Electronic Visit Verification Project
In December 2016, Congress passed H.R. 34 - 21st Century Cures Act, mandating that all States require the use of an Electronic Visit Verification system for all Medicaid funded personal care services that are provided under a State plan or a waiver of the plan, including services provided under section 1915(c), 1915(i), 1915(j), or 1915(k) or under a waiver under section 1115. States not requiring the use of an EVV system for such services by January 1, 2019 will see a reduction in the federal funding received.
In order to comply with this recently passed federal regulation, the Division of Health Care Financing and Policy, which operates Nevada's Medicaid program and other health benefit programs, is in the process of obtaining an EVV system to meet the federal mandate, but will also help meet the following DHCFP objectives:
- Ensure timely service delivery for recipients including real time service gap reporting and monitoring;
- Reduce administrative burdens associated with hard copy timesheet processing; and
- Generate cost savings from the prevention of fraud, waste and abuse.
Personal Care Attendant (PCA) Enrollment and National Provider Identifier (NPI) Requirement
Currently Personal Care Services (PCS) Agencies enroll as Medicaid providers under the following provider types: 30, 48, 58, and/or 83. In order to differentiate between the billing provider (PCS Agency) and the servicing provider (personal care attendants), Nevada Medicaid will be requiring that all personal care attendants (PCAs) obtain a National Provider Identifier (NPI) and enroll as a Medicaid provider under the provider types(s) for which they provide services.
The first step to enrollment requires each PCA to obtain a NPI through the National Plan and Provider Enumeration System (NPPES). There is no cost associated with obtaining a NPI. Please note it may take up to three (3) weeks to obtain these numbers. Failure to obtain a NPI could delay payment for services rendered. When the NPI requirement is implemented, the NPI of the PCA will be required on claims. However, the NPI of the PCA is not required for the prior authorization process.