Medicaid Service Update: July 28, 2021
To: ADvantage Case Managers and Home Care Provider Agencies
Subject: Live-in Caregivers and EVV Use
Date: July 28, 2021
As part of the 21st Century Cures Act it was determined by Centers for Medicare and Medicaid Services (CMS) that live-in caregivers may be exempt from using Electronic Visit Verification (EVV). CMS is leaving it up to individual states to determine whether or not to require a live-in caregiver to use EVV. Medicaid Services Unit (MSU) is leaving this exemption determination up to the Home Care (HC) Agency that employs the live-in PCA. A PCA is designated as a live-in caregiver anytime they reside in the same household as the Member in which they provide care.
- If the HC Agency elects to require PCA’s, that meet the criteria of PCA live-in caregiver, to use EVV then the normal T1019 (Personal Care) or T1019:TF (Advanced Supportive/Restorative) codes should be used on the service plan.
- If the HC Agency elects to not require PCA’s, that meet the criteria of PCA live-in caregiver, to use EVV then a U8 modifier must be added to the personal care codes. T1019:U8 (Personal Care) or T1019:TF:U8 (Advanced Supportive/Restorative) codes should be used on the service plan.
- On the Member Demographics Tab the HC Agency should check the box next to the question of “Check yes if PCA & Member reside in the same household”. If checked, an additional question will appear that must be completed by the HC Agency to designate the status of EVV requirement. The HC Agency should select Yes or No appropriately.
- These questions should be updated anytime there is a change in the PCA live-in caregiver status.
- If a change in codes on the current plan is required:
- ADvantage - The HC Agency should notify the CM of the need for an addendum by sending the CM a note using Note Type = Service Plan, Note Sub-Type = Change in Service. The CM should update the planned services appropriately and process as an addendum.
- SPPC – The HC Agency should update the planned services appropriately and process as an addendum.
- The U8 modifier process should be used for all new and existing Members that have a PCA live-in caregiver.
- CDPASS live-in caregivers will be identified within the Acumen system and the Case Manager will not use a special service code for S5125 and S5125:TF.
- As a reminder the EVV Device question on the Member Demographics Tab should be updated anytime there is a change.
If you have any questions regarding the information provided above, please feel free to contact us via Harmony Provider Question.
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ADvantage Administration | State Plan Care Unit | Medical Eligibility Services
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