of the interface process. Providers can only use one system (either the State EVV Solution or their Provider Choice System) at a time. Providers may switch from using the Provider Choice System to the State EVV Solution if you choose. Providers must notify HHAeXchange of the transition and complete all necessary training to use the State EVV Solution or Data Aggregator view for Provider Choice Systems.

Self-Direction vendor switching: ACES$ is utilizing a Provider Choice System. At this time, ACES$ is the only FMS vendor contracted with DDD; therefore, this is their only option for utilizing an EVV system.

Individually Hired PSW Options for Compliance

EVV Exceptions are available for Employers/PSWs when there is an occasional need for them. The over usage of Exceptions does not meet EVV requirements.

  • Employer/PSW - New Enrollee Grace Period - Exceptions for an Employer/PSW-New Enrollee are excluded from the following procedures for an allowable 90 days.
  • Employer/PSW - Post-New Enrollee Status - The Exceptions process will apply to all Employers and PSWs. For a New Enrollee, the process begins after the 90-day grace period.
  • ACES$ engages in communication and educational opportunities with Employers/PSWs who repeatedly have Exception errors. The internal controls used by ACES$ to monitor this process establish responsibility, document procedures and ensure independent internal verification.
Exception Outreach Process - -
Outreach Type Criteria Contact Method
Engagement / Reminder 1 After [45] exceptions within [30] days.
  • ACES$ contacts the Employer and PSW via No Reply email (bulk blind copy).
  • If no email is on file or email is rejected, ACES$ Participant Care places a phone call to the Employer and PSW regarding suggested retraining and reminder of exceptions requirements.
Engagement / Reminder 2 After [30] exceptions between days [31] to [60].
  • ACES$ contacts the Employer and PSW via No Reply email (bulk blind copy).
  • If no email is on file or email is rejected, ACES$ Participant Care places a phone call to the Employer and PSW regarding suggested retraining and reminder of exceptions requirements.
Engagement / Reminder 3 After [15] exceptions between days [61] to [90].
  • ACES$ contacts the Employer and PSW via No Reply email (bulk blind copy).
  • ACES$ contacts the Employer and PSW via phone number on file to complete a verbal outreach regarding the exceptions requirements and informing about next steps being required retraining.
Training / Warning After day [91] to [120] with continued exceptions - [15] or more exceptions.
  • ACES$ contacts the Employer and PSW via No Reply email (bulk blind copy).
  • ACES$ contacts the Employer and PSW via phone number on file to complete a verbal outreach regarding the exceptions requirements and required retraining.
  • ACES$ will send an approved letter to the Employer and PSW regarding the training request due to the exceptions.
Pass Training
  • Employer and PSW are given [1] payroll period to complete training and Survey Monkey questions.
  • Employer and PSW complete and pass the Survey Monkey questions.
  • ACES$ contacts the Employer and PSW via No Reply email (bulk blind copy).
  • If no email is on file or email is rejected, ACES$ Participant Care places a phone call to the Employer and PSW regarding passed training.
  • After training is passed, the Exceptions are reset to zero and the process restarts.
  • If training is required a second time, DDD will be notified for further direction.
Fail Training
  • Employer and PSW are given [1] payroll period to complete training and Survey Monkey questions.
  • Employer and/or PSW fail or do not complete the Survey Monkey questions.
  • ACES$ contacts the Employer and PSW via No Reply email (bulk blind copy).
  • If no email is on file or email is rejected, ACES$ Participant Care places a phone call to the Employer and PSW regarding failed training.
  • ACES$ will engage Employer and PSW with an outbound call to assist with a reschedule of training. If the individual is unavailable, ACES$ will leave a voicemail if possible.
  • ACES$ provides a list of Employers/PSWs to DDD for additional case manager outreach.
Training Not Completed
  • Employer and PSW are given [1] payroll period to complete training and Survey Monkey questions.
  • Employer and/or PSW do not complete the Survey Monkey questions.
  • Move to DDD re-evaluation.
  • ACES$ contacts the Employer and PSW via No Reply email (bulk blind copy).
  • If no email is on file, or email is rejected, ACES$ Participant Care places a phone call to the Employer and PSW regarding incomplete training.
  • ACES$ will engage Employer and PSW with an outbound call to assist with scheduling the training. If the individual is unavailable, ACES$ will leave a voicemail if possible.
  • ACES$ provides a list of Employers/PSWs to DDD for additional case manager outreach.
DDD Engagement * In extreme situations, if an Employer and PSW do not comply with program requirements after repeated communication and training by ACES$, ACES$ will work with DDD for next course of action, which may include transfer out of the self-direction program.
  • ACES$ provides DDD with details, including dates of outreach/communication and training efforts (pass/fail training questionnaire) made with Employer and PSW.
  • Referral to DDD and ISC agency to re-evaluate the customer's placement within the participant-direction program.
  • DDD, ACES$, and the individual's ISC agency will work with the customer to determine and execute the best course of action for the customer.

D. Live-in Caregivers
The DDD does not require EVV from Live-in Caregivers for Personal Care Services (PSWs) if the PSW and Employer have requested and been approved for the live-in caregiver exemption.
Live-in Caregiver Definition
The DDD has developed the following definition:
Live-in Caregiver means a caregiver who permanently or for an extended period of time (defined below) resides in the same residence as the customer receiving services. Live-in Caregiver status is determined by meeting requirements established by the U.S. Department of Labor, Internal Revenue Service, and DDD.
IRS requirements:

  • A PSW is an individual care provider receiving payments under a qualifying state Medicaid program, as defined in IRS notice 2014-7, for care the PSW provides to a customer living in the PSW's home.
  • U.S. Department of Labor requirements:
  • A PSW resides on the customer's premises permanently when the PSW lives, works, and sleeps on the customer's premises seven days per week and therefore has no home of their own.
  • A PSW resides on the customer's premises for an extended period of time when the PSW lives, works, and sleeps on the customer's premises for five days per week (120 hours or more). If a PSW spends less than 120 hours per week working and sleeping on the customer's premises, but consistently spends five consecutive days or nights residing on the premises, this also constitutes an extended period of time.

Types of Services Eligible for Live-in Caregiver Exemption

Services provided by Live-in Caregivers are often delivered incrementally and without clearly defined start and end times. DDD recognizes the unique challenges of collecting EVV for this type of care and allows providers (as defined above) to exempt PSWs from EVV if provided by a documented Live-in Caregiver.

Provider Responsibilities

Providers are responsible for compiling, maintaining, and validating all records justifying the status of each Live-in Caregiver for DDD verification and auditing. The Live-in Caregiver Attestation Form (English version) or Live-In Caregiver Attestation Form (Spanish version), located on the EVV website, and all supporting documentation must be collected and validated prior to utilizing the Live-in Caregiver exemption. Documentation must be valid during the time of services and billing dates if EVV is not collected. Providers should review instructions and requirements outlined in the Live-in Caregiver Attestation Form (English version) or Live-In Caregiver Attestation Form (Spanish version) for additional details.

Attestation forms will be required to be completed annually. If a living arrangement changes prior to the annual submission of the Attestation Form, the Employer of Record (EOR), customer, and/or guardian, if applicable, must notify the Provider within 5 days of the change in living arrangement. The notification must be made on the Attestation Form in the section for removing the Live-in Caregiver Exemption. Once notified, the Provider will immediately remove the Live-in Caregiver Exemption.

Self-Directed Customer Responsibilities

The EOR, customers, and/or guardians, if applicable, are responsible for compiling, maintaining, and validating all records justifying the status of a Live-in Caregiver to be provided to the Provider. The Live-in Caregiver Attestation Form (English version) or Live-In Caregiver Attestation Form (Spanish version) must then be completed and, with all supporting documentation included, submitted to the Provider prior to utilizing the Live-in Caregiver exemption. Any documentation provided with the Attestation Form, that contains an expiration date, must not be expired at the time of submission.

Acceptable documentation of customer and PSW residence must clearly display the PSW or customer's home address. If using a document that is mailed on a monthly basis (for instance, bank statement or utility bill), the document must be within the most recent 3 months. If the document has an expiration date, the document must not be expired. Choose one of the following:

  • Copy of current IL State Driver's License, State ID or other State provided Photo ID;
  • Vehicle registration or voter registration card showing name and address of customer or PSW;
  • Utility or other household bill showing name and address of customer or PSW;
  • Address on federal or state income tax returns or refunds;
  • Bank statement with name and address of customer or PSW;
  • Medicaid records;
  • Mail from medical service providers when the address is clearly stated;
  • School ID Card (if an address is clearly stated on the ID card); and/or
  • Other documentation, upon Division of Developmental Disabilities (DDD) approval.

The Provider must maintain records designating the status of Live-in Caregivers. The Provider may make the effective date of the Live-in Caregiver exemption as the start of the next pay period. Documentation must be valid during the time of service and billing dates when an exemption of EVV requirements has been approved. The EOR and the Provider should review instructions and requirements outlined in the Live-in Caregiver Attestation Form (English version) or Live-In Caregiver Attestation Form (Spanish version) for additional details.

Claims adjudicated as provided by a Live-in Caregiver without required Live-in Caregiver documentation or EVV records are subject to recoupment. The EOR, customers, and/or guardians, if applicable, are responsible for the validation of Live-in Caregiver documentation. If information is incorrect or falsified or the EOR, customer, and/or guardian, if applicable, fails to notify the Provider of a change in living arrangement, the customer could lose their right to self-direct services and be required to use Agency-Based PSW services, and/or the case could be turned over to the Illinois State Police Medicaid Fraud Control Unit (ISP - MFCU) to further investigate potential fraud. If Live-in Caregiver documentation is not collected and verified by the Provider prior to the approval of the exemption from EVV, liability is with the Provider. If the living arrangement changes prior to the annual submission of the Attestation Form, the EOR, customer, and/or guardian, if applicable, must notify the Provider, within 5 days of the change in living arrangement, so they can remove the Live-in Caregiver Exemption. The notification must be made on the Attestation Form in the section for removing the Live-in Caregiver Exemption.

Independent Service Coordination (ISC) Agency Responsibilities

ISC agencies will confirm Live-in Caregiver status during visits throughout the year. If the ISC agency is unable to verify the Live-in Caregiver status during a visit, the ISC must notify the Provider as soon as possible, at which point the Provider will take the necessary steps as outlined above.

Operational Methods of Billing for Live-in Caregiver Services

Billing providers may submit claims, including both Live-in Caregiver services and services requiring EVV records, at the same time through the ROCS billing system. PSW services that must comply with EVV will continue to bill services using the 55D program code. The Division is developing a new program code for PSW services that are exempt from EVV requirements. The Division will communicate the new program code once its developed. For the time being, PSW services that are exempt from EVV will bill using the 55D program code.

E. Manual Entry Guidance

Manual Visit Entry means an EVV record input of one or more Verification Points of Data in the Provider EVV Portal after the time-of-service delivery, which requires system acceptance and processing of the entry(ies) by an EVV administrative user. As a reminder, manually entering any EVV data point does qualify as a non-compliant EVV entry.

Providers utilizing the State EVV Solution can find information on entering a Manual Visit Entry in the Client Support Portal in the Learning Management System (LMS) on the EVV Solution Information web page.

Providers utilizing Provider Choice EVV Systems should reach out to their vendors for information on entering a Manual Visit Entry. Provider Choice EVV Systems submit new data to the EVV Data Aggregator, which updates existing records. Providers utilizing a Provider Choice System can see the latest version of data in the Data Aggregator.

F. Minimum Necessary

EVV records are used to verify that services have been delivered in as real-time a method as possible. EVV technologies are not prohibited from integrating into other technologies (such as service scheduling, payroll, or electronic health records); however, only information required for the collection and submission of EVV records is necessary. Many EVV technology solutions have the capacity to collect much more information than is required to be collected and submitted for EVV. DDD recognizes that some business practices may find this capacity useful, but DDD cautions that doing so may end up creating additional administrative burden in keeping all information correct.

The State only receives EVV-related data through the EVV program. DDD does not prohibit the use of additional capabilities, but if providers choose to use EVV technology for other uses, that information will not be sent to the State through the EVV Program.

G. Modifications

Electronic Visit Verification Record Modification Guidance

Electronic Visit Verification (EVV) helps assure the excellence of care delivery to HCBS Waiver customers in the Illinois DDD system by requiring all visit verification points of data to be collected at the time and place of service delivery. DDD considers visit details added or modified after the time of service to be visit modifications. Manual visit entry is when the entire visit is added after the time of service. While DDD recognizes the practical need for visits to be modified, doing so should only be done as an exception to normal practice, and the majority of all EVV records should remain unmodified. As a reminder, a modified visit entry is a non-compliant EVV entry.

DDD will review and monitor EVV records for appropriately documented reasons for modifications and will address with the providers if issues persist.

After claims are paid, EVV records will be reviewed in a post-payment review to determine if appropriate thresholds have been met. Modified and manually entered EVV records will not automatically stop payments and may allow claims to pay; however, exceeding thresholds persistently and intentionally could imply a need for performance improvements that may result in a DDD audit, corrective actions or recoupment.

Provider Billing

Providers are advised that exceeding thresholds surrounding modified and manual entry EVV records will not automatically stop payments but may result in a DDD audit, corrective actions or recoupment. After claims are paid, EVV records will be reviewed in a post-payment review to determine if appropriate thresholds have been met. If the provider modifies an EVV record already matched to a paid claim, the provider is responsible for re-billing the matched claim to assure it still matches.

Unmodified EVV Record

Providers are responsible to maintain accurate service delivery records. If the provider merges multiple EVV records and no points of the visits were modified, the record will remain an Unmodified EVV Record.

If the provider updates EVV records indicating an alternate location and no other verification data points are modified, the record will remain an Unmodified EVV Record.

If the provider modifies an EVV record already matched to a paid claim, the provider is responsible for re-billing the matched claim to assure it still matches.

H. Telemedicine/Telehealth and EVV

Telemedicine and Telehealth are not authorized service delivery methods for PCS or HHCS services. PCS and HHCS services are required to be provided face to face.

I. Self-Directed Personal Support Worker Services

Self-directed customers are required to submit Electronic Visit Verification (EVV) records, unless they qualify for the Live-in Caregiver Exemption. Beginning September 1, 2023, all services submitted to DDD through ACES$ must have an EVV record. DDD has prepared this guidance specifically for self-directed customers to clarify what this means in practice in Illinois.

Self-directed Customers/Employers, who don't qualify for the Live-in Caregiver Exemption, are responsible for the following:

  • Ensuring PSW collection of EVV records at the time-of-service delivery. The PSW may manually enter EVV records if the record was not collected at the time of service, but it will be considered a non-compliant EVV record.
  • If an EVV record that has been submitted needs to be modified, the Employer is responsible for updating the record.
  • Ensuring that EVV records precede all approved service hours submitted to ACES$ by the designated billing deadlines. This allows billing to be compared to existing EVV records.
  • If an issue arises from incorrect billing (for example, approving service hours without associated EVV records), then the customer/EOR must update the EVV record and re-bill. ACES$ will work with the customer/EOR to ensure the claim was correctly billed and reconciled with the payment to the PSW.
  • EVV is only a visit record component, it does not complete the other billing requirements for PSW reimbursement. Customers/EORs and ACES$ are required to follow all normal business, contractual, and DDD requirements for billing, including correct coding, timely filing, and any other DDD requirements.
  • Customers/EORs are also advised to communicate and coordinate with ACES$ in the case of an EVV record dispute or experiencing issues.

Responsibilities of the PSW:

  • Collecting EVV at the time of service by utilizing ACES$'s EVV App and/or Telephony options.
  • If EVV is not collected at the time of service, notifying the EOR so the EOR may add or update the EVV record as needed.

Responsibilities of ACES$:

  • Having a system that collects and submits required EVV records correctly to the State and can be used by customers/EORs to bill against.
  • All technical support questions regarding this system may be directed to ACES$ directly.

In addition to the defined roles and responsibilities of using EVV for self-directed customers, please also be aware of the following:

Thresholds refer to the proportion of manual or modified EVV entries to unmodified EVV entries.

  • Any record not collected at the time of service and then manually entered after the time of service is considered a manual entry.
  • Any record that has been modified after the time of service is considered a modified entry.
  • Any record that has not been modified in any way since the collection at the time of service is considered an unmodified entry.

DDD is allowing a slower compliance pace to allow customers to become familiar with EVV and work through any technology issues. DDD wants to ensure that those utilizing EVV are sending the necessary records and are not focused on threshold violations during the first few months after implementation.

Thresholds will not be used to deny payments, but self-directed customers/EORs with abnormally high proportions of EVV records not recorded at the time of service may be subject to corrective action plans or payment recoupment by DDD in the future.

  • Technical support of ACES$'s system should be referred to ACES$ for training and assistance.
  • EVV does not change the nature of the self-direction program, and all program rules for the self-direction program still apply with the addition for the collection of EVV for visits.

Self-directed customers/EORs are again reminded that they are the Employer and must submit billing to ACES$ correctly. Specifically, customers/EORs must submit time according to ACES$'s payroll schedule. Self-directed customers/EORs may update EVV records in accordance with the Self-Directed Program policy on timely filing and may re-bill if needed as allowed within policy.

Please refer all EVV use questions directly to ACES$ to expedite issue resolution.

J. Overtime (OT):

Customers/Employers who utilize PSWs must hire a sufficient number of providers to cover the weekly hours in their Personal Plan/Service Authorization and name a back-up caregiver, per their Individualized Back-Up Plan, for coverage when another PSW is unable to provide services. A back-up caregiver may be a non-paid caregiver, an additional PSW or an agency.

Key points of the Overtime Policy:

  • PSWs who work more than forty (40) hours per work week shall be paid at time and one half the hourly rate up to a maximum of sixty (60) hours per work week.
  • Customers cannot exceed their monthly budget and are not to authorize the PSW to work more than the number of hours listed on the Personal Plan/Service Authorization.
  • A PSW cannot work more than 16 hours in a 24-hour period. (See below for the 16-hour policy.)

K. 16-hour Rule:

The Department of Labor requires that the Division must pay a PSW for time worked if the time is verified by the Employer and the EVV system. Therefore, if a PSW works more than 16 hours in a 24-hour period and the time can be verified as stated above, the time must be paid. The PSW and Employer will be required to submit supporting documentation for working over 16 hours in a 24-hour period.

PLEASE NOTE: In no instance should the hours be reduced, or the timesheet returned to the EOR or PSW for correction.

Non-compliance:

  • Once the timesheet has been paid, a 16-Hour Rule Violation Letter should be sent to the customer regarding the customer's non-compliance with the 16-hour rule as defined in this Manual.
  • Please also contact the PSW to ensure the PSW is aware of and familiar with the non-compliance.
  • A copy of the letter should be maintained in the customer file.
  • Continued non-compliance of the 16-hour rule by the customer and PSW may result in a change to PSW services, up to and including a restriction of the customer's right to self-direct services. This change may be supported by the customer's inability to manage a PSW and should be supported with case notes and copies of written notifications to the customer and PSW regarding their failure to comply with the rule.
  • If a change to PSW services is appropriate, Appendix E-1, m. of the Adults with Developmental Disabilities Waiver and the Children and Young Adults with Developmental Disabilities - Support Waiver is the supporting language which authorizes the involuntary termination of self-direction when a customer fails to direct their own services (non-compliance). The Personal Plan will be amended/edited, and individually hired PSWs will be replaced with Agency-Based PSW provider(s).

L. Correcting Customer IDs

State EVV Solution: The provider will need to end date the customer ID with the incorrect Medicaid ID and re-enter the customer using the correct Medicaid ID. Then, fix any visits associated with the customer.

If additional assistance is required, contact HHAeXchange and give the following information when requesting help with a customer ID that was entered incorrectly in HHAeXchange:

  • STX Account Number
  • Customer First/Last Name
  • Customer ID (HHAeXchange ID)
  • Wrong Medicaid ID
  • Correct Medicaid ID

M. Data Storage and Security

  • Confidentiality - System deliverables must be compliant with the Health Insurance Portability and Accountability Act 5010 Standards and the Medicaid Information Technology Architecture (MITA) to ensure protection of customers' confidential information and medical data security.
  • Backup and Recovery - The EVV system being used must maintain reliable backup and recovery processes (outlined below) in the event of a system malfunction or a disaster situation and provide an alternative system for timekeeping due to a provider's failure or inability to use the system for a start or end shift.

N. Disaster Recovery

The Provider EVV system (State EVV Solution or Provider Choice EVV System) must maintain a Disaster Recovery Plan that complies with Federal Guidelines (45 CFR 94.62(f)), including identifying every resource requiring backup, providing the full extent of backup needed, and ensuring backup is occurring minimally on a daily basis, in the event of a system failure. The plan must include offsite electronic and physical storage in the United States, preferably in Illinois, and should also include, at a minimum, all of the following:

  • Recovery procedures for all events ranging from a minor malfunction to a major disaster;
  • For offsite environments, roles and responsibilities of vendor and outsourcer staff;
  • Checkpoint/restart capabilities;
  • Retention and storage of backup files and software;
  • Hardware backup for the main processor;
  • Application and operating system software libraries, including related documentation;
  • Identification of the core business processes involved in the EVV system;
  • Documentation of Contingency Plans;
  • Definition of triggers for activating contingency plans; and
  • Plan for replacement of hardware and software.

EVV Types of Service

This section may be used more extensively in the future if more services are required to comply with EVV requirements.

Billing providers interested in which billing codes are included in each Type of Service, as well as the specific circumstances in which they apply, should refer to the next section "EVV Types of Service Billing Conditions and Code Inclusions."

A. Illinois DDD EVV Types of Service Billing Conditions and Code Inclusions

This section lists all billing conditions and codes included in each corresponding Illinois DDD EVV Type of Service. All service descriptions are for reference only. If there is a difference in description between this manual and/or DDD Waiver/Program Manuals located on the DDD web page, providers must adhere to that advice.

All billing codes listed in this document will require the corresponding EVV Type of Service on file as part of a verified EVV to correctly bill DDD. If a service code or condition of service delivery is not mentioned in this section, it does not require an EVV record at the time of publication. All billing codes and conditions are subject to change.

Personal Care

  • Used by HCBS Providers (Billing Provider Type 91 and 94)
  • Applicable in all locations
  • All billing codes associated with Personal Care are:
HCPC Program Code Service Description
T1019 55D Personal Support
T1019 TU 55O Personal Support - Overtime
T1019 U7 55E (not ready to use) Personal Support - Exempt
T1019 TU U7 55F (not ready to use) Personal Support - Exempt Overtime
T2034 53C Temporary Assistance
T2034 TU 53O Temporary Assistance Overtime

Tasks:

Home Health Care Services

  • Used by HCBS Providers (Billing Provider Type 91 and 94)
  • Applicable in all locations
  • All billing codes associated with "Home Health Care" are:
HCPC Program Code Service Description
G0151 52P Physical Therapy Visit
G0152 52O Occupational Therapy Visit
G0153 52S Speech Therapy Visit
T1002 55N Registered Nurse Visit
T1003 55P Licensed Practical Nurse Visit

Tasks:

Appendix A: Alternate Location Guidance for State EVV Solution

Correcting EVV locations after PCS or HHCS provider has completed visit

All EVV records may be updated to reflect actual locations of service delivered. Providers are responsible for reporting correct EVV records and billing appropriately.

Provider notification (if needed) Provider Agency creates and fixes EVV record Exception
o Report any relevant information of actual service delivery location and reasoning to Provider Agency o Correct the visit based on the instructions for the State EVV Solution or Provider Choice System.

Alternate Location using Mobile Visit Verification (MVV/mobile app)

Though the mobile application should capture a GPS location, if service is being delivered at a location other than what is recorded, Alternate Locations may be entered. This may occur if the device used to capture EVV loses connectivity.

Provider notates Alternate Location from the mobile application Provider Agency fixes MVV record Exception
o Provider identifies issue with mobile app and notifies Provider Agency. o Correct the visit based on the instructions for the State EVV Solution or Provider Choice System.

Alternate Locations using Telephony Visit Verification (TVV)

Providers may enter up to three phone numbers in the State EVV Solution. The primary address(es) listed will link to each entered phone number in the Customer file when TVV is used. Cell phones aren't an authorized phone number to use for TVV. If calling from a known phone number, but service is delivered at a location other than the customer's primary address, an Alternate Location must be notated:

Provider notates Alternate Location from a known phone number Provider Agency fixes TVV record Exception
o Provider must follow the process for calling in using the State EVV Solution or Provider Choice System. o Correct the visit based on the instructions for the State EVV Solution or Provider Choice System.

The provider may call from a phone number that is not entered in the Customer Module of the Provider Portal to record EVV; however, a call from an unrecognized number will be recorded as an "unknown phone number" and will trigger an Exception that must be fixed.

Provider notates Alternate Location from an unknown phone number Provider Agency fixes TVV record Exception
  • Calling from a number not associated with the customer will automatically create an Exception, and further notation is not needed from the provider.
  • After completing the TVV call, report the actual location of service delivery and reasoning to the Provider Agency.
  • If an additional phone line is added or the number associated to the customer's home is changed, the customer/employer needs to notify the Provider Agency or ACES$ with the updated information.
  • The Exception "Unknown Phone Number" will appear on the Call Dashboard in HHAeXchange.
  • If the phone number is correct, add it to the Customer Profile then on the Call Dashboard, click "Reprocess" and the call will link.
  • If the phone number is not valid, click "Reject" and confirm the visit manually.

Manual Visit EVV Records

If no EVV data is recorded at the time of service, a Manual Visit entry may be entered. The State EVV Solution requires the location component of Manual Entries to be entered as a Reason Note:

Provider requests a Manual Visit EVV Provider Agency enters a Manual Visit EVV record
o Report any relevant information of actual service delivery location and reasoning to the Provider Agency
  • In the Customer calendar, click on the date and "New Non-Skilled Visit".
  • Enter the Date, Time, Service, and PCS or HHCS provider to the schedule tab. Click "Save".
  • Navigate to the Visit Info tab to confirm the Start and End Times, Location and the Reason for manually verifying the visit. Click "Save".

Appendix B: EVV Live-in Caregiver Attestation

The EVV Live-in Caregiver Attestation form is available as a fillable pdf in the Live-In Caregiver Attestation Information section of the DDD EVV website.

Links to the form in English and Spanish:

Live-in Caregiver Attestation Form (English version) or Live-In Caregiver Attestation Form (Spanish version)

 Version History

This program manual will be updated in the EVV Resources section of the DDD EVV website to reflect the current state of the Illinois DDD EVV program. As items are added or modified a short note will indicate the version date.

Original version posted: