TX HHS Form 2821. Electronic Visit Verification (EVV) Responsibilities and Additional Information

The TX HHS Form 2821, Electronic Visit Verification (EVV) Responsibilities and Additional Information, helps solve the problem of ensuring that personal care Medicaid services are properly documented and verified. This form is used in situations where in-home respite providers offer services to individuals authorized to receive those services.

This form outlines the responsibilities of both the provider and the individual receiving services. The provider must use EVV to clock in and out, while the individual must allow the provider to do so using one of three approved methods: their personal smartphone, home landline telephone (with approval), or an EVV alternative device. Additionally, the individual must report any issues with the device to their Wraparound Provider Organization (WPO) representative.

The form also provides additional information on the confidentiality and security of personal data in the EVV system. If you have questions about EVV, you can request a meeting with your WPO representative or submit a complaint to the HHS Office of the Ombudsman. Key points to note include:

• The provider must use EVV to clock in and out.
• The individual must allow the provider to use one of three approved methods to clock in and out.
• The individual must report any issues with the EVV alternative device to their WPO representative.