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Guide · Compliance

Do private-pay home care agencies need EVV?

What the federal electronic visit verification requirement covers, why private-pay and long-term-care-insurance visits fall outside it, and how to document those visits instead.

Last reviewed . This is general information for agency owners, not legal advice. Rules change and vary by state, so confirm with your state agency or an employment attorney before changing how you pay or train staff.

The short answer

Federal EVV rules apply to Medicaid-funded personal care and home health visits. If the client, their family or a long-term-care insurance policy pays for the care, federal law doesn’t require EVV for those visits. You still need good records, and your state or a payer contract may have its own rules.

What the EVV law requires

Section 12006 of the 21st Century Cures Act, codified at 42 U.S.C. 1396b(l), requires states to use electronic visit verification for Medicaid personal care services and home health care services. A state that doesn’t faces a reduction in its federal Medicaid matching funds. The system has to verify six things:

  1. the type of service performed,
  2. the individual receiving the service,
  3. the date of the service,
  4. the location of service delivery,
  5. the individual providing the service, and
  6. the time the service begins and ends.

The statutory deadlines were January 1, 2020 for personal care services and January 1, 2023 for home health care services. Many states used a CMS-approved good-faith exemption for home health, and CMS measured their compliance as of January 1, 2024.

CMS guidance adds a few limits worth knowing:

  • EVV applies to in-home visits, not to congregate settings such as group homes or assisted living.
  • It doesn’t apply when the caregiver and the Medicaid beneficiary live together, though a state may choose to require it anyway.
  • For Medicaid, web-based timesheets on their own aren’t enough to meet the requirement.

Which visits it covers

Who pays for the visitFederal EVV requirement?
Medicaid (state plan or waiver personal care, home health)Yes, through your state’s EVV system
The client or their family (private pay)No
Long-term-care insuranceNo, though insurers ask for proof of care. Genworth, for example, asks for invoices with care notes
Other programs (for example, VA or state-funded programs)Not under the Cures Act. We found no VA-published EVV mandate; check your contract. Some state programs, such as Illinois’s Community Care Program, have their own EVV rules

Agencies with Medicaid and private-pay clients

The requirement follows the payer, not the agency. If you serve a few Medicaid clients, those visits go through your state’s EVV system, often a state-provided app or an approved vendor. Your private-pay visits don’t have to, so many agencies keep a simpler system for them rather than forcing every caregiver and client through EVV.

Documenting private-pay visits

Without EVV, the question a family or insurer asks is the same: did the visit happen, and was the care delivered? A solid record has:

  • Clock times tied to the schedule, so worked time can be compared with the shift.
  • The care provided, marked against the client’s signed Plan of Care.
  • The client’s or representative’s signature on an attestation of the hours, or a recorded reason they couldn’t sign.
  • A correction trail, so any change after the fact has a reason and a name on it.

The free caregiver timesheet and daily log templates capture all of this on paper.

Do you need GPS?

Not for private-pay visits. Even under Medicaid EVV, federal law requires verifying the location of service, and CMS has said no particular system or GPS is required; states use different methods. For private pay, the completed care plan and the client’s signature are usually stronger proof than a location pin, and caregivers don’t have to share their location.

AideBook documents private-pay visits this way on the caregiver’s phone, without GPS, and checks every visit automatically. See visit verification. For Medicaid visits, keep using your state’s EVV system.

Sources

  1. 42 U.S.C. 1396b(l), Electronic visit verification (LII)
  2. Medicaid.gov: Electronic Visit Verification
  3. CMCS Informational Bulletin: Additional EVV Guidance (Aug. 8, 2019)
  4. CMS FAQs on Section 12006 of the 21st Century Cures Act (May 2018)
  5. CMS: EVV compliance status for home health care services
  6. Illinois Department on Aging: EVV standards (Community Care Program)
  7. Genworth: long-term care claim payments
  8. 21st Century Cures Act, Pub. L. 114-255, section 12006

Questions

EVV questions

Not under federal law. The EVV requirement in the 21st Century Cures Act applies to personal care and home health services paid for by Medicaid. Visits paid by the client, their family or long-term-care insurance fall outside it, though a state program or a payer contract can add its own rules.

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.

The federal law requires verifying the location of service delivery, but CMS has said no particular system or GPS is required. States use approaches such as GPS on a mobile app, telephony from the client’s landline, or a fixed device in the home.

Keep a record of each visit with clock times tied to the schedule, the care provided against the client’s Plan of Care, and the client’s or representative’s signature confirming the hours, or the reason they couldn’t sign.

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