What services require EVV?

Under federal law, Medicaid personal care services and Medicaid home health care services that require an in-home visit by a provider, including personal care furnished under the waiver authorities the statute lists. States had to require it for personal care from 2020 and for home health from 2023, or accept a cut in their federal Medicaid share.

What are the six EVV requirements?

42 USC 1396b(l)(5)(A) lists them: 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, and the time the service begins and ends. Each visit must be verified electronically on all six.

Do we need EVV if only a few of our clients are on Medicaid?

For those clients’ Medicaid visits, the state’s EVV rules apply, whatever the rest of the census looks like. The statute is written to states, and each state sets how agencies comply, so read the state Medicaid agency’s EVV page and provider notices, and ask counsel about anything unclear.

Does long-term care insurance require EVV?

The federal EVV statute does not mention it. Each insurer sets its own claim rules. The federal employees’ program, FLTCIP, asks home care agencies for itemized invoices with individual dates of service, total hours per day, charges per day and a description of services — visit data, whatever tool records it.

When did EVV become mandatory?

For Medicaid personal care services, for calendar quarters beginning on or after January 1, 2020, and for Medicaid home health care services, on or after January 1, 2023, under section 12006 of the 21st Century Cures Act. The statute waived the first year’s reduction for states that showed a good-faith effort and unavoidable delays.

Answers · Home care agencies

Is EVV Required for Private-Pay Home Care? What the Medicaid Law Covers and What It Leaves to the Agency

Is EVV required for private-pay home care? Not by federal law: the electronic visit verification requirement is written into the Medicaid statute, 42 USC 1396b(l), and it covers personal care and home health services paid under a state’s Medicaid plan or waiver, enforced by cutting the federal share of that state’s Medicaid spending if the state does not require it. A visit a family pays for from its own funds is outside that subsection. That does not settle the question for an agency. Other payers set their own proof rules — the federal employees’ long-term care insurance program, for one, asks home care agencies for itemized invoices with each date of service and the hours per day — and a state can add rules of its own. This guide quotes the statute, sets out what it leaves open, and shows how the six data points the law names double as a private-pay agency’s own check of payroll against invoices. It is rule text as of 2026-10-17; the agency’s counsel and its state’s rules decide what applies.

By Tamara Stepanyan, founder of Lumina Business Advisory · Updated October 27, 2026 · Sources checked October 17, 2026 · Editorial standards

What the federal EVV law actually says

Section 12006 of the 21st Century Cures Act added subsection (l) to section 1903 of the Social Security Act, codified at 42 USC 1396b(l). The text applies “with respect to any amount expended for personal care services or home health care services requiring an in-home visit by a provider that are provided under a State plan under this subchapter (or under a waiver of the plan).” For personal care services, it starts with calendar quarters beginning on or after January 1, 2020; for home health care services, on or after January 1, 2023.

The law is written to states, not to agencies. Unless a state requires electronic visit verification for those services, its Federal medical assistance percentage — the federal share of its Medicaid spending — is reduced. For personal care services the reduction reached 1 percentage point for quarters in 2023 and after; for home health care services it is .75 of a point for quarters in 2026 and 1 point from 2027. The CMS Medicaid page summarizes it the same way: Section 12006(a) “mandates that states implement EVV for all Medicaid personal care services (PCS) and home health services (HHCS) that require an in-home visit by a provider.”

The statute also tells states how to build it. A state must consult the agencies that provide these services so that the arrangement “is minimally burdensome,” takes account of what is already in use in the state, and follows HIPAA privacy and security law, and it must offer training to the people who furnish the services. An agency’s own duty arrives through its state’s Medicaid rules and contracts, which is why the details differ from state to state.

Is EVV required for private-pay home care? Who the law reaches

Read against an agency’s census, the subsection sorts clients by who pays:

A client and family paying from their own funds: the service is not “provided under a State plan” or waiver, so 1396b(l) does not reach the visit.
A client whose long-term care insurance reimburses the cost: the policy and the insurer’s claim rules apply. The subsection does not mention private insurance.
A client covered by another public program under a contract with the agency: that program’s contract and rules apply, and this subsection does not address them.
A client on Medicaid personal care or home health services, even one: the state’s EVV rules apply to those visits. The statute lets each state require a state-operated arrangement or one it does not operate, with different federal matching for each, so the state’s own EVV page and provider notices are the place to read what that means.

What the statute does not settle is whether a state licensing rule, a state-funded program outside Medicaid or a payer contract asks for visit verification anyway. That is a state and contract question, and the state’s licensing agency and the agency’s counsel answer it. This guide does not.

What payers outside Medicaid ask for instead

Payers outside Medicaid write their own proof rules into policies, contracts and claim forms. Not every payer publishes them; the Federal Long Term Care Insurance Program (FLTCIP), run under the Office of Personnel Management, does, which makes it a useful public example. Its reimbursement page defines a formal caregiver as one “whose services are arranged and supervised by a home care agency,” and for that caregiver it asks for an itemized invoice that includes:

The name, address and phone number of the agency.
Individual dates of service.
Total hours per day.
Total charged per day.
A description of the services provided.
The total amount charged per invoice.

The same program says its plan of care includes “hourly rates for caregivers, and quantified time for specific care services,” and that it is “used to validate invoices we receive for reimbursement.” It typically reimburses within 10 days “after all required documents have been received.” No EVV app is named anywhere in those rules. Every item on the list is visit data, though: the date, the hours and the charge for each day. An agency that cannot produce those from its own records retypes them from timesheets, which is where errors and delays start.

The six EVV data points as a private-pay checklist

The statute defines an electronic visit verification arrangement as one that verifies six things about each visit. They were written for Medicaid, but each one answers a money question in a private-pay agency too:

The type of service performed: which bill rate applies — companion care, personal care, overnight, live-in — and whether the visit matches what the service agreement priced.
The individual receiving the service: which client’s invoice carries the hours, including two clients served in one household.
The date of the service: holiday rates on both the pay and the bill side, and the day count toward a long-term care policy’s waiting period.
The location of service delivery: mileage, and the travel between clients that 29 CFR 785.38 counts as hours worked.
The individual providing the service: payroll, and weekly hours for each caregiver across every client.
The time the service begins and ends: the paid hours and the billed hours, the two numbers a payroll-to-invoice reconciliation compares.

An agency that captures these six for every visit, whatever tool records them, has what it needs to reconcile payroll against invoices and to answer a family or an insurer from the record. One that captures them for Medicaid visits through the state’s tool and on paper timesheets for private-pay visits runs two standards of record in one office, and the private-pay side is the one with no outside check.

Before buying EVV software: questions for the data already there

The private-pay question is not “EVV or not.” It is whether the agency’s visit records are clean enough to pay caregivers, bill families and support an insurance claim from one source. If the scheduling software already records clock-ins, five questions show whether it does the job:

How many visits last month had a missing or edited clock-in or clock-out, and who fixed each one?
Are invoices drawn from the verified visit times, or from the schedule?
When a caregiver stays late because the family asked, where is that recorded, and does the invoice see it?
When a family questions a visit, can the office answer from the record in one call?
For a long-term care insurance client, can the itemized invoice the insurer needs be produced from the visit records without retyping?

If the answers are good, a new app adds little. If they are poor, a new app records the same gaps faster. The first fix is a rule — who corrects a missed punch, and on which record — and only then, perhaps, a purchase.

When EVV is not the problem — and when not to hire anyone

If every client is private pay, the visit records are complete, and payroll and invoices agree for the same dates, there is nothing here to fix, and no consultant is needed. If some clients are on Medicaid, the state’s EVV program, its provider notices and its training are the right place to start; an operations review is not a compliance review, and this one makes no regulatory judgment.

An outside look can help when visit data exists but nobody uses it to check the invoice — when paid hours, billed hours and insurer claims each come from a different record. The Revenue Review reads visit, payroll and invoice exports by client ID, with no care details, alongside the agency’s inquiries, call-offs and receivables. It takes two weeks and ends in a written report that puts a monthly dollar figure on each leak the records support. It does not select software, give legal or regulatory advice, or contact caregivers, families or payers.

If the numbers suggest it, the next step is a free 20-minute call. Asking the five questions above of last month’s visits first will answer much of it.

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Asked right after

Is EVV required for private pay home care?: Not by federal law. The federal requirement, 42 USC 1396b(l), covers personal care and home health services provided under a state’s Medicaid plan or waiver. Visits paid from a client’s own funds are outside it. A state rule, a payer contract or an insurance policy can still ask for visit records, so check with the state and the agency’s counsel.
What services require EVV?: Under federal law, Medicaid personal care services and Medicaid home health care services that require an in-home visit by a provider, including personal care furnished under the waiver authorities the statute lists. States had to require it for personal care from 2020 and for home health from 2023, or accept a cut in their federal Medicaid share.
What are the six EVV requirements?: 42 USC 1396b(l)(5)(A) lists them: 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, and the time the service begins and ends. Each visit must be verified electronically on all six.
Do we need EVV if only a few of our clients are on Medicaid?: For those clients’ Medicaid visits, the state’s EVV rules apply, whatever the rest of the census looks like. The statute is written to states, and each state sets how agencies comply, so read the state Medicaid agency’s EVV page and provider notices, and ask counsel about anything unclear.
Does long-term care insurance require EVV?: The federal EVV statute does not mention it. Each insurer sets its own claim rules. The federal employees’ program, FLTCIP, asks home care agencies for itemized invoices with individual dates of service, total hours per day, charges per day and a description of services — visit data, whatever tool records it.
When did EVV become mandatory?: For Medicaid personal care services, for calendar quarters beginning on or after January 1, 2020, and for Medicaid home health care services, on or after January 1, 2023, under section 12006 of the 21st Century Cures Act. The statute waived the first year’s reduction for states that showed a good-faith effort and unavoidable delays.

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