EVV: How It Works and Why It Matters

Last Updated on August 6, 2026

EVV is important for administrators, care and support workers, and participants because it:

• Can help reduce Medicaid fraud and abuse levels.
• Extends cost savings to participants and programs.
• Improves accountability of care and support workers, ensuring that the right care is being delivered when and where it is invoiced for.
• Lays the groundwork for improved outcomes in healthcare.

EVV technology uses a smart phone or tablet to record your care/support worker’s start time and location at start time, then their end time and location at end time. EVV helps ensure that participants receive consistent services.

EVV mobile technology makes it easy for you to collect crucial details about home-based care services, including:

• The type of service performed.
• The name of the person who received the service.
• The date the service was provided.
• The location of the service delivery during clock-in and clock-out.
• The name of the person who provided the service.
• The start and end times for the service.

EVV applies to Medicaid-funded personal care services and home health services that require an in-home visit by a provider, including services delivered through self-direction. This covers most of the day-to-day personal care that self-directed participants receive from a hired caregiver, whether that caregiver is a professional, a friend, or a family member.

Not every service falls under the requirement. According to guidance from the Centers for Medicare & Medicaid Services (CMS), EVV does not apply to services delivered in 24-hour settings like group homes or facilities, since those aren’t considered in-home visits in the same sense. It also generally does not apply to services that consist only of instrumental activities of daily living, such as chore or homemaker services, when no personal care or home health service is involved. 

If you’re unsure whether a specific service in your program requires EVV, your fiscal intermediary, such as PPL, or the state Medicaid office can confirm.

There are three types of EVV solutions that allow state departments and MCOs, care/support workers, and participants to comply with the 21st Century Cures Act:

A dedicated hardware device is installed in participant homes and used to record the caregiver’s fingerprint at the start and end of care delivery.

While this system is simple in concept, it’s easy for care and support workers to forget to check in, check out, or both. This puts extra stress on participants to remind their caregiver to use the biometric device. These devices are also costly and must be installed in the participant’s home, which can create inconvenience and make it difficult for participants to remain active in the community.

This phone-based check-in and check-out service requires the caregiver to use the participant’s landline phone to dial a toll-free number, then navigate a menu using the number pad. Because of the call-in nature of the system, there is also limited real-time visibility into hours worked or hours needing approval.

It’s a simple process, but landlines are far less common than they once were. According to the CDC’s National Health Interview Survey (July–December 2024), nearly 78% of U.S. adults now live in wireless-only households, making telephony a less viable primary option for most of the population. In addition, participants and caregivers who rely on this method are tied to the home during check-in and check-out, which can make it harder for participants to attend workshops, classes, and out-of-home therapies. 

That said, telephony still plays an important role for caregivers without smartphone access, and many states now offer formal EVV exemptions for live-in caregivers who provide care in the same home where they reside.

This mobile device-based EVV app solution is installed on a caregiver’s mobile device and uses GPS technology to collect key details on the care provided.

This approach takes advantage of existing technology and is particularly effective when an EVV and Financial Management Service (FMS) solution are integrated into one easy-to-use mobile app. The best mobile EVV and FMS solutions analyze both EVV rules and FMS program rules together, giving caregivers instant feedback on their time entry and making it easier to correct errors before pay day, along with reporting and monitoring functionality that helps improve care delivery.

With EVV, every visit is recorded, validated, and submitted at the time of the service – making it easier for your care/support workers to be paid on time and ensuring that participants receive their personalized care.

The PPL Time4Care™ EVV mobile app workflow highlights how streamlined the process becomes:

1. Your care/support workers and participants download an integrated EVV and FMS mobile application to their mobile device.
2. Your care worker logs in to the app to clock-in and to indicate the participant they are delivering care to.
3. Your care/support worker provides the care and then clocks-out to indicate the service delivery is completed. During the clock-in and clock-out process, the location is automatically recorded.
4. The clock-out function automatically submits your care worker’s timesheet and it is immediately validated against the program’s timesheet rules. The care worker receives instant confirmation or feedback indicating a correction is required. Any issues are immediately identified, making it easy to resolve these quickly.
5. Participants and their representative have real-time visibility and can easily see any issues with timesheets and schedules.
6. Your participant approves the timesheet on their mobile device.
7. Your care worker is paid on time.

EVV has come a long way since the 21st Century Cures Act first introduced the requirement. Personal care services have been required to use EVV nationwide since January 1, 2020, and home health services followed by January 1, 2023, with a small number of states granted approved one-year extensions to account for unavoidable implementation delays. Today, every state has an EVV system in place for both service types.

States implement EVV through one of several vendor models recognized by the CMS: provider choice, where agencies select their own vendor; MCO choice, where managed care plans select the vendor for their network; a state-mandated single vendor used by everyone in the program; or an open vendor model that gives providers flexibility while still meeting state requirements. Many states also use a centralized EVV data aggregator, which matches submitted claims against EVV visit data before a claim can be paid.

As a result, the compliance conversation has shifted. In the early years of EVV, the priority was simply getting a compliant system in place. Today, the focus for most states and programs is on data quality and accurate claims matching, since EVV visit data is now actively used to approve or deny Medicaid claims in many programs. Live-in caregiver exemptions have also become more standardized, recognizing that a caregiver who lives with the participant they support doesn’t need the same clock-in and clock-out process as a caregiver traveling to a different home each visit.

If you’re a state department or MCO supporting a self-direction program, EVV plays a direct role in program integrity and compliance. Beyond satisfying the 21st Century Cures Act, EVV data gives you the visibility to know what care is being provided, who is receiving it, and who is delivering it through detailed reporting. That reporting functionality allows you to flag and monitor care inconsistencies, making it easier for case managers to communicate with participants about their satisfaction with the care they’re receiving.

Because care and support workers are recording the duration of care in real time, this data also helps ensure the right care is being provided, and it gives administrators the information needed to run a more efficient program overall, which can extend more home-based care options to participants who want to remain at home.

The easier an EVV vendor solution is to use, the more compliance you’ll see and the fewer issues you’ll run into with learning curves and staff turnover. The goal is to make EVV compliance as simple as possible without adding unnecessary friction to a caregiver’s day-to-day routine.

If you’re a participant, or a family member helping someone navigate self-directed care, EVV is designed to work in the background so you can focus on the care itself. For caregivers, job satisfaction is often affected by paperwork and uncertainty over pay. EVV eliminates a lot of that uncertainty, since time is submitted as the caregiver records their shift, which supports timely, accurate pay and lets caregivers focus on the person they’re caring for rather than administrative back-and-forth.

For participants, EVV also means more transparency. You or your authorized representative can see submitted hours in real time, catch discrepancies quickly, and know that your caregiver’s pay is tied directly to verified visits. If your caregiver lives with you, ask your program about live-in caregiver exemptions, since many states no longer require the same clock-in and clock-out process in that situation.

PPL’s Time4Care™ EVV mobile application is built to make EVV compliance simple for administrators, caregivers, and participants alike. An integrated EVV and FMS solution gives you convenience, flexibility, visibility, and clarity in one place.

Download on Apple Store Download on Google Play

Contact us to learn how our expertise and Time4Care™ EVV solution can improve your program while fulfilling the 21st Century Cures Act requirements. You can also learn more about how EVV fits into a full Financial Management Services solution.