Electronic Visit Verification (EVV)

Frequently Asked Questions (FAQs)

G1 Q: What is Electronic Visit Verification?

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.

G2 Q: Why is New York State implementing an EVV system?

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).

G3 Q: What are the goals of EVV?

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.

G4 Q: What happens if a State Medicaid Program does not implement the EVV requirement?

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.

Year PCS HHCS
2021 0.25%  
2022 0.50%  
2023 0.75% 0.25%
2024 1.00% 0.25%
2025 1.00% 0.50%
2026 1.00% 0.75%
2027 & Thereafter 1.00% 1.00%

Reduction percentages do not compound each year.

G5 Q: When must EVV be implemented?

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).

On December 5, 2019, New York State Received the Good Faith Effort Exemption from Federal Centers for Medicare and Medicaid (CMS), delaying EVV implementation for PCS until January 1, 2021.

G6 Q: What services does the federal law apply to?

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." 10 NYCRR 700.2(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." 10 NYCRR 700.2(c) (15)

G7 Q: Does the EVV requirement apply to the Program of All-Inclusive Care for the Elderly (PACE) program?

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

G8 Q: Which NYS programs does the EVV requirement apply to?

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

  • 1905(a)(24) State Plan Personal Care Benefit
    • Consumer Directed Personal Assistance (CDPA)
    • Personal Care Assistance (PCA I & II)
  • 1915(c) Home and Community Based Services waivers
    • Children´s Waiver
    • Nursing Home Transition and Diversion (NHTD) waiver
    • Traumatic Brain Injury (TBI) waiver
    • Office for People with Developmental Disabilities (OPWDD) comprehensive waiver
  • 1115 Demonstration
    • CDPA
    • PCA I & II
G9 Q: How will DOH collect input from the Stakeholders?

A: NYSDOH has carefully considered feedback from Medicaid beneficiaries, family caregivers, providers, advocates, and other stakeholders on the State´s implementation of EVV. We have received input during EVV Listening sessions, responses to the EVV Readiness Survey and conducted a Request for Information (RFI) for EVV solutions. NYS DOH has established an email address dedicated to responding to questions and comments related to EVV.

New York State will continue to engage with stakeholders to ensure smooth and well-informed implementation, including any required training for the those impacted by EVV. We will monitor the implementation, and work to address issues that may arise.

Upcoming opportunities for stakeholder engagement will be posted to the NYS EVV Website at www.health.ny.gov/EVV. NYSDOH will also notify the public via the EVV Listserv.

To sign up for the EVV Listserv, email listserv@listserv.health.state.ny.us with the following: SUBSCRIBE EVV-L YourFirstName YourLastName. Any questions, comments, or additional feedback is welcomed to the EVV Help Email at EVVHelp@health.ny.gov.

G10 Q: Can providers opt out of using EVV?

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

G11 Q: Will there be any changes to the OMIG Verification Organization (VO) program once EVV is in place in New York State?

A: Currently, there are no planned changes to the Social Services Law that enacted the Verification Organization program under OMIG in 2014. Providers must comply with both the 21st Century Cures Act and the VO program through OMIG.

G12 Q: Our agency does not meet the $15 million minimum of the VO program; do we still need to participate in EVV?

A: Yes. The 21st Century Cures Act is a federal law, passed by Congress in December 2016, that requires all state Medicaid programs to require that providers of Medicaid-funded personal care services (PCS) that begin or end in the home implement an EVV system by 1/1/2021 regardless of revenue. Home Health Care Services (HHCS) will take effect on 1/1/2023.

G13 Q: Are Care Coordination Organization (CCO) Health Homes required to use EVV?

A: Care Coordination Organizations Health Homes are not service providers and therefore not subject to EVV. EVV information must be submitted for Medicaid-funded Personal Care Services that begin or end in the home.

G14 Q: Will there be costing sharing or increased reimbursement rates to account for the additional costs associated with implementing EVV?

A: Under the Choice Model, providers self-select an EVV vendor that meets the needs of their constituents and self-fund its implementation. Providers with an existing EVV solution must ensure it meets federal and state requirements and configure data collection to meet NYS standards as published and periodically updated on the NYS EVV website.

G15 Q: Is EVV required for in-home hospice?

A: EVV does apply to in-home hospice. EVV information must be submitted for Medicaid-funded Personal Care Services that begin or end in the home.

G16 Q: Does EVV apply to services under the Children´s Waiver?

A: Yes, EVV does apply to Medicaid-funded Personal Care Services that begin or end in the home under the Children´s Waiver. A list of applicable rate and procedure codes can be found here.

G17 Q: Is EVV required for both FFS Medicaid and Managed Care?

A: EVV is required for both Medicaid Fee for Service (FFS) and Managed Care (MC).

G18 Q: Can a manual entry or paper timesheet be used to capture services when necessary?

A: All EVV services are required to have complete EVV data in order to be considered a verified visit. Manual entries should only be used when absolutely necessary. Manual entries are auditable by OMIG and NYSDOH and will be monitored and reviewed on a case-by-case basis due to the situational circumstances of each agency and their need to utilize manual entries as an option for capturing services. The provider agency or FI must retain and maintain documentation of the reason for the manual entry.

G19 Q: Some Community Habilitation services are provided in the community. Is EVV still required if the services are not provided in the home?

A: : Community Habilitation (CH) services are frequently provided in the community outside of the person's home. A CH service claim would not require EVV reporting if the services being claimed are delivered entirely in the community. CH Services that are delivered entirely in the community are CH services that are not provided completely or partially in the home. Please see EVV Applicable Billing Codes document for OPWDD CH rate codes that are impacted.

G20 Q: Are Supported Employment Programs through OPWDD subject to EVV?

A: No, Supported Employment (SEMP) and the Employment Training Program (ETP) are not subject to EVV. To confirm that the service you are currently providing is within the EVV scope, please see EVV Applicable Billing Codes document for procedure and rate codes that are impacted.

G21 Q: Will the Unique Identifier requirement for home care workers through the Office of Medicaid Inspector General (OMIG) impact EVV?

A: No, not at this time. Currently, OMIG is developing a process for establishing a unique identifier for home care workers. Once established, stakeholders will be informed through the EVV Website and Listservs.

G22 Q: What if the consumer has no phone for the aide to use and/or the aide has no phone to capture EVV services?

A: It is the responsibility of the provider agency to determine how EVV data will be captured by the aide when an electronic device is unable to be used, to ensure Electronic Visit Verification (EVV) compliance.

G23 Q: Can the aide use the consumers cell phone to capture EVV services?

A: It is the responsibility of the provider agency to determine how EVV will be captured by the aide to ensure EVV compliance.

G24 Q: As a provider, should I round my EVV data to align with the current universal billing codes rounding guidance?

A: No. The submission of EVV data is separate from your current billing practices. The EVV data submitted should be the exact time the service started and ended. Providers should continue to bill as they currently do for those services. The Department will continuously assess EVV data needs and requirements and update the EVV stakeholder community appropriately.

G25 Q: How do I submit EVV data and billing data for overnight visits?

A: The submission of EVV data is separate from your current billing practices. When submitting EVV data for overnight visits, the start date and time is required for the begin date of service, and the end date and time is required for the end date of service. For example: Start date and time: 2020-07-15 08:03:46PM. End date and time 2020-07-16 7:16:09 AM. To learn more about data specifics, please review the Interface Control Document (ICD) on the EVV website. Providers should continue to bill as they currently do for those services. The Department will continuously assess EVV data needs and requirements and update the EVV stakeholder community appropriately.

G26 Q: Is the signature from the consumer participating in the CDPAP or Self-Direction required to accompany EVV data when providing a Medicaid-funded service?

A: No, the signature is not required to be submitted to the NYS Aggregator.

G27 Q: What is considered an EVV "in-home" visit and how does it differ from an EVV "Community" visit?

A: A visit is considered an EVV applicable "in-home" visit when a portion of the service occurs within the home, the service includes ADLs or IADLS, and the EVV applicable service is billed to NYS Medicaid as a FFS claim or through Managed Care. It is not considered an "in-home" visit if the aide is picking up or dropping off a consumer at their residence and briefly touches the home to assist that consumer in and out of the home because the site of service did not occur within the home.

G28 Q: What level of compliance is required of providers for EVV?

A: All EVV services are required to have complete EVV data in order to be considered a verified visit. If NYSDOH detects steady non-compliance over time, the NYSDOH reserves the right to conduct a compliance review. Depending on the results of the compliance review, NYSDOH may refer a provider agency or FI to OMIG for audit, which may result in the review and recovery of overpayments.

G29 Q: Are services delivered through telehealth subject to EVV?

A: At this time, EVV applicable services that occur via telehealth are not required to have data submitted to the NYS aggregator; however, the Department cautions that further guidance is likely on this issue as telehealth utilization has increased during the COVID-19 pandemic and may continue as an emergent care method moving forward.

G30 Q: When utilizing GPS for EVV data collection, how close to a designated location will the visit need to be recorded to be considered a valid visit. What is the acceptable range?

A: It is the providers responsibility to determine that visit data collected through the GPS is collected within the means of the EVV company´s validating capabilities. It is the responsibility of the Provider to monitor GPS clock in and clock out coordinates against client´s locations on the date of service. Visits validated by GPS are auditable by OMIG and reviewed on a case-by-case basis due to the situational circumstances of each consumer´s location and acceptable range to be considered ´home´.

E1 Q: What is the selected Model for implementing EVV in New York State?

A: New York selected the Choice Model for the following reasons: (1) it best ensures that consumers will have EVV options from which to consider when selecting a provider; (2) it gives providers of service the flexibility to select an option that best meets their business needs and the needs of the consumers they serve; and (3) it recognizes that many providers serving New York´s Medicaid consumers have already implemented EVV systems that meet the requirements of the Cures Act, preserving the investment that has already been made, avoiding duplicative costs, and eliminating disruption to consumers and caregivers.

To implement the Choice Model, NYSDOH will require that providers of Medicaid-funded personal care services (PCS) select, and put into production use, EVV systems that meet the requirements of the 21st Century Cures Act by January 1, 2021. Providers of Medicaid-funded Home Health Care Services (HHCS) will be required to select and implement such systems by January 1, 2023. In addition, providers will be required to submit EVV data to NYSDOH, which will be aggregated for reporting and audit purposes.

E2 Q: What is the Choice Model?

A: Under the Choice Model, providers are able to implement an EVV system that best meets the needs of the recipients they serve, and that they determine is best suited to meet their individual administrative needs. Such systems must meet the requirements of the 21st Century Cures Act, and in addition, must be able to submit data to New York State, which will be aggregated for reporting and audit purposes.

As recommended by CMS guidance, NYSDOH will provide statewide EVV data aggregation through New York´s Medicaid Management Information System (MMIS). In keeping with the Cures Act requirement to implement EVV in a way that is "minimally burdensome ," and in response to concerns from stakeholders regarding privacy and self -direction, during its initial implementation, only the minimum set of EVV data elements necessary to meet the obligations under the Cures Act will be aggregated. To illustrate, while the Choice Model allows providers to utilize multiple methods of collecting EVV data (for example, home phone number, fob, or GPS-enabled mobile applications), New York will launch data aggregation with a limited set of data needed to meet the requirements of the Cures Act. Once the initial implementation period is complete, NYSDOH will assess the EVV program and may, as a result, modify data aggregation to support initiatives to improve quality and access to services.

E3 Q: What type of EVV system must be used?

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:

  • type of service performed;
  • individual receiving the service;
  • date of the service;
  • location of service delivery;
  • individual providing the service; and
  • time the service begins and ends

Note: Under the Choice Model DOH will not endorse, approve, or recommend any specific EVV systems, or provide a list of systems from which providers must select.

E4 Q: How can I successfully select and implement an EVV solution under the New York State EVV Choice Model?
  1. A: Selected systems must comply with the Federal 21st Century Cures Act requirements. Providers are responsible for reviewing the Cures Act and making sure that they select systems that comply.
  2. DOH will not endorse, approve or recommend EVV systems, or provide a list of systems from which providers must select.
  3. Providers are advised to select systems with flexible interfaces. Systems should be capable of submitting required elements to the NYS data aggregation mechanism, interoperating with claims submission functions, and should be able to adapt to any future Federal or State policies with regard to submission of EVV data.
  4. Providers are responsible for ensuring that selected systems meet privacy and security rules and laws.
  5. Providers are advised to select systems that offer alternative methods for collecting data electronically in the event of system failure, natural disaster, or services provided in geographic areas with limited or no internet or cellular connectivity.
  6. EVV systems should retain and back up data in keeping with all standard Medicaid Audit data retention requirements.
  7. The provider EVV system must be able to accommodate the following scenarios:
    • Consumers who use multiple aides
    • Multiple individuals receiving services in the same home and/or same time with one or multiple aides.
  8. All EVV systems must be accessible for input or service delivery 24/7.
  9. EVV systems must have the ability to enter visit information in an offline mode when there is inadequate network capacity or other technical disruption and enable upload to the EVV system upon return of connectivity.
  10. NYS will not require EVV data for caregivers that live full-time with their care recipients. The caregiver´s permanent place of residence must be the same as care recipients.
  11. Providers may utilize multiple methods of collecting EVV data (for example, home phone number, fob, or GPS-enabled mobile applications). New York will launch data aggregation with a limited set of data needed to meet the requirements of the Cures Act. Once the initial implementation period is complete, NYSDOH will assess the EVV program and may, as a result, modify data aggregation to support initiatives to improve quality and access to services.
E5 Q: Must I purchase an EVV System?

Providers who have already invested in an EVV System may continue to use that system, modifying it as needed to meet the federal requirements of the Cures Act and NYS requirements.

Providers who do not have an EVV system, have the flexibility and freedom to choose a solution that best fits the needs of the consumers they serve and their organization.

Under the Choice Model DOH will not endorse, approve, or recommend any specific EVV systems, or provide a list of systems from which providers must select.

E6 Q: Are there any special scenarios my EVV system needs to accommodate?

A: The provider EVV system must be able to accommodate the following scenarios:

  • Consumers who use multiple aides
  • Multiple individuals receiving services in the same home and/or same time with one or multiple aides.

All EVV systems must be accessible for input or service delivery 24/7.

E7 Q: Is a Global Positioning System mandatory for EVV?

A: No. GPS is not currently required for EVV in New York State in order to submit EVV data to the NYS Aggregator through eMedNY. If a provider agency or FI chooses to utilize a GPS system to capture EVV data, it is the responsibility of the provider agency or FI to maintain and store the GPS data points in the event of an audit for verification purposes. For more information on data submission, please review the EVV Interface Control Document.

E8 Q: When using GPS, is it required to be on during the full duration of the visit or only the start and end times?

A: Electronic Visit Verification may be implemented in any way that complies with both the Cures Act and New York State requirements. The Cures Act requires that Begin and End times be captured by EVV systems, and these are the elements that New York will require be submitted to the Statewide Aggregator. (For more information on required elements for statewide aggregation, please review the draft ICD which is located here.

E9 Q: Will New York State provide a list of approved systems?

A: New York State will not endorse, approve or recommend a vendor or EVV system. Under the Choice model, providers have the flexibility to select a system that best meets the needs of their practice and consumers and meets the 21st Century Cures Act requirements.

E10 Q: Will New York State certify EVV systems?

A: No. Currently, New York State Department of Health (NYSDOH) does not plan to certify EVV vendor systems.

E11 Q: How do we know if our current EVV provider/component is compliant with the requirements?

A: Providers have the flexibility and freedom to utilize their current EVV systems or choose an EVV solution that best fits the needs of the consumers they serve and their organization, so long as it meets the requirements of the 21st Century Cures Act and is capable of submitting EVV data to eMedNY. There is currently no NYSDOH process for certifying that individual EVV solutions meet these requirements.

Providers must make independent decisions about what EVV systems they will purchase or continue to utilize. Providers should ensure that they review the 21st Century Cures Act and should also reference the NYSDOH EVV Website for recommended considerations for selecting your EVV System

E12 Q: In the ICD, it states that there will be a 99.98% uptime excluding planned outages. How often will outages be planned and how will notice be sent to users?

A: Planned outages will occur very infrequently. Notices will be sent through the eMedNY listserv to notify users in advance in the event of an outage.

E13 Q: Are providers required to enroll with eMedNY for EVV data to be accepted?

A: Yes, if you are not currently enrolled with eMedNY, please visit the eMedNY website to learn more about how to enroll.

E14 Q: Can we use our existing eMedNY credentials to access the API Gateway for EVV Data Submission?

A: NYSDOH is working to determine the requirements for registering EVV solutions to submit data to the statewide aggregator. The goal is to utilize current provider enrollment processes to the greatest extent possible. The process for registering will be communicated on an upcoming Technical Assistance Call and via the EVV and eMedNY PCS and HHCS Listservs and will be posted on the NYSDOH EVV website.

E15 Q: Do I need to send EVV applicable manual entries to the NYS Aggregator?

A: The NYS Aggregator only collects verified visits. In an event that a service was not electronically verified, NYS requires that providers and fiscal intermediaries maintain all EVV data documentation and a brief justification for why a manual entry was used instead of using a compliant EVV method.

E16 Q: Do I need to send edited EVV entries to the NYS Aggregator?

The NYS Aggregator only collects verified visits. Verified records that have been edited may still be sent to the NYS Aggregator, but providers and fiscal intermediaries must retain both the original set and edited set of data with a brief justification explaining why the entry was edited in the event of an audit or other review.

A1 Q: Where can I find more information on Electronic Visit Verification (EVV) from the Centers for Medicare and Medicaid Services (CMS)?

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

A2 Q: How do I contact the State regarding EVV if I have any questions or concerns?

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