EVV is federally required, but it is administered state by state — and the model your state chose determines whether you get to pick a vendor at all. This is what the rule actually requires, where a verified visit still fails to bill, and how Elixir keeps verification attached to the authorization and the claim.
Six data elements
What the Cures Act requires every EVV system to verify.
Five state models
Whether you choose your vendor depends on your state.
Submitted ≠ billable
Four milestones sit between a visit and a payable claim.
Connected to the claim
Verification attached to the authorization, not a separate silo.
The requirement
Electronic Visit Verification is a system that electronically confirms a home visit actually happened as billed. It was made a federal requirement by section 12006 of the 21st Century Cures Act, which directed states to require EVV for Medicaid personal care services and home health care services delivered in the home.
The deadlines have passed. States had to require EVV for personal care services by 1 January 2020 and for home health care services by 1 January 2023. A state that made a good-faith effort and hit unavoidable delays could apply for an extension; otherwise, non-compliance carries incremental reductions to federal medical assistance percentage funding of up to one percent.
Those penalties land on the state, not on you. But they are the reason your state passes the requirement down as a condition of payment — and why a visit that cannot be billed is, in practice, a visit that cannot be billed.
The rule
The Cures Act names exactly six things an EVV system has to verify. Everything else a vendor offers sits on top of these. If a system cannot produce all six for a given visit, that visit is not verified.
Element 01
Which service was delivered, matched to the service type on the authorization.
Element 02
The client or patient the visit was for, tied to the person's record.
Element 03
The calendar date the visit took place.
Element 04
Where the service was delivered. This is the element most people mean when they say "EVV", and it is one of six.
Element 05
The caregiver who delivered the care, authenticated rather than typed in.
Element 06
Check-in and check-out, which together establish the duration billed.
Source: CMS, EVV Requirements in the 21st Century Cures Act (PDF).
State variation
This is the question to settle before you evaluate any EVV vendor, because in two of these models the decision is not yours to make. CMS describes five implementation models, and states choose independently — so a multi-state provider can be operating under several at once.
Providers select and fund their own EVV system, usually from a state-approved list.
Ask: what are the approval and interface requirements?
The state offers a default system, and providers or plans may use an alternative that meets the state's interface standards.
Ask: what does the alternative system have to send, and how often?
The managed care organisation selects and funds the EVV vendor rather than the state.
Ask: do your plans differ from one another?
One contracted vendor is required for every provider in the state.
Ask: how does your own system feed it?
The state builds and runs its own EVV platform, which providers must use.
Ask: what are the submission windows and correction rules?
In a mandated model you do not choose the EVV system. You choose what feeds it — and whether your own record stays intact when it does.
Source: CMS, EVV Requirements in the 21st Century Cures Act (PDF). Model names follow CMS terminology; individual states use their own labels.
Scope
The federal requirement covers Medicaid-funded personal care services and home health care services that are delivered in the home and require an in-home visit by a provider. Beyond that floor, states extend scope in their own ways — which is why "do we need EVV for this programme?" is a state question rather than a federal one.
| Service area | Federal position | What to confirm for your state |
|---|---|---|
| Personal care services | EVV required since 1 January 2020. | Which waiver and state plan programmes are in scope, and the applicable aggregator arrangement. |
| Home health care services | EVV required since 1 January 2023. | Whether skilled visits follow the same submission rules as personal care. |
| Home and community-based waiver services | In scope where the service meets the personal care or home health definition. | Programme-by-programme scope, since waiver service definitions vary widely. |
| Self-directed and family caregiver models | Not exempt from EVV by virtue of being self-directed. | How your state expects verification to work when the caregiver is a family member. |
| Services delivered outside the home | The federal requirement centres on in-home visits. | Whether your state requires verification for community-based delivery too. |
Scope varies by state and programme. Elixir confirms supported states, programmes and aggregator arrangements per implementation rather than claiming blanket coverage.
The operational reality
Almost nobody fails EVV because a caregiver did not show up. Visits fail because something between the front door and the claim did not line up — and because most EVV systems are a separate application that knows nothing about the authorization.
These are the five that recur.
The care was delivered and documented, but the record sat on the device. Whether it survives depends on whether the original check-in and check-out times are preserved on upload, or quietly replaced by the sync time.
The visit verifies perfectly and still cannot be billed, because the authorization was exhausted or expired before the date of service. An EVV system that cannot see the authorization cannot warn anyone.
Missed check-ins and corrections are normal in home care. What matters is whether each one routes to a supervisor with a reason code and an audit trail, or gets edited quietly in a spreadsheet.
A client was at a day programme, or the address on file is wrong, or GPS accuracy was poor. A flagged visit is a review item, not a fraud finding — but it has to reach someone before the billing window closes.
A rejection returns the visit for correction. It does not erase the original visit and it does not mean payment was denied. Teams lose money here by treating submission as completion.
The Elixir approach
Most home care organisations run EVV in one system and care, authorizations and billing in another, then spend the month reconciling the two. Elixir treats the verified visit as part of the same record as the authorization it draws down and the claim it produces.
The visit, the client, the care plan, the authorization and the claim are the same record. Nothing is exported to be reconciled later.
Missed check-ins, manual entries and geofence flags go to a supervisor with a reason code, and the correction keeps its review history.
Records captured offline keep their original check-in and check-out times when they upload, and retries do not create duplicate visits.
Verification status, authorization and documentation checks are all part of claim readiness, rather than something discovered after a denial.
Go deeper
Two views of the same workflow — the platform side and the caregiver side.
Platform
How verification, geofencing, exception management and aggregator connectivity sit alongside the EHR, care plans, authorizations and revenue cycle.
The field
The same visit from the caregiver's phone: preparation, arrival, documentation, escalation, departure and what happens after submission.
The questions home care operators ask most often when reviewing EVV.
A system that electronically verifies a home visit took place as billed, by capturing six required data elements: the service performed, the individual receiving it, the date, the location, the individual providing it, and the start and end times.
Yes. Section 12006 of the 21st Century Cures Act directed states to require EVV for Medicaid personal care services by 1 January 2020 and for home health care services by 1 January 2023.
A non-compliant state faces incremental reductions to its federal medical assistance percentage of up to one percent. States that made a good-faith effort and encountered unavoidable delays could apply for an extension.
It depends on the model your state adopted. Under Provider Choice and Open Vendor you generally can, subject to interface requirements. Under a State Mandated model you cannot — you choose what feeds the mandated system instead.
Self-directed and family caregiver arrangements are not exempt simply for being self-directed. How verification works in those cases is set by your state, so confirm it programme by programme.
The visit record was returned for correction. It does not erase the original visit, and it does not mean a claim was denied — the claim may not have been submitted yet.
Not on its own. Submission, synchronization, internal verification and aggregator acceptance are separate milestones, and billing still depends on authorization and documentation checks.
Visits are captured offline and queued on the device. What matters is whether the original check-in and check-out times survive the upload, and whether retries can create duplicate visits.
See EVV in Elixir
We will walk the visit from the caregiver's phone through verification, exception review and billing readiness — against the states and programmes you actually operate in.
