Form DDD-2102A Electronic Visit Verification (Evv) Designee Attestation - Arizona

What Is Form DDD-2102A?

This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form DDD-2102A?
A: Form DDD-2102A is the Electronic Visit Verification (EVV) Designee Attestation form for Arizona.

Q: What is Electronic Visit Verification (EVV)?
A: Electronic Visit Verification (EVV) is a system that electronically verifies and documents when personal care services are provided to individuals receiving Medicaid-funded in-home care.

Q: Who is the EVV Designee?
A: The EVV Designee is a person designated by the individual receiving in-home care to oversee the use of the EVV system on their behalf.

Q: What is the purpose of the EVV Designee Attestation form?
A: The EVV Designee Attestation form is used to attest that the Designee listed on the form has been designated by the individual receiving in-home care.

Q: Who needs to complete the EVV Designee Attestation form?
A: The individual receiving in-home care or their legal representative needs to complete the EVV Designee Attestation form.

Q: What happens if I don't designate an EVV Designee?
A: If you don't designate an EVV Designee, the individual receiving in-home care will be responsible for the timely and accurate verification of services through the EVV system.

Q: Can I change my EVV Designee?
A: Yes, you can change your EVV Designee at any time by completing a new EVV Designee Attestation form and submitting it to the appropriate agency.

Q: Is the EVV Designee Attestation form required for all in-home care services?
A: Yes, the EVV Designee Attestation form is required for all in-home care services that are subject to Electronic Visit Verification.

Q: What information do I need to provide on the EVV Designee Attestation form?
A: You will need to provide the Designee's name, address, phone number, and relationship to the individual receiving in-home care on the form.