Insights you can act on from OPRA
EVV (Electronic Visit Verification)
Electronic Visit Verification (EVV) is federally mandated to ensure accountability and accuracy in the delivery of certain Medicaid-funded services. For Ohio’s DD providers, EVV uses technology to record when and where services are delivered, by whom, and for how long. This requirement, while sometimes challenging to implement, is intended to protect individuals receiving services, prevent billing errors or fraud, and provide assurance that supports are delivered as authorized. For providers, understanding EVV is essential, not only for compliance and timely reimbursement, but also for maintaining trust with the people and families they serve.
| Federal Mandate | The federal 21st Century Cures Act requires states to implement EVV for Medicaid-funded personal care and home health services by January 1, 2023. States that fail to comply face phased reductions in Federal Medical Assistance Percentage (FMAP) unless a “good faith effort” to avoid delays is demonstrated. |
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Applicable Services |
Multiple services administered by the Ohio Department of Developmental Disabilities are subject to EVV. Whether or not a service requires EVV is determined by what service is billed. The required EVV services are:
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Claims Validation |
Starting October 1, 2025, claims for above services that require EVV must have a sufficient EVV record on file with the Ohio Department of Medicaid. To have sufficient claims, the number of logged EVV units must be equal to or greater than the number of units of billed services. Claims with fewer EVV units than billed units of service will be denied. |
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Claims |
When a claim is denied based on insufficient EVV units, what opportunity does a provider have to get paid for the service they provided? When a claim is denied, a provider should be able to correct their EVV visit to update the units for the visit in the system they are using for EVV (either Sandata or the provider’s alternate vendor). Once the EVV errors are cleared, the provider should be able to bill for the service. |
Resources
ODM EVV Webpage |
The Ohio Department of Medicaid EVV page serves as the central hub for providers to access the latest information, tools, and guidance related to the Electronic Visit Verification (EVV) program. |
| EVV Service Codes | The Ohio Medicaid EVV Program and Service Code Guide lists all services subject to EVV along with their billing codes. For DD providers, see pages 7–9 for the DODD-specific services and codes. |
| DODD Claims Workflow | This flowchart outlines the DODD claims workflow, showing how claims are evaluated for EVV. Specifically, it asks whether EVV is required, whether EVV data is present, and how errors are handled. Providers must have access to eMBS to view these reports and address any issues before claims proceed to Medicaid. |
| Aligning DODD Claims with EVV | This document provides examples as to how EVV visit minutes are converted into billing units for DODD services. |
| DODD Provider Contract Guidance |
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| Navigating the EVV Provider Dashboard |
The EVV Provider Dashboard is a vital tool for providers that offers both insight into EVV claims as well as detailed help in navigating the Provider Dashboard. Additionally, it provides instructions for Sandata and alternate vendors to support timely error correction. |
| Sandata Helpdesk |
The helpdesk can assist with problems stemming for the state provided Sandata system and the Sandata aggregator. |
| Sandata Office Hours |
Daily time where providers can sign up to attend virtual office hours to have individual questions answered by Sandata representatives. |
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For more information or resources on EVV, |
Key Changes to the Major Unusual Incident (MUI) Rule
Ohio's updated Major Unusual Incident (MUI) Rule under OAC 5123-17-02 strengthens provider
accountability, improves protections for individuals, and modernizes investigation practices. Here’s what DD
providers need to know to stay compliant and support safety.
| Updated Definitions | The rule updates and/or changes several definitions, including those listed below: Unanticipated and Unexpected Death • Emotional Abuse • Missing Individual • Systems Issue • Medical Emergency • Peer-to-Peer • Unanticipated Hospitalization • Significant Injury • Program Implementation • Failure to Report |
| Efficiencies |
Category C MUIs (Law Enforcement, Unanticipated Hospitalization, Unapproved Behavior Support) now require an administrative review, a more efficient and less intensive process. |
| Updated Appendix Forms |
Appendix C = Law Enforcement |
| Process Updates |
The timeline to notify the Director of Operations or Administrator of MUIs involving misappropriation, neglect, or abuse is now 1 working day (reduced from 2). Providers must continue to keep and review a monthly UI log for trend/patterns. However, they are now only required to submit it to the County Board if requested. Logs will still be reviewed during compliance surveys/reviews. Adds procedure for removing a DD employee during abuse investigations, including a |
Resources
5123-17-02 MUI Rule |
The updated Major Unusual Incident Rule goes into effect July 1, 2025. |
| MUI Toolkit | A comprehensive resource for incident reporting, investigation, and management. It includes health and welfare alerts, training and education materials, and tools for promoting quality and compliance. |
| FAQs and Interpretive Guidelines | FAQs provide quick answers to the most common questions providers ask about MUIs—what to report, when, and how. Interpretive guidelines are practical guides that break down the MUI rule and help providers understand what’s expected in everyday terms. |
| Health and Welfare Alerts | Initial and annual MUI training for employees must include a review of Health and Welfare Alerts from the past year. |
| MyLearning Training |
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For more information or resources on the updated MUI rule or to explore OPRA led MUI training opportunities, please contact Rachel Hayes, Director of Residential Resources, at rhayes@opra.org. |
The OPRA Advantage
| OPRA membership gives you access to the tools, training, and support you need to stay compliant and deliver high-quality services. From the Great Provider Playbook to expert policy guidance and a strong provider network, ORPA helps you stay focused on what matters most—supporting people with IDD. To learn more about becoming a member of OPRA, please contact Sonya Summers, Member Communication Manager, at ssummers@opra.org. |
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