EVV Requirements by State: What Home Care Providers Need to Know

Electronic visit verification (EVV) requirements by state can feel like a moving target, and understanding EVV compliance is just as critical. While the federal mandate sets the baseline, each state applies its own rules, systems, and timelines. For Medicaid-funded home care and home health providers, understanding requirements is essential to staying compliant.

This guide outlines EVV requirements by state and offers actionable steps to help your agency navigate compliance confidently.

What Is EVV and Why Does It Matter?

EVV is a system that confirms home care services are delivered as scheduled and properly documented. It acts as both a digital timesheet and a location verification tool, helping reduce fraud, support accountability, and protect caregivers and the people they serve.

At its core, EVV captures key data points that confirm a visit took place. To meet federal requirements, all EVV systems must document:

• The type of service performed (e.g., personal care, skilled nursing)
• The name of the individual receiving the service
• The date and time the service begins and ends
• The exact location where the service is delivered
• The identity of the individual providing the service

The federal mandate for EVV stems from the 21st Century Cures Act, a comprehensive healthcare law enacted in 2016. Under this legislation, Medicaid-funded programs must meet specific EVV deadlines:

• Personal care services were required to adopt EVV as of January 1, 2020
• Home health services followed with a deadline of January 1, 2023

While these dates mark official implementation deadlines, many states provided grace periods or staggered rollouts to accommodate the transition. Nevertheless, the law makes it clear: failure to comply results in financial penalties. Specifically, states that do not implement an EVV system risk a reduction in their Federal Medical Assistance Percentages (FMAP), a serious consequence that directly affects state healthcare budgets.

States are under pressure to both enforce EVV requirements and monitor agency compliance with these requirements. As a result, providers have faced increased audits, expanded reporting obligations, and a growing need for caregiver training and support with proper documentation.

Understanding EVV Requirements by State

While EVV is a federal requirement under the 21st Century Cures Act, states are responsible for determining how they implement it. EVV requirements by state can vary widely from one location to another. For home care and home health agencies, tracking these changes is part of everyday operations. It requires time, attention, and a clear understanding of each state's rules to remain compliant.

Each state selects the EVV model that best fits its Medicaid program, as long as it meets federal guidelines. The Centers for Medicare & Medicaid Services (CMS) has outlined five primary models that states may adopt:

• Provider choice: Agencies are responsible for choosing and paying for their own EVV system.
  
• Managed care plan (MCP) Choice: MCPs choose and fund the EVV system used by their network providers.
  
• State-mandated in-house system: The state builds and manages its own EVV system, offering a standardized solution for all providers.
  
• State-mandated external vendor: The state partners with a single vendor and requires all providers to use that EVV system.
  
• Open model: The state offers a preferred EVV system (or aggregator) but allows providers and MCPs to continue using other systems, as long as they meet integration and reporting requirements.

What providers must track in each state

Since EVV compliance varies, it’s not enough to know that it’s a requirement. Agencies need to understand exactly how their state defines and enforces compliance. Important questions to consider include:

• Does the state mandate a specific EVV vendor?
  Closed states assign a single vendor, while open states often publish a list of approved vendors or provide integration specifications.
  
• Which services are covered under EVV?
  Most states include personal care services and home health services, but some also cover private duty nursing and therapy services.
  
• Are there training or certification requirements?
  Certain states require specialized caregiver training or provider administrator certification before submitting EVV-compliant claims.
  
• What are the timelines for compliance and associated penalties?
  Many states have phased deadlines based on provider type, region, or service scope. Failure to comply can lead to claim rejections, repayments, or audits.
  
• Does the state allow mobile or offline capture?
  Providers in rural or low-connectivity areas should be aware of whether offline visit verification is accepted or if real-time mobile check-in is required.

Since EVV policies and state interpretations change rapidly, it’s important to regularly check your state’s official Medicaid website or EVV program page for the latest updates.

Many states are continuing to refine or expand their EVV programs, so understanding where your state is headed helps you stay ahead of compliance deadlines and avoid disruption. Providers should watch for:

• Expansion to new service types: Some states are broadening EVV requirements to include additional home-based services or behavioral health care.

• Increased audits: As EVV data becomes more accessible, states are ramping up enforcement through both automated and manual audits.

• System transitions: States that previously mandated specific vendors are moving to open models, requiring system updates and retraining.

• Provider feedback loops: Some states now offer advisory boards or pilot programs that allow providers to give feedback on EVV implementation.

Overcoming Operational and Training Barriers

EVV systems may be digital, but they require human reliability. If caregivers and support staff don’t understand how to use the tools, it puts your agency at risk for non-compliance. These systems can also disrupt day-to-day workflows if training and support aren’t consistent. 

The steps below can help you reduce those risks:

Train every staff member on EVV usage

Everyone involved in the EVV process must understand how the system works to keep operations running smoothly and maintain compliance. Training should include:

• ​​Caregivers: Need clear guidance on clocking in/out, troubleshooting GPS or app issues, and documenting visits accurately to prevent claim denials or audits.
  
• Administrative staff: Must understand how EVV data connects to payroll, billing, and compliance reporting to catch discrepancies early and ensure accurate records.
  
• Supervisors: Should be trained to review EVV logs, resolve staff questions, and provide timely support to prevent small errors from becoming compliance problems.

Audit and monitor EVV logs regularly

Without routine checks, small issues can escalate into larger problems, such as rejected claims or flagged audits. Consider setting a weekly schedule for EVV reviews and assigning someone to track trends or follow up with staff. Regular reviews of your EVV data can help you:

• Detect errors before they lead to claim denials, penalties, or audits.
  
• Identify patterns that indicate recurring issues, such as missed clock-ins or GPS mismatches.
  
• Pinpoint training gaps that require targeted refresher sessions, improving overall accuracy.
  
• Maintain accountability by verifying that visits are properly documented and align with care plans and billing records.

Build EVV into your onboarding process

Caregivers should know what to expect before they step into the field. Including EVV training in onboarding helps set a consistent standard across your team. Include EVV protocols in onboarding by:

• Providing detailed walkthroughs of how the EVV system works within your agency’s specific workflows.
  
• Using quizzes, checklists, or practical exercises to confirm understanding and retention.
  
• Reinforcing the importance of accurate EVV data for compliance and care quality.
  
• Making EVV training a required step before new staff begin client visits to reduce errors and delays.

How CareAcademy Supports EVV Compliance and Training

Navigating EVV requirements by state can be complex, but staying compliant doesn’t have to feel like a constant scramble. With the right training foundation in place, your agency can operate with confidence, even as regulations evolve.

CareAcademy simplifies EVV compliance by offering state-specific caregiver training that aligns with Medicaid requirements and evolving regulations.

Start your free trial today and see how CareAcademy can support more efficient, more resilient operations.

FAQ

What is EVV and why is it required for home care agencies?
EVV verifies that home care visits occur as scheduled. It captures data such as time, location, and caregiver identity to reduce fraud and improve accountability. The federal government requires EVV for Medicaid-funded services under the 21st Century Cures Act.

How do EVV requirements vary by state?
Each state chooses its own EVV model and implementation timeline, despite the federal mandate. States may mandate a specific vendor, offer an open model, or allow providers to choose their system. Requirements also vary in terms of training, service types covered, and whether offline functionality is permitted.

What are common operational challenges with EVV compliance?
Agencies face hurdles like caregiver training gaps, software integration issues, and strict documentation demands. Inconsistent training can lead to claim denials or audits due to input errors or missed data. Ongoing updates and audits add pressure to maintain accurate and timely records.

How can agencies stay compliant with evolving EVV rules?
Regularly checking state Medicaid or EVV program updates is essential. Agencies should schedule routine audits of their EVV logs, track staff errors or gaps, and incorporate EVV into onboarding. Building a strong training program reduces risk and ensures consistent, accurate use of the system.