Revision 25-1; Effective March 12, 2025

The Electronic Visit Verification (EVV) Policy Handbook provides EVV standards and policy requirements with which the following entities must comply:

  • Program providers contracted with Texas Health and Human Services Commission (HHSC) and managed care organizations (MCOs), including those approved as a proprietary system operator (PSO);
  • Financial Management Services Agencies (FMSAs) contracted with HHSC and MCOs, including those approved as a PSO; and
  • Consumer Directed Services (CDS) employers.

Program providers, FMSAs, CDS employers and PSOs must also comply with any stand-alone EVV policies HHSC published on the HHSC EVV webpage.

EVV standards and policy requirements do not replace or supersede program or licensure requirements. Program providers, FMSAs, CDS employers and PSOs must follow all applicable program and licensure rules and policies in addition to EVV policies.

The EVV Policy Handbook has EVV requirements for HHSC and MCOs (the payers). Program providers and FMSAs, including those approved as a PSO, must adhere to their individual contracts with HHSC or an MCO and contact the payer for questions on EVV and non-EVV requirements.

The requirements in this handbook apply to the programs and services identified in Title 1 of the Texas Administrative Code (1 TAC) Part 15, Chapter 354, Subchapter O, Sections 354.4005 Personal Care Services that Require the Use of EVV and 354.4006 Home Health Care Services that Require the Use of EVV.

1100 EVV Overview

Revision 25-1; Effective March 12, 2025

A program provider, FMSA, CDS employer or PSO must use the state provided EVV system or an HHSC-approved EVV proprietary system to electronically document the delivery of an EVV service.

EVV is a computer-based system that electronically documents and verifies service delivery information, such as date, time, service type and location for certain Medicaid service visits.

An EVV system must capture the following data elements:

  • The type of service provided
  • The name of the recipient to whom the service is provided
  • The date and times the provider began and ended the service delivery visit
  • The location, including the address and geolocation, at which the service was provided
    • Note: Geolocation is only captured for visits recorded by the mobile application.
  • The name of the service provider who provided the service
  • Other information the commission determines is necessary to ensure the accurate adjudication of Medicaid claims

To make sure EVV is used for all required services, HHSC or an MCO will not pay an EVV claim without a matching EVV visit transaction.

Texas HHSC determines when a program provider, FMSA, CDS employer, or PSO must use EVV based on the services delivered. EVV is required for all programs and services listed in the Programs and Services Required to Use EVV documents.

1200 State Laws and Texas Administrative Code

Revision 25-1; Effective March 12, 2025

Texas law requires HHSC to implement an EVV program.

Program providers or FMSAs contracted, including those approved as a PSO, with HHSC or an MCO must follow state law, the Texas Administrative Code (TAC) and published policies established by HHSC when delivering Medicaid services.

Texas EVV statute and TAC include:

Live-in caregivers are not exempt from EVV requirements in Texas.

1300 Federal Law

Revision 25-1; Effective March 12, 2025

The 21st Century Cures Act (the Cures Act), enacted by the U.S. Congress in December 2016, added Section 1903(l) to the Social Security Act (Title 42 of the United States Code (42 USC) Section 1396b(l)) to require all states to use EVV.

The Cures Act requires the use of EVV for personal care services (PCS) provided under a State plan of the Social Security Act or under a waiver of the plan including sections 1905(a)(24), 1915(c), 1915(i), 1915(j), 1915(k) and Section 1115; and home health care services (HHCS) provided under 1905(a)(7) provided under a State plan of the Social Security Act or a waiver of the plan. This includes services delivered under the CDS option.

States must implement EVV by the following deadlines or risk a loss of federal Medicaid matching dollars:

  • PCS by Jan. 1, 2020.
    • Texas received approval for a one-year delay and implemented PCS on Jan. 1, 2021.
  • HHCS by Jan. 1, 2023.
    • Texas received approval for a one-year delay of the deadline and implemented EVV HHCS on Jan. 1, 2024

Failure to implement EVV per the Cures Act will result in a reduction of federal Medicaid funding for Texas.

1400 Failure to use an EVV System

Revision 25-1; Effective March 12, 2025

Program providers, FMSAs, CDS employers and PSOs must make sure an approved EVV system is used to document the delivery of EVV-required services.

Failure to use an approved EVV system to document service delivery for required programs and services will result in denied or recouped EVV claims. Per 1 TAC, Part 15, Chapter 354, Subchapter O, Section 354.4009, EVV Visit Transaction and Claim HHSC and MCOs will not pay a claim for reimbursement unless the data from the EVV system corresponds with the claim line item and is consistent with an approved prior authorization.

Program providers and FMSAs, including those approved as a PSO, who fail to use an EVV system may also be subject to contract actions, such as corrective action(s) or contract termination. CDS employers who fail to use an EVV system may be subject to removal from the CDS option.

If the service provider or CDS employee fails to clock in and clock out of the EVV system, the program provider, FMSA, CDS employer or PSO must manually enter the visit into the EVV system. Manually entered visits will negatively impact EVV compliance.

In the event the EVV system is unavailable, the service provider or CDS employee must document service delivery information and submit the documentation to the program provider, FMSA, CDS employer or PSO for manual entry of an EVV visit.

Service delivery documentation should include:

  • Program Provider, FMSA, CDS employer and PSO Name;
  • Member First and Last Name
  • Member Medicaid ID
  • Services Delivered
  • Date of the Visit
  • Actual Time In and Actual Time Out
  • Service provider First and Last Name
  • Location of the Visit - in the home or in the community

Program providers, FMSAs, CDS employers and PSOs must keep all service delivery documentation and manually enter EVV visits into the EVV system according to the service delivery documentation once the EVV system is operational or as otherwise instructed by HHSC.

1500 Resources and Communications

Revision 21-1; Effective Nov. 1, 2021

All program providers, FMSAs and CDS employers must sign up for GovDelivery to receive the most current news and alerts related to EVV. 

Program providers, FMSAs and CDS employers can visit the HHSC EVV webpage to access the most up to date information such as:

  • EVV News and Alerts
  • Programs and services which require the use of EVV
  • Statutes and rules governing EVV
  • Service bill codes for EVV
  • EVV contact information guide
  • EVV training requirements and resources

1600 Key Terms

Revision 25-1; Effective March 12, 2025

Key Terms are words regularly used throughout the EVV Policy Handbook. If a term is defined in the handbook, the reference is provided below.

Actual Hours – The hours calculated by the clock in time and clock out time captured in the EVV system from an HHSC-approved clock in and clock out method. This may or may not be the same as the bill hours.

Auto-Verification (auto-verify) – An automatic process the EVV system performs to confirm an EVV visit transaction matches existing critical data elements and schedule data, if applicable, in the EVV system with no exceptions.

Bill Hours – The total hours on the EVV visit that will be submitted to the payer for payment. The EVV system calculates bill hours by subtracting the bill time in from the bill time out, rounded to the nearest quarter hour increment.

Business Day – Monday through Friday, except national or state holidays.

Consumer Directed Services (CDS) Employer – A member or the member’s legally authorized representative (LAR) who participates in the CDS option. The CDS employer is responsible for hiring and retaining a service provider who delivers a Medicaid service to a member.

Consumer Directed Services (CDS) Option – A service delivery option where a CDS employer employs and retains a service provider and directs the delivery of services.

Data Error – Critical data that is missing on an EVV visit record.

Designated Representative (DR) – A willing adult designated by the CDS employer to help meet or perform CDS employer responsibilities.

Electronic Visit Verification (EVV) – A computer-based system that electronically documents and verifies service delivery information, such as date, time, service type and location for certain Medicaid service visits.

EVV Aggregator –A centralized database that collects, validates and stores statewide EVV visit transaction data transmitted by an EVV system.

EVV Compliance Reviews – Refer to 11000 EVV Compliance Reviews.

EVV Claim – Documentation submitted to HHSC or an MCO for reimbursement of services required to use EVV.

EVV Optional Services – Services commonly delivered in situations similar to EVV-required services but do not require EVV. Can be transmitted to the EVV Portal if verified by the program provider, FMSA, CDS employer or PSO.

EVV Portal – An online system established by HHSC that allows users to perform searches and view reports associated with visit data and EVV claim match results in the EVV Aggregator.

EVV Proprietary System – An HHSC-approved EVV system purchased or developed by a program provider or FMSA approved by HHSC that a program provider or FMSA uses instead of the state provided EVV system. Refer to 5000 EVV Proprietary System for more information.

EVV Proprietary System Operator – A program provider or FMSA that has been approved to use an HHSC-approved EVV proprietary system. Any reference to program provider or FMSA includes a PSO unless specifically stated otherwise.

EVV Proprietary System Vendor – A person or company that develops and offers an automated EVV proprietary system for use by an approved proprietary system operator.

EVV-Required Services – Personal care or home health care services provided in the home or in the community HHSC has identified that a service provider or system user must document in an EVV system as a service delivery visit. State and federal statute requires these services use EVV to document service delivery. They are listed in the EVV Service Bill Codes tables.

EVV System – A state provided EVV system or an EVV proprietary system used to electronically document and verify critical data elements related to the delivery of EVV services.

EVV System Administrator – A person appointed by a program provider or an FMSA, including those approved as a PSO, to serve as the primary contact for administering access to an EVV system. Refer to 4130 Select an EVV System for more information.

EVV Visit Maintenance – Process used by the program provider, FMSA, CDS employer or PSO to correct inaccurate data elements, add missing data elements, indicate the visit transaction is valid or manually enter a visit transaction. Refer to 9000 Visit Maintenance for more information.

EVV Visit Transaction – A record generated by an EVV system that contains data elements for an EVV visit. Refer to 6000 EVV Transaction for more information.

Fee for Service (FFS) – A payment model where the state pays contracted providers directly for each covered service delivered to a member.

Financial Management Services Agency (FMSA) – An entity that contracts with HHSC or an MCO to provide financial management services to a CDS employer.

Legally Authorized Representative (LAR) – A person authorized by law to act on behalf of a member and may be a parent, guardian or managing conservator of a minor, or the court-appointed guardian of an adult.

Member – A person eligible to receive Medicaid services that require the use of EVV.

Non-EVV Services – Authorized services not required to use EVV, such as transportation and supported employment.

Payer – Entities that pay Medicaid claims, administer the EVV program and enforce EVV requirements. In Texas, the payers are HHSC and the MCOs.

Program Provider – An entity that contracts with HHSC or an MCO to provide an EVV service.

Reason Code Description and Reason Code Number – Refer to 10000 Reason Codes.

Service Provider or CDS Employee – A person who provides an EVV service to a member and is employed by or contracted with a program provider or CDS employer. Note: Service providers who are contracted directly with HHSC or an MCO as a program provider must meet applicable EVV requirements for service providers and program providers.

Service Provider Discipline – The type of service provider.

Service Responsibility Option (SRO) – A service delivery option where a member or LAR selects, trains and provides daily management of a service provider while the fiscal, personnel and service back-up plan responsibilities remain with the program provider.

Signature Authority – A person who has legal authority to sign contracts and make transactional decisions.

State Provided EVV System – An EVV system developed and operated by a vendor that contracts with HHSC or HHSC's designated contractor. The current state provided EVV system vendor is HHAeXchange.

State Provided EVV System Vendor – The vendor that develops and operates the State Provided EVV System.

Subcontractor – An individual or entity that has a contract with an MCO that relates directly or indirectly to the performance of the MCO's obligations under its contract with the State.

Texas EVV Service Provider ID – A unique identifier generated by the EVV system for each service provider. The ID includes the last four digits of the service provider Social Security number or passport number plus the service provider’s last name.

Texas Medicaid & Healthcare Partnership (TMHP) - The state’s claims administrator.