Practical guide · EVV and visits
What is EVV? Requirements and which services need it.
Published 2026-10-27 · Updated 2026-10-29
EVV, electronic visit verification, is the federal requirement that Medicaid personal care and home health services delivered in a person's home be confirmed electronically. It comes from the 21st Century Cures Act. Each state runs its own EVV program within the federal rules, so this guide covers what applies nationwide and what you need to confirm with your state.
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Key points
The short version.
- EVV comes from Section 12006 of the 21st Century Cures Act.
- It verifies six facts: service, person, date, location, staff and times.
- It covers Medicaid personal care and home health that require an in-home visit.
- Federal rules exclude institutions and 24-hour congregate settings; states may go further.
- Personal care deadline: 2020; home health: 2023.
- Your state chooses the system and publishes the service list.
01 · EVV and visits
Where the EVV requirement comes from.
Section 12006 of the 21st Century Cures Act added section 1903(l) to the Social Security Act. It requires states to use an EVV system for Medicaid personal care services and home health care services that require an in-home visit by a provider.
States that did not implement EVV in time face reductions in their federal Medicaid matching rate (FMAP) of up to 1%. That is why states, and the managed care plans they contract with, enforce EVV with providers.
02 · EVV and visits
The six things EVV must verify.
Federal law does not require a particular system, but whatever a state uses must electronically verify six facts about each visit.
- The type of service performed.
- The individual receiving the service.
- The date of the service.
- The location of service delivery.
- The individual providing the service.
- The time the service begins and ends.
03 · EVV and visits
Which services need EVV.
The requirement covers personal care services and home health care services that require an in-home visit, whether they are provided under the Medicaid state plan, an HCBS waiver or a demonstration, and in both managed care and fee-for-service. CMS has said that a service with a different name still counts if it meets the definition of personal care or home health.
In practice, the services IDD agencies most often see under EVV are in-home personal assistance or attendant care, in-home respite and home health visits. Your state publishes the exact list of service codes that require EVV.
04 · EVV and visits
What EVV does not cover.
According to CMS guidance, the federal requirement does not apply to personal care provided to inpatients or residents of a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities (ICF/IID) or institution for mental diseases, or to personal care that does not require an in-home visit.
CMS also interprets "in-home visit" to exclude personal care in congregate residential settings where 24-hour service is available, such as many group homes, and in 2019 guidance said care from a live-in caregiver is not an in-home visit. CMS does not apply the requirement to PACE.
These are federal minimums. A state can require EVV for more services or settings than federal law does, so confirm your state's list before assuming a service is exempt.
- Institutional settings: hospital, nursing facility, ICF/IID, institution for mental diseases.
- Congregate residential settings with 24-hour service availability.
- Live-in caregivers, under 2019 CMS guidance.
- Your state may still require EVV for any of these.
05 · EVV and visits
EVV deadlines.
States had to require EVV for Medicaid personal care services by January 1, 2020, and for home health care services by January 1, 2023. States that showed a good-faith effort and unavoidable delays could receive an exemption of up to one year: January 1, 2021 for personal care and January 1, 2024 for home health.
Both deadlines have passed. If your agency provides an EVV service today, your state expects visits to be verified now, and depending on your state's rules, payers can hold or deny claims that do not match EVV records.
06 · EVV and visits
How states run EVV.
States choose their own system design. Some provide one state system every provider uses. Others let providers use a third-party EVV system that sends visit data to the state's or managed care plan's aggregator. Some combine the two.
GPS is not required. CMS describes telephone check-in from the home (interactive voice response) as a common alternative, and says capturing the location where a service starts and ends is enough to meet the federal minimum. CMS also notes that EVV options exist that do not rely on the person receiving services to supply a phone or internet connection.
07 · EVV and visits
What EVV means for an IDD agency day to day.
First, identify which of your services are EVV services. Residential services in a 24-hour home often are not, while the same person's in-home respite or personal assistance may be.
Second, make clocking in and out part of each visit, and train staff on what to do when the app, phone or signal fails. Third, review exceptions every day: missed punches, visits outside the scheduled time and visits without a matching schedule. Corrections must follow your state's rules and keep a reason, because manual edits are often limited and reviewed.
- List which services and people require EVV.
- Train staff on clock-in, clock-out and what to do when it fails.
- Work exceptions daily and keep the reason for every correction.
08 · EVV and visits
What happens if a caregiver forgets to clock in or out?
The visit becomes an exception that usually must be resolved before it can be billed, usually by an authorized staff member who confirms what happened and records a correction with a reason. What counts as an acceptable correction, and how many manual edits are allowed, is set by your state and payers.
Build a routine so exceptions do not pile up. The caregiver reports the missed punch the same day. A supervisor checks other evidence that the visit happened, such as the schedule, the progress note and, where your policy allows, a call to the person or family. The correction is entered using the reason codes or notes your state accepts, and repeated misses lead to coaching.
- Report a missed punch the same day, not at the end of the pay period.
- Check the visit against the schedule and the progress note.
- Correct only through the method your state allows, with a reason.
- Never edit a visit without evidence that it happened.
- Look for patterns: the same caregiver, the same home or the same time of day.
09 · EVV and visits
How does EVV work when services happen in the community?
The federal EVV requirement applies to personal care and home health services that require an in-home visit, so the key question is where the visit begins and ends. CMS has said that capturing the location where a service starts and ends meets the federal minimum, and your state decides how to handle visits that begin at home and continue in the community.
For example, a caregiver who picks a person up at home, goes to the store with them and brings them back may clock in and out at the home. A visit that starts somewhere else may be handled differently. Your state may allow other locations to be recorded or may limit where clock-in can happen, so read its EVV policy for community visits and train staff on it before they leave the house.
- Find your state's rule for visits that start or end outside the home.
- Tell staff where to clock in and out for each type of visit.
- Review community visits with unusual locations as part of exception work.
10 · EVV and visits
What is an EVV aggregator?
An EVV aggregator is a system that collects visit records from different EVV systems into one place for the state or a managed care plan. It lets the payer accept visit data from providers that use their own EVV system instead of the state's.
Whether your agency deals with an aggregator depends on your state's model. States choose their own system design and may run more than one system. If every provider uses one state system, your visit data is already there. If you use a third-party system, it must send visits in the format the aggregator requires, and someone must watch for rejected or unmatched records.
- Ask which aggregator your state and each managed care plan use.
- Get the data specification your EVV system must meet.
- Check rejected visit files as part of your daily exception work.
- Ask what happens to a visit the aggregator rejects and how long you have to fix it.
11 · EVV and visits
What is the difference between EVV and a time clock?
A time clock records when an employee worked; EVV verifies that a specific Medicaid service was delivered to a specific person at a specific place and time. EVV must capture six facts about each visit, including the person receiving the service and the type of service, which an ordinary time clock does not.
The two are related but not interchangeable. A caregiver may clock in for a shift on a time clock and still need a separate EVV visit for each person served during it. When staff are paid from time records and Medicaid is billed from EVV records, the two can disagree, so compare them and resolve differences before claims go out.
Some agencies use one system for both purposes. If yours does, check that each visit still carries the person, the service and the location, not only the employee's hours.
12 · EVV and visits
How should agencies explain EVV to the people they support?
Tell the person and their family what EVV records, why Medicaid requires it and what it does not do. EVV verifies a visit's service, person, date, location, caregiver and start and end time; CMS says GPS is not required, and the federal minimum is the location where the service starts and ends.
People may worry about privacy or about having to provide a phone or internet connection. CMS has noted that EVV options exist that do not rely on the person receiving services to supply technology, so ask your state what alternatives it offers. Protect EVV records as health information under HIPAA and share them only with people who need them.
If a person or family member says a visit record is wrong, treat it as a concern to look into, not an argument. Check the record, talk to the caregiver and write down what you found.
- Explain the six facts EVV records and why.
- Explain what to do if a visit record does not match what really happened.
- Give a contact for questions or concerns about a visit.
13 · EVV and visits
Checking an EVV setup.
Whether you use your state's system or a third-party one, confirm that it captures all six data points, connects to the aggregator your state or managed care plans require, and shows exceptions to the people who must resolve them.
LunahUP shows EVV exceptions with the visit details so authorized staff can investigate and record a decision, and a configured CareBridge workflow prepares visit files and records responses. Confirm your program, agency enrollment and required specification before relying on any EVV connection.
Questions people ask
Short answers.
Is EVV required in group homes?
CMS interprets the federal requirement to exclude personal care in congregate residential settings where 24-hour service is available, which includes many group homes. Your state can still require EVV, so check its service list.
Does EVV require GPS?
No. CMS says GPS is one approach but not required. Telephone check-in from the home is a common alternative, and capturing where the service starts and ends meets the federal minimum.
Does EVV apply to live-in caregivers?
Under 2019 CMS guidance, care from a caregiver who lives with the person is not an in-home visit for the federal requirement. States may still require EVV in those cases.
What happens if a visit is missing a clock-in or clock-out?
It becomes an exception to review. Authorized staff find out what happened and correct the record the way your state allows, keeping the reason. Unresolved exceptions can affect claims.
Does LunahUP replace my state's EVV system?
Not necessarily. It depends on your state's EVV model, your payers and the connection available. Confirm your program, enrollment and required specification first.
Who has to use EVV?
Agencies and caregivers delivering Medicaid personal care or home health services that require an in-home visit must use the EVV system their state requires. That includes state plan, waiver, managed care and fee-for-service visits. Your state publishes which services and providers are covered.
Can a caregiver clock in from their own phone?
It depends on your state's system. Some EVV systems use a mobile app on the caregiver's device, while others use telephone check-in from the home or another method. Federal rules don't require a specific device, so follow your state's approved methods and your agency's device policy.
How long should an agency keep EVV records?
Follow your state's Medicaid record retention rules and your payer contracts. EVV records support the claims you billed, so keep them, along with the reason for every correction, for as long as you keep the related billing and service records.
Sources
Check the official source.
Requirements change and differ by state. Confirm current rules with your state agencies and payers.
Keep the work connected
Related LunahUP workflows.
Start with one recurring task
Bring the visit question that keeps returning to the supervisor.
Inspect a fictional visit, its available evidence and the human decision needed before any next step.
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