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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".

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONTINUED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NO AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

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.

4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT 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. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does no t directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with TMHP or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly 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 file/product. This Agreement will terminate upon notice to you if you violate the terms of the Agreement. The ADA is a third party beneficiary to this Agreement.

5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must exit from this computer screen.

EVV Proprietary Systems

Last updated on 9/11/2023

An Electronic Visit Verification (EVV) proprietary system is an HHSC-approved EVV system that a program provider or Financial Management Services Agency (FMSA) may opt to use instead of an EVV vendor system from the state vendor pool that:

Is purchased or developed by a program provider or an FMSA.
Is used to exchange EVV data with the EVV Aggregator.
Complies with HHSC EVV Policy as it relates to EVV Proprietary Systems.
Complies with HHSC EVV Business Rules for Proprietary Systems.
Complies with the requirements of Texas Government Code Section 531.024172 or its successors.

An EVV Proprietary System Operator (PSO) is a program provider or FMSA that is approved to operate an EVV proprietary system.

Refer to the EVV Policy Handbook including Section 5000 EVV Proprietary System for more information.

EVV PSO Process Instructional Videos

The EVV PSO Process Instructional Video links below will provide a summary and key takeaways that will help you navigate the PSO Process.

EVV Proprietary System Operator (PSO) Onboarding Process

The PSO Onboarding Process Overview and Timeline document outlines the steps and required timeframes for a program provider or FMSA to onboard their proprietary system in the Texas EVV operating environment managed by HHSC and the state Medicaid claims administrator, TMHP.

Program providers and FMSAs must complete, sign, and submit the EVV Proprietary System Request Form to start the approval process to become a PSO.

Program providers and FMSAs must select from the following onboarding paths based on the system they have chosen:

The Standard Path is for requesting approval to use an EVV system that has not been previously approved by HHSC.
The Expedited Path is for requesting approval to use an existing operational EVV system that HHSC has previously approved.
Please refer to the EVV Proprietary Systems Approved by HHSC document for further information.

HHSC reviews submitted EVV Proprietary System Request Forms to assign an Operational Readiness Review (ORR) session. The ORR session is a validation process to determine approval for a PSO. ORR sessions are assigned based on the date of receipt of a complete and signed EVV Proprietary System Request Form.

In order to use the automated features of the EVV Proprietary System Request Form (including the ability to select responses, the ability to use an electronic signature to sign the form, and the ability to submit the form to TMHP as an email attachment using the “Submit” button):

a) The user must successfully download/install Adobe® Reader to their local computer.

b) The user must download and open the EVV Proprietary System Request Form in Adobe® Reader.

If the user is unable to download the EVV Proprietary System Request Form, or is unable to successfully download/install Adobe® Reader, the user may fill out the PDF form as before and print the completed form to manually sign and date the form.

The program provider or FMSA must complete, sign, and submit the EVV Proprietary System Request Form to EVV_PSO@tmhp.com.

EVV Operational Readiness Review (ORR)

Session 4 ORR Schedules

Program Providers and FMSAs must contact their selected proprietary system vendor before submitting an EVV Proprietary System Request Form (Request Form) to discuss expected timelines for compliance of their system to Business Rules v3.0, to coordinate all onboarding activities, and to submit required documentation by the published deadlines below.

HHSC has developed a special abbreviated PSO onboarding Path, Session 4 Operational Readiness Review (ORR), to enable program providers and financial management services agencies (FMSAs) to onboard with a previously approved proprietary system. Please refer to the EVV Proprietary Systems Approved by HHSC (PDF) document and the EVV Proprietary Systems Undergoing ORR (PDF) document.

Session 4 ORR requirements and deadlines in the Session 4 ORR PSO Onboarding Overview and Timeline document.

Currently, all scheduled onboarding sessions are full; however, HHSC encourages anyone interested to submit their request form to be added to the waitlist.

Please continue to check back here for information and schedules of future PSO ORR sessions.

HHSC EVV Business Rules for Proprietary Systems

The Business Rules document outlines the set of standards that a PSO must comply with as a condition of participation in the Texas Medicaid EVV Program. The standards cover guidelines for business processes related to EVV, and compliance with them is critical to producing successful outcomes for the program.

The guidelines govern the system set up (onboarding) for PSOs, the documentation and verification of services requiring EVV, the maintenance of the visit data, and transmission of the data to TMHP for inclusion in the EVV Aggregator.

The Business Rules document refers to several appendices that can be accessed through the links in the document or accessed directly below:

PSO Business Rules v3.0

Published: 01/02/2023 | Effective Date: 08/01/2023

EVV Business Rules Proprietary Systems v3.0

Appendix A – HHSC EVV Reason Codes

Appendix B – EVV PCS Service Bill Codes Table

Appendix B – EVV HHCS Service Bill Codes Table

Appendix C – EVV Visit Transaction File

Appendix D – EVV Master Provider Web Service

Appendix E - Medicaid Eligibility Companion Guide

Appendix F – EVV Prior Authorization File

Appendix G – EVV Standard System Reports

Appendix J – Service Delivery Locations

Appendix K – Texas-EVV Specific Terms

Appendix L – Payer Plan Code Web Service

Appendix M – EVV Visit Data Layout Edits Crosswalk

Appendix N – EVV Data Transfer Guide

Appendix O – Visit Maintenance

Appendix P – Auto Verification

Appendix Q – CDS Process Flow

Appendix S – EVV Visit Batch Submission and Response Process

ORR Compliance Documents for EVV Business Rules for Proprietary Systems v3.0

EVV Proprietary System Compliance Method – Certification (Example)

EVV Proprietary System Compliance Method – Trading Partner Testing

EVV Proprietary System Compliance Method – Demonstration

EVV Proprietary System Compliance Method – Documentation

PSO Business Rules v2.0

EVV Business Rules Proprietary Systems v2.0

Effective Date: 05/31/2022

Refer to the EVV Business Rules Proprietary Systems v2.0 for the Appendices.

To view archived appendices for the HHSC EVV Business Rules for Proprietary Systems, click here.

EVV Data Transfer

Vendors and program providers/FMSAs should use the EVV Data Transfer Guide to transfer data between vendors, between a vendor and a PSO, and between a PSO and a PSO.

EVV Proprietary System Maintenance

Approved PSOs are fully responsible for ongoing maintenance of the EVV proprietary system.

The PSO may not make changes to its approved EVV proprietary system that conflict with any state-defined EVV standards and requirements. In addition, the PSO must inform HHSC within two business days of discovery if the PSO is not compliant with any state-defined standards and requirements.

HHSC may periodically change or update EVV standards, policies, and requirements, including the HHSC EVV Business Rules for Proprietary Systems. HHSC will notify the PSO of updates to standards and requirements. The PSO assumes full responsibility to make updates to the EVV proprietary system and gain HHSC approval when HHSC publishes new standards or requirements.

HHSC will allow the PSO 90 calendar days to make the modifications necessary to comply with updated standards and requirements unless otherwise instructed by HHSC. In the event HHSC requires an emergency system or policy change, HHSC and the PSO will mutually agree upon an earlier effective date.

The PSO must notify HHSC of any planned system changes which alter a component of the system which the PSO tested, demonstrated, or documented during the ORR. Based upon the nature of the change, HHSC may require approval prior to the PSO implementing the change.

For any system changes HHSC requires, or changes HHSC approves, HHSC will specify ORR steps that the PSO must complete prior to deployment.

TMHP will assist the PSO in resolving production problems in their EVV proprietary system related to data exchange with the EVV Aggregator as needed.