Electronic Visit Verification (EVV) is a digital system designed to confirm that personal care and home health services funded through Medicaid are actually delivered to the recipient. Functioning as an electronic time clock, EVV replaces older paper-based logging methods by using various electronic means to verify the time, location, and nature of a caregiver’s visit. The primary goal is to bring transparency and accountability to the expanding home care industry, establishing a regulatory requirement for how agencies operate and how caregivers document their daily work.
The Federal Mandate Driving EVV Adoption
The requirement for Electronic Visit Verification stems directly from federal legislation aimed at improving the fiscal integrity of public healthcare programs. Section 12006 of the 21st Century Cures Act, passed in 2016, mandated the use of EVV across state Medicaid programs for all Medicaid-funded personal care services (PCS) and home health care services (HHCS). This legislation addressed concerns about fraud, waste, and abuse, as agencies previously relied on manual logs susceptible to falsification, such as billing for services never provided.
The Cures Act set deadlines for implementation: January 1, 2020, for PCS and January 1, 2023, for HHCS. States that failed to comply faced financial consequences, specifically incremental reductions to their Federal Medical Assistance Percentage (FMAP). This mandate shifted the verification process from paper-based review to an automated, real-time electronic data capture system.
Core Functionality: How Electronic Visit Verification Works
An EVV system operates by electronically capturing and storing specific data points to confirm that a service was delivered as planned and billed. The technology verifies the presence of the caregiver at the service location and the precise time of the visit. Regardless of the method used, the system must capture six federally mandated data elements for every service encounter:
- The type of service performed.
- The individual receiving the service.
- The individual providing the service.
- The location of the service delivery.
- The date of the service.
- The time the service begins and ends.
Three common technical methods capture this required information. Mobile application EVV uses a smartphone app for the caregiver to electronically “clock in” and “clock out,” utilizing GPS capabilities and often geofencing to verify the location. Telephony EVV relies on the caregiver calling a toll-free number from the client’s home phone, verifying the location by matching the landline’s caller ID to the registered address. When mobile apps or landlines are not feasible, a Fixed Object Device (FOB) can be used. This small, non-mobile device is installed in the client’s home, and the caregiver interacts with it to verify their presence and service time.
Practical Impact on Home Care Stakeholders
The introduction of EVV has significantly altered the day-to-day operations for all parties involved in home care delivery.
For Caregivers, the system replaces traditional paper timesheets with a requirement for real-time digital check-in and check-out. This mandates adherence to a specific electronic process (app, landline, or FOB) to ensure their work is accurately recorded and they are paid correctly. While EVV streamlines payroll, failure to properly log the visit can potentially lead to a denial of the claim.
Home Care Agencies face initial challenges, requiring investment in training and system integration to manage technical exceptions. Once implemented, the system provides real-time visibility into service delivery, allowing agencies to monitor schedules and ensure regulatory compliance. The automation of visit verification streamlines the billing process, reducing administrative errors and speeding up reimbursement.
For Recipients, the role is largely passive, centered on cooperating with the caregiver’s need to use the verification technology. The EVV system is designed to monitor service delivery by the agency, not to track the client’s personal activities. However, the use of location-tracking technology has raised concerns about client privacy and flexibility. Ultimately, the system ensures recipients receive the full scope of services defined in their care plan, leading to greater accountability for care quality.