EVV (electronic visit verification) for home care agencies: requirements and setup

EVV stands for electronic visit verification: an electronic record of an in-home visit, produced instead of a paper timesheet or a handwritten log.

Section 12006 of the 21st Century Cures Act added the requirement to federal Medicaid law, at section 1903(l) of the Social Security Act.

The statute requires states to use EVV for Medicaid personal care services beginning January 1, 2020, and for Medicaid home health care services beginning January 1, 2023, or face reductions in their federal Medicaid funding.

Only services that require an in-home visit are covered.

The enforcement mechanism is federal money.

A state that does not require EVV faces a reduction in its federal medical assistance percentage — the federal share of its Medicaid spending.

That reduction escalates.

For home health care services it starts at 0.25 percentage points across 2023 and 2024, rises to 0.75 points in 2026, and reaches 1 point from 2027 on; for personal care services it reached 1 point from 2023.

The penalty lands on the state, not on your agency — but states carry the requirement down to providers through their Medicaid programs.

That is why the system you record visits in, and how your state's policy treats each service, is set by your state Medicaid agency — while CMS holds the federal statute and the guidance that interprets it.

What EVV produces is the point of the whole exercise: a checkable electronic record of each visit — what service, to whom, from whom, when and where.

For an agency owner, the work is making sure every covered visit produces a complete record, every shift.

The statute lists six data elements that an EVV system must verify electronically for each covered visit.

The six come from section 1903(l)(5) of the Social Security Act.

• the type of service;
• the individual receiving it;
• the date;
• the location;
• the individual providing it; and
• the begin and end times.

Treat the list as a floor, not a build spec.

What formats your state accepts, how each element must be captured, and what counts as a complete record are your state Medicaid agency's decisions — confirm them before you configure anything.

A record missing any of the six is an incomplete record for that visit.

Building a daily check for incomplete records into your scheduler's routine surfaces problems while the visit is still fresh, instead of at billing time.

One duty EVV does not replace: your wage-and-hour records.

Domestic-service employers must keep records of each worker's name, Social Security number, address, hours worked each week, cash wages and overtime pay, and preserve them for 3 years.

If EVV times feed your payroll, the FLSA duty to keep those records sits with you all the same.

The mandate covers two Medicaid service lines on two dates: personal care services (PCS) from January 1, 2020, and home health care services (HHCS) from January 1, 2023.

CMS restated those deadlines in its August 2019 EVV guidance, alongside a limited first-year good-faith exception for states with unavoidable system delays.

Personal care services reach further than agency-delivered care.

CMS reads the EVV mandate to cover personal care services under section 1905(a)(24) of the Social Security Act and under the 1915(c), 1915(i), 1915(j), 1915(k) and section 1115 authorities — which puts self-directed and consumer-directed Medicaid arrangements in scope too.

If your agency supports clients who direct their own care, their visits still need EVV.

Some arrangements fall outside the mandate because they are not in-home visits at all.

CMS treats services delivered by someone who lives with the beneficiary that way, and it treats personal care provided in congregate residential settings with 24-hour service availability — group homes and assisted living among them — the same way.

Those exceptions have their own conditions, covered in the last section below.

Notice what drives all of this: Medicaid.

The Cures Act EVV mandate runs through state Medicaid programs and the Medicaid-funded services your agency delivers.

Work paid privately or by payers outside Medicaid is not governed by this federal rule — though your own client contracts, your state's other rules and your payroll obligations still apply.

The Cures Act requires no particular or uniform EVV system.

It leaves each state to choose its model — for example, a state-operated system or provider choice.

No federal rule names a required app for home care agencies.

Three shorthand labels — closed, open and hybrid — describe the arrangements; the statute uses none of these words.

In a closed model, providers record every visit into one state-run system.

In an open model, providers choose or bring a system that meets the state's requirements.

A hybrid mixes the two.

They all answer the same underlying question of who runs the technology.

In a provider-choice state, ask your state Medicaid agency how visit data reaches it — the hand-off between providers' separate systems and the state's is where the term aggregator comes up.

The federal match also tracks the model.

A state draws a 90 percent federal match for designing, developing or installing a state-operated EVV system, and 75 percent for operating it.

Which model your state picked, and which systems it accepts, sits with your state Medicaid agency — ask before you buy anything.

A setup that works in one state tells you nothing about the next: each state chooses its own arrangement, so nothing carries over automatically.

Start with two questions to your state Medicaid agency: does the state run the EVV system, or do providers choose their own; and which systems does the state accept.

The answers decide everything downstream.

If your state runs a closed system, your setup work is registration with the state, provider onboarding on its system, and caregiver training on that specific app.

If your state is open or hybrid, you are selecting a vendor — and the state's requirements, not the vendor's feature list, are the test your choice has to pass.

Weigh how a candidate system fits the rest of your operation: scheduling, payroll, billing and the visit records your schedulers review.

Comparing systems before you sign is worth the time, and so is a trial with a few real visits rather than a sales demo.

Rollout is a training problem more than a technology problem.

Put the clock-in walkthrough into onboarding, run a supervised visit or two before a caregiver works solo, and give schedulers a daily view of visits with missing or late records so gaps surface while the client's schedule can still be fixed.

Pricing is vendor-specific, so confirm costs directly before you commit.

EVV is also just one system an agency owner sets up: the employer hiring hub maps the rest, from licensing and payer enrollment to recruiting and pay compliance.

Live-ins first.

CMS's guidance of August 8, 2019 states that EVV requirements do not apply when the caregiver and the beneficiary live together, because services by someone living in the residence are not an in-home visit.

The same guidance lets states require EVV anyway — especially for hourly-billed services — and CMS encourages states to apply appropriate oversight to live-in caregiver services to curb fraud, waste and abuse.

So never assume a live-in arrangement is outside EVV: your state's policy decides, and you confirm it with the state Medicaid agency before you drop the clock-in.

Congregate settings are the second exception.

CMS's May 2018 EVV FAQ reads the statute's in-home-visit language to exclude personal care services provided in congregate residential settings where 24-hour service is available — group homes and assisted living are its examples.

If you staff clients in assisted living, how your state treats those visits is again a state call; ask before you stop capturing them.

Then there is the everyday exception: the visit that did not capture cleanly.

A caregiver forgets the clock-out, a phone battery dies, a record shows the wrong start time.

What your state allows next — whether it permits a manual visit entry, who may make it, what documentation it needs, and by when — is answered by your state's EVV policy.

Read that policy before you need it.

Ask your state Medicaid agency how it wants corrections made and what happens to a claim sitting on an incomplete record, then write your agency's own correction steps to match.

Your agency's fix-it process should also make sure a correction never turns into an hours dispute with the caregiver: your FLSA duty to record each worker's weekly hours does not pause when the app fails.

Employer information, not licensing, legal, medical, benefits or tax advice. EVV policy is state-specific and keeps changing — confirm the current rules with your state Medicaid agency, and with CMS on the federal Medicaid requirements, before you set up or change a system.