# Electronic Visit Verification Policy and Procedure **Starting point, not a finished policy.** Read this first. EVV rules are set state by state. The system you must use, the deadlines, what counts as an acceptable correction and how long records must be kept all differ depending on where you operate and which payers you contract with. A policy copied from the internet and filed unchanged is worse than no policy, because it says you have a process you do not actually follow. Every blank marked `[ ]` needs your own answer. Every line marked **confirm** needs checking against your state Medicaid agency's published EVV guidance and your managed care plan contracts before you adopt it. This is not legal advice and it does not make your agency compliant. --- Agency: `[ agency legal name ]` Policy owner: `[ name and title ]` Effective date: `[ date ]` Last reviewed: `[ date ]` Review interval: `[ annually, or on any state EVV change ]` --- ## 1. Purpose This policy sets out how `[ agency name ]` electronically verifies service visits, in order to meet the requirements of section 12006 of the 21st Century Cures Act and the EVV requirements of `[ state ]` Medicaid and our contracted payers. ## 2. Scope This policy applies to: - `[ list service types, for example personal care services, home health care services ]` - All caregivers delivering those services - All office staff who review, correct or transmit visit records **Confirm** which of your service lines are actually within your state's EVV scope. Private pay visits are outside the federal requirement, and your agency may still choose to verify them. State that choice here explicitly. ## 3. The six required data elements Every visit within scope records: 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 6. The time the service begins and ends ## 4. System used Our EVV system of record is: `[ name of system ]` Our state's EVV model is: `[ open vendor / closed / hybrid ]` **confirm** Where a state or payer sponsored system is provided at no cost, we use it for the visits it covers. Where we use an additional system, that system does not replace the state system for claims purposes. `[ If you use a third-party vendor, record here whether your state requires you to also register with the state solution. Several states do. confirm ]` ## 5. How caregivers capture a visit Accepted capture methods at this agency: - `[ mobile application ]` - `[ telephony from the client's registered landline ]` - `[ other method permitted by the state ]` **confirm** Caregivers must check in on arrival and check out on departure. Recording both at the end of a visit, or in advance of it, is not permitted. ## 6. When capture fails Capture failures are expected and are not, by themselves, a disciplinary matter. Caregivers must never delay or refuse care because a device is not working. If check-in fails, the caregiver must: 1. Deliver the scheduled care 2. Record the actual start and end times 3. Notify the office within `[ time period ]` 4. Provide the reason for the failure The office must then correct the record following section 7. ## 7. Manual corrections Every manual correction records: - Who made the change - When it was made - What the value was before and after - The reason for the change Corrections are made by `[ named roles only ]`. A caregiver may not correct their own visit record. Corrections must be completed within `[ number ]` days of the visit. **Confirm** your state's and your payers' correction windows; they are often shorter than agencies expect and may differ between payers. ## 8. Review `[ Named role ]` reviews outstanding exceptions `[ daily / each business day ]`. Exception categories reviewed include late starts, missed visits, visits with no check-out, and visits recorded outside the expected location. ## 9. Transmission and claims Visit data reaches `[ state system or aggregator ]` by `[ method ]`. `[ Record who confirms that transmission succeeded, and how often. A silently failing transmission is a common and expensive failure, because it is invisible until claims are denied. ]` ## 10. Record retention EVV records are retained for `[ number ]` years. **Confirm** against your state requirement and your payer contracts, and use the longest applicable period. ## 11. Privacy Visit records contain protected health information. Access is limited to staff whose role requires it. Location data is captured at check-in and check-out only, and caregivers are not tracked between visits. Caregivers are told this in writing during onboarding. ## 12. Training Every caregiver is trained on visit capture before their first shift, including what to do when capture fails. Training is repeated `[ annually / on system change ]` and recorded in the personnel file. ## 13. Non-compliance Repeated failure to capture visits without a valid reason is handled under `[ reference your disciplinary policy ]`. Falsifying a visit record is `[ gross misconduct / grounds for immediate termination ]` and may be reportable to `[ state agency ]`. **Confirm** your reporting obligation. --- Approved by: ______________________ Title: ______________ Date: __________ --- Template from getcareverify.com/resources/templates. Free to copy, edit and reuse, including commercially. No attribution required. **This template does not make your agency compliant and is not legal advice.** It is a structure to fill in with your own state's requirements. Confirm every item marked **confirm** with your state Medicaid agency and your contracted payers before adopting it.