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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept".

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

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Cures Act EVV: The EVV Practice Period Begins July 1

Last updated on 8/18/2020

This article has been updated. Click here to see the update.

From July 1, 2020, through November 30, 2020, an Electronic Visit Verification (EVV) practice period will allow program providers and financial management services agencies (FMSAs) impacted by the 21st Century Cures Act to practice using the EVV system, EVV Portal, and EVV claims matching. Consumer directed services (CDS) employers can practice using the EVV system.

EVV claims will not be denied for a mismatch during the practice period.

Beginning December 1, 2020, all service visits for an EVV-required service must be captured in the EVV system. Claims that don’t have a matching EVV visit transaction in the EVV Portal will be denied.

Get Ready for the Practice Period

To take full advantage of the practice period, HHSC encourages program providers and FMSAs to prepare for the July 1, 2020, start date by:

Onboarding with their EVV vendor.
Completing EVV training requirements.
Note: CDS employers must also complete training requirements.
Preparing to submit managed care claims for EVV-required services (EVV claims) to TMHP, if applicable.

If program providers or FMSAs have chosen to use an EVV proprietary system, they are considered to be “proprietary system operators (PSOs)” and can begin practicing at any time.

Onboard with Your EVV Vendor

If an EVV vendor system has been selected or assigned, program providers and FMSAs must complete the onboarding process with their vendor before they will be given access to the EVV system. Once they have completed the onboarding process, they can begin practicing anytime ahead of the July 1, 2020, start date.

Complete EVV Training Requirements

Program providers, FMSAs, and CDS employers must complete EVV training requirements before they will be given access to the EVV system, and they must also complete additional training requirements by December 1, 2020, and then annually. The HHSC Cures Act EVV Required Training Checklist provides more information about training requirements and various ways to complete them.

HHSC and TMHP are hosting live EVV policy and EVV Portal webinar training in May and June. These webinars will count towards the training requirements.

Prepare to Submit Managed Care EVV Claims to TMHP

STAR Health, STAR Kids, STAR+PLUS, and STAR+PLUS Medicaid-Medicare Plan (MMP) program providers and FMSAs submitting claims for EVV services directly to an MCO are encouraged to take full advantage of the claims matching practice period and prepare to submit managed care EVV claims to TMHP on July 1, 2020.

When a managed care EVV claim is submitted to TMHP, the EVV Aggregator will perform the claims matching process, return claims matching results to the EVV Portal, and automatically forward the claim within 24 hours to the appropriate managed care organization (MCO) for final processing.

Beginning October 1, 2020, all managed care EVV claims:

Must be submitted to TMHP.
Will be denied or rejected if they are submitted directly to an MCO.

To prepare for submitting EVV claims to TMHP, refer to Preparing to Submit EVV Claims to TMHP guide.

Practice Using the EVV System

During the practice period, program providers, FMSAs, and CDS employers can familiarize themselves with the EVV system. Practice activities include:

Identifying appropriate methods for clocking in and clocking out when delivering services to capture visits.
Providing training on clock in and clock out methods.
Reviewing EVV visit transactions to:
- Confirm that all of the data elements that are needed to verify a service delivery visit are correct.
- Perform visit maintenance to correct any errors, such as missing clock in or clock out times.
Reviewing reports.

For more information, see EVV Tool Kit Module 4: EVV Visit Transactions.

Practice Using the EVV Portal and EVV Claims Matching

When EVV claims are submitted to TMHP, the claims matching process is performed and claims matching results can be viewed in the EVV Portal. Claims matching results identify whether the EVV-required services on the claim match the accepted EVV visit transactions in the EVV Portal. After the matching process is performed, the claim is forwarded within 24 hours to the appropriate payer for final processing.

Important: Acute care and long-term care fee-for-service programs will continue to submit claims using their current process, and their EVV claims matching results will be available in the EVV Portal, including:

Community Living Assistance and Support Services (CLASS)
Deaf Blind with Multiple Disabilities (DBMD)
Home and Community-based Services (HCS)
Texas Home Living (TxHmL)
Youth Empowerment Services (YES) Waiver

Home and Community Based Services-Adult Mental Health (HCBS-AMH) providers will also submit claims using their current process, and they should contact AMH.Services@hhsc.state.tx.us for more information about EVV claims matching.

EVV Portal and EVV claims matching practice activities include:

Confirming that EVV visit transactions are accepted in the EVV Portal before submitting an EVV claim.
After submitting an EVV claim, checking claims matching results to confirm that the line items on the claim match the accepted EVV visit transactions.

Note: The EVV Portal will be upgraded on June 29, 2020, to provide more information about claims matching results during the practice period. Training materials, including a demonstration, will be available in the TMHP Learning Management System (LMS).

Reviewing reports.

For more information, refer to EVV Tool Kit Module 7: EVV Portal and Module 8: Submitting an EVV Claim.

For instructions on how to create an EVV Portal account, refer to the Accessing the EVV Portal for Program Providers and Financial Management Services Agencies (FMSAs) job aid.

For more information, contact evv@tmhp.com.