Provider Notice issued 09/18/2024

This notice applies specifically to home health care services (HHCS) provider agencies billing fee-for-service Medicaid, HealthChoice Illinois (HCI) Managed Care Organizations (MCOs), and Medicare-Medicaid Alignment Initiative (MMAI) MCOs. HHCS provider agencies billing the Illinois Department of Human Services-Division of Developmental Disabilities (IDHS-DDD), Illinois Department of Human Services-Division of Rehabilitation Services (IDHS-DRS), or University of Illinois Chicago-Division of Specialized Care for Children (UIC-DSCC) should reach out to those agencies directly for their respective EVV policies.

EVV is mandatory for all Medicaid-funded HHCS per the 21st Century Cures Act ("Act"). IDHS-DRS implemented EVV for HHCS provider agencies billing IDHS-DRS in 2021. The Department of Healthcare and Family Services (HFS), as the State Medicaid agency, implemented EVV for HHCS providers billing IDHS-DDD, UIC-DSCC, and the fee-for-service program on December 31, 2023. HHCS include services provided by a Home Health Aide (HHA), Certified Nursing Assistant (CNA), Licensed Practical Nurse (LPN), Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT), Speech Therapist (ST), Occupational Therapy Assistant (OTA), and Physical Therapy Assistant (PTA).

HFS has posted an EVV Policy for HHCS provider agencies billing fee-for-service, HCI MCOs, and MMAI MCOs on the HFS EVV website. Provider agencies should review the policy and the requirements within as soon as possible and begin compliance immediately to avoid corrective actions. Please note the HFS EVV Policy for fee-for-service HHCS provider agencies includes the following key components:

·         HHCS provider agencies that have elected to use third-party systems but have not completed integration with HHAeXchange by September 30, 2024, must begin taking steps to use the free HHAeXchange option. Guidance on how to complete this transition is offered in HHAeXchange’s FAQ.

·         HCCS provider agencies must comply with the requirement to track caregivers by their full Social Security Number (SSN) no later than October 17, 2024. This requirement was relayed by HFS in a July 26, 2024, HFS Provider Notice and covered during Illinois EVV Townhall webinars. HHAeXchange discussed programming updates to address privacy concerns and guidance for EDI providers during the September 4, 2024, Illinois EVV Townhall webinar.

·         HFS will begin monitoring overall HHCS provider agency visit compliance rates every month on October 31, 2024. The first compliance check will include running a report on overall visit compliance rates for every fee-for-service HHCS provider agency from September 30, 2024, through October 31, 2024. Outreach will be conducted to HHCS provider agencies who do not achieve 50% overall visit compliance within six (6) months. HFS has already begun outreach to HHCS provider agencies who are showing no EVV activity, either because the agencies are not using HHAeXchange, or because the agencies are not transmitting EVV data from third-party EVV systems to HHAeXchange. HHCS provider agencies that do not achieve 75% overall visit compliance by September 30, 2025, will be placed on a Corrective Action Plan (CAP). Failure to complete remediation activities within ninety (90) days of receiving CAP approval from HFS will result in a referral to HFS’ Office of Inspector General (OIG) for fraud, waste, and abuse investigation.

For questions regarding this notice, please email HFS.EVV@illinois.gov. 

Kelly Cunningham, Administrator
Division of Medical Programs