NY Medicaid Electronic Visit Verification Program (EVV)

Electronic Visit Verification FAQs

A: Electronic Visit Verification, or EVV, is an electronic system that verifies when provider visits occur and captures the date and time of the visit, the location of the visit, the person who received the services, the person who provided the services, and the services provided. In most cases, a signature or voice verification from the individual receiving the services can also be captured.

A: New York Medicaid is required by federal law to implement an EVV system for certain home–and–community–based services. The law, referred to as the 21st Century Cures Act can be found in Public Law 114–255, Section 12006(a)(4)(B).

A: The goals of EVV are to ensure timely service delivery for members, including real–time service gap reporting and monitoring, reduce the administrative burden associated with paper timesheet processing and generate cost savings from the prevention of fraud, waste, and abuse.

A: If EVV is not implemented, federal law requires The Center for Medicare and Medicaid Services (CMS) to reduce the Federal Medical Assistance Percentage (FMAP) rate or amount of federal payments given to a State for personal care and home health care services. The reduction can be up to one percent.

A: States must require EVV for all Medicaid–funded Personal Care Services (PCS) by January 1, 2020, and Home Health Care Services (HHCS) by January 1, 2023.

Per Section 12006(a)(4)(B) of the 21st Century Cures Act, states can apply for a one–year extension, if a state has encountered unavoidable system delays in implementing an EVV system and can show it has made a "good faith effort" to comply. If a "good faith effort" exemption is granted, CMS will not reduce the federal medical assistance percentage for calendar quarters in 2020 (for personal care services) or for calendar quarters in 2023 (for home health care services).

A: An example of a "good faith effort" would include complying with the EVV requirements, by taking steps to adopt the technology used for an electronic visit verification system.

A: The federal law applies to Medicaid–funded Personal Care Services (PCS) and Home Health Care Services (HHCS). These services are defined in the state regulations as follows.

"Personal cares services shall mean assistance to the patient with personal hygiene, dressing, feeding, and household tasks essential to his/her health." 10NYCRR700.2(c) (17)

"Home health aide services shall mean health care tasks, personal hygiene services, housekeeping and other related supportive services essential to the patient’s health." 10NYCRR700.2(c) (15)

A: The EVV requirement applies to services provided under the following NYS programs:

  • Personal Care Services Program (PCSP)
  • Consumer Directed Personal Assistance Program (CDPAP)
  • Certified Home Health Aide (CHHA)
  • OPWDD Community Habilitation Program

A: Under federal law, the EVV requirement does not apply to PACE program services.

A: Federal law does not require the use of one particular or uniform EVV system. However, it does require that the system can electronically verify visits conducted as part of personal care services or home health care services. The following must be captured:

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

A: No. Providers will not be able to opt out of using EVV.

A: New York State DOH has scheduled multiple opportunities for stakeholder input. An EVV Readiness Survey will be sent to those Medicaid providers subject to EVV requirements and in–person EVV Regional Listening Sessions have been scheduled. NYS DOH has established an email address dedicated to responding to questions and comments related to EVV.

For more information, please refer to the Stakeholder Information page.

A: Information released by CMS related to EVV can be found here.

A: You may contact New York State with any questions or comments at EVVHelp@health.ny.gov