GHP Family notice to home health agencies and caregivers

Geisinger Health Plan (GHP), in partnership with the Pennsylvania Department of Human Services (DHS), is committed to ensuring accurate and timely documentation of services delivered in members’ homes. This notice outlines EVV compliance expectations, monitoring procedures, and corrective protocols for non-compliance.

We encourage you to review your participating provider agreement with us, specifically Section 1.28: Compliance with Governmental Requirements, which outlines expectations for adherence to applicable laws and regulations from CMS and other federal and state agencies. These requirements may evolve over time, and we appreciate your continued attention to these updates.

EVV Compliance Requirements

Effective January 1, 2025, all providers delivering Personal Care Services (PCS) and Home Health Care Services (HHCS) must maintain at least 85% of EVV records verified without manual edits. This requirement applies to both personal care services and home health care services across Fee-for-Service and Managed Care delivery systems. You’re encouraged to read the Medical Assistance Bulletin.

To meet this threshold:

• Use GPS-enabled mobile apps or landline telephony for visit verification.
• Avoid cell phone telephony and manual entries, which do not count toward compliance.
• Upgrade to EVV systems that integrate with DHS’s aggregator and support real-time auto-verification.
• Provide thorough training for caregivers and monitor EVV metrics regularly.

Monitoring and compliance

GHP monitors provider compliance quarterly using the EVV aggregator and DOMO Sandata dashboards. Providers can access their EVV compliance reports by logging into the aggregator and selecting the appropriate report options.

Reports can be customized by date range, account, client, or employee to provide detailed visit information. The final report page summarizes compliance percentage to help providers monitor performance against the 85% requirement. Reviewing these reports regularly can help providers maintain compliance. Some other strategies to maintain compliance include:

• Ensuring visits are verified using GPS-enabled mobile apps or landline telephony.
• Avoiding cell phone or manual entries, as these do not count toward compliance.
• Looking for platforms that offer alerts for missing or incorrect data before submission.
• Providing hands-on training to ensure caregivers understand how to use the EVV system properly.
• Emphasizing the importance of accurate and timely data entry.
• Tracking your agency’s EVV compliance rate on a weekly or monthly basis.
• Using dashboards or reports to identify trends and address issues proactively.

DHS will provide GHP Family with a list of non‑compliant providers for awareness. GHP Provider Engagement Team will then follow up with non-compliant providers.

Continued non-compliance will result in corrective action. If a provider exceeds the 15% manual edit threshold for two consecutive quarters, GHP Family will initiate a corrective action process with the provider and submit the corrective action plan to DHS.

Corrective actions

1. Level 1 outreach: Providers falling below the 85% threshold will receive a friendly reminder with resources and support options. Providers are encouraged to acknowledge and collaborate on solutions.
2. Level 2 support: Continued non-compliance for two consecutive quarters will result in a corrective action plan (CAP). Providers will review their processes, access monthly reports and share them with GHP to support improvement.
3. Level 3 review: GHP Provider Engagement Team will conduct outreach phone calls, schedule meetings with those groups who continue to have ongoing compliance issues. This may lead to further discussion with additional GHP teams to discuss next steps. Decisions will be made with a focus on the quality of member care.

Need help?

GHP is here to support your agency in achieving EVV compliance. For questions or assistance, please contact your Provider Engagement Liaison or visit the DHS EVV resource page.