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DHHS Clarification regarding "Three Strikes" process for EVV Claims
DHHS is posting this announcement to provide clarification for providers subject to EVV for Personal Care Services. Through recent discussions with providers, we've learned that there is confusion and misunderstanding regarding how the "three strikes process" for caregivers is applied for all visits/claims after a caregiver has reached their three strikes.
As background, DHHS implemented the requirement for all visits to have the GPS (or alternative) visit verification present on all visits for the visit to be allowed for billing. In response to provider feedback regarding the potential difficulty adapting to the enforcement of this 21st Century cures as requirement, the department communicated that we would allow each caregiver three opportunities to have visits missing this requirement approved for payment via the claim reconsideration Monday.com process. After a caregiver exhausted their first three "strikes", any visits completed that did not contain the required clock in/clock out visit verification, would have the critical error and would not be approved via the claim reconsideration Monday.com process.
After a caregiver reaches 3 strikes, any subsequent visits that are completed will continue to process and be paid as normal if the visits contain the required data elements, such as visit verification clock in/clock out. The three strikes process does not disqualify or prohibit the provider from continuing to provide services, or prevent valid visits from being billed to the department.
Please reach out to DHHS.MedicaidFA-EVV@nebraska.gov for any questions regarding this communication.
Continued EVV System Enhancements
Nebraska Medicaid required that PAS and HCBS providers must begin using Electronic Visit Verification (EVV) for billing as of January 2021. The program continues to make enhancements to EVV to ensure compliance with federal and state regulations, including the 21st Century Cures Act and NAC Titles 403, 404, 471, and 480.
The enhancements have been introduced in two phases. On February 19, 2025, DHHS implemented the first set of changes to begin strengthening compliance and data integrity within the EVV system. The second phase of updates will go into effect on June 25, 2025, introducing additional claim validation requirements:
- Claims will be declined if the provider or caregiver does not have a National Provider Identifier (NPI) linked to the EVV visit.
- Claims will be declined if caregivers or independent providers report more than 16 hours of visits in one day for certain, applicable service codes.
- Claims will be declined if recipients are recorded as receiving over 16 hours of services in a single day for certain, applicable service codes.
- Claims will be declined if providers are not aligned with applicable state and federal EVV requirements.
These requirements also apply to claims submitted by Alternative EVV Vendors. If you utilize an Alternative EVV Vendor, please contact your Vendor to ensure compliance.
Nebraska Medicaid is collaborating with its EVV vendor, Netsmart, to incorporate system-level checks to support these requirements. To assist providers, DHHS is conducting targeted outreach, communication, and training sessions according to the schedule below:
June 20, 2025, 9:00-10:30 a.m. – SAI Phase II Session 4
Topics: client 16-hour limit for applicable service codes, caregiver 16-hour limit for applicable service codes
Join from PC, Mac, iPad, or Android: https://us06web.zoom.us/j/84653696298?pwd=PAePXstrGwvPiDqZaAebypt4YrWebS.1
Passcode:046807
Phone one-tap:
+12532050468,,84653696298#,,,,*046807# US
Webinar ID: 846 5369 6298
Passcode: 046807
International numbers available: https://us06web.zoom.us/u/kyrGqGPSc
Past Townhalls and Forums Provider Training Sessions
Force Pay by State Adjustment Request and Provider Schedule and Go
DD/FSW Waiver
AD/TBI Waiver & PAS
Provider Townhalls
Provider Forums
- 7/30/24 session - Slides from July 30, 2024 Provider Forum
- 8/6/24 session for Aged and Disabled and Traumatic Brain Injury waiver providers
- 8/8/24 session for Personal Assistance Services providers
- 8/9/24 session for Developmental Disabilities waiver providers
Nebraska Medicaid to Begin EVV Home Health Implementation
Nebraska Medicaid will begin the phased implementation of the new electronic visit verification (EVV) system for home health providers on
January 1, 2024.
Registration for home health providers opens on
December 18, 2023.
EVV for personal care services was implemented by Nebraska Medicaid on January 1, 2021.
EVV Home Health Frequently Asked Questions
If you have a question that is not on the FAQ or need additional assistance, you can contact Nebraska Medicaid via email at DHHS.EVVHomeHealth@nebraska.gov.
Background
The Federal
21st Century Cures Act (2016) required Nebraska to implement a new electronic visit verification (EVV) system for Medicaid personal assistance services and home health providers.
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Section 12006 of the Cures Act amended the Social Security Act mandating state Medicaid agencies to implement EVV for personal care services requiring an in-home visit by a provider beginning January 1, 2019.
A federal change later adjusted the date to January 1, 2020, and provided an option for states to apply for a 'Good Faith Exemption' request to implement EVV for personal care services at a later date.
Nebraska applied for the Good Faith Exemption and was approved by CMS to implement EVV for personal care services prior to January 1, 2021. Home health care services will be required to utilize EVV beginning January 1, 2023.
What is Nebraska doing to implement EVV?
Nebraska is implementing EVV in two separate phases. Phase 1 focused on Personal Care Services and Phase 2 will be implemented on January 1, 2024, and focuses on Home Health Services.
EVV allows providers to clock in and out of service appointments using an application on their smartphone or other electronic device. Providers will be able to record the exact date, time, service provided, and location of a visit. This will help the Department of Health and Human Services (DHHS) verify visit information.
EVV is good for participants, providers, and DHHS. Some of EVV's benefits include:
- Providers will not need to use paper time sheets for services verified by EVV.
- It will be easier for DHHS will record and verify visit information to make sure members receive only DHHS-approved services and that the service was provided.
Project History - Important Dates
- Production-ready for third-party EVV vendors: 11/13/2020
- Registration date: 12/20/2020
- Start date for DD waiver providers using Therap: 01/01/2021
- EVV for Personal Care Services launch date: 01/03/2021
- Start date for agency providers with third-party EVV vendors: 01/03/2021
- EVV for Personal Care Services was certified by CMS : 07/27/22
- DHHS has received approval from CMS for its Good Faith Effort (GFE) exemption request to extend the implementation of electronic visit verification for home health care services from January 1, 2023 to January 1, 2024.
- EVV System Implemented on January 1, 2021.
- Personal Care Services Include:
- Consumer Direct Services
- Home Health Agency Services
- Communications
- Personal Care Services FAQ
The phased implementation of EVV for home health begins on January 1, 2024.
|
Implementation Timeline | (Estimated) Start Date
|
Self-Registration Opens
| December 18, 2023
|
Visit Capture Begins
| January 1, 2024
|
Visit Capture Mandated
| April 1, 2024
|
Claims Mandated through Mobile Caregiver+
| April 1, 2024*
|
Home Health Services Include:
- Home Health Aid Services
- Occupational Therapy
- Physical Therapy
- Skilled Nursing Services
- Speech Therapy
EVV will not be required for all services that a Home Health Agency may deliver.
EVV is not required for durable medical equipment and supplies.
Consistent with previous guidance, as of April 1, 2024, all providers will be required to capture their visits in the Netsmart Electronic Visit Verification (EVV) system.
* DHHS is extending the requirement that claim submissions must also be submitted through the Netsmart EVV system to May 1, 2024. This is to allow all providers additional time to complete the implementation of their technical solutions. Please contact the Heritage Health managed care plans that you are enrolled with as a provider if you have any further questions.
Guidance & Updates
DHHS will require alternate EVV Vendors to sign an attestation for Netsmart saying their system is compliant.
Resources