Summary
Electronic Visit Verification (EVV) is an important requirement for many Medicaid-funded home care services in the United States. It helps verify essential information about services delivered during home visits.
However, some clients may feel uncomfortable with EVV technology. They may have concerns about GPS tracking, privacy, personal devices, or how their information will be collected and used.
When a client refuses Electronic Visit Verification, home care agencies need to understand the reason, explain the applicable requirements, explore permitted alternatives, and document the situation appropriately.
A client’s refusal to use a particular EVV method does not automatically mean they have refused home care services. The available options depend on the state’s Medicaid EVV program, payer requirements, and circumstances.
Home Care Software with EVV capabilities can help agencies organize visit information, document exceptions, and support follow-up workflows where those functions are available.
Introduction
Imagine a caregiver arrives at a client’s home for a scheduled personal care visit.
Before beginning the assignment, the caregiver prepares to record the visit using an EVV application.
The client notices that the application may use location information and immediately expresses concern.
“I don’t want anyone tracking my location. Can you provide the service without using that app?”
For the caregiver, this creates an uncomfortable situation.
The client wants to receive care, but the caregiver must also follow the agency’s EVV procedures.
Should the caregiver continue the visit? Can another verification method be used? Does the agency need to notify the Medicaid payer? What happens if the visit cannot be verified?
These questions demonstrate why home care agencies need clear procedures for handling EVV refusals.
The objective is to respect client concerns, maintain appropriate service continuity, and follow applicable Medicaid requirements.
What Is Electronic Visit Verification?
Electronic Visit Verification is a method of electronically recording required information about certain home care services.
Under the 21st Century Cures Act, states must implement EVV for specified Medicaid-funded personal care services and home health care services that require an in-home visit.
EVV systems must capture six essential data elements:
- The type of service performed.
- The individual receiving the service.
- The individual providing the service.
- The date of service.
- The location of service delivery.
- The time the service begins and ends.
States have flexibility in selecting their EVV systems and determining how these requirements are implemented.
As a result, the available technology, documentation procedures, and exception-handling rules can vary between states and Medicaid programs.
Why Might a Client Refuse EVV?
A client’s concerns about EVV may arise from several different situations.
Understanding the actual reason for refusal is important because different concerns may require different responses.
1. Privacy Concerns
Some clients worry that EVV allows agencies, caregivers, or government programs to monitor their personal activities. They may be uncomfortable with location information being collected during home visits.
Agencies should explain what information the applicable EVV system collects, why it is needed, and how it is protected. They should avoid promising that no location information is collected unless that is accurate for the specific system.
2. Concerns About GPS Tracking
GPS is one method of verifying visit location, but federal EVV requirements do not mandate GPS technology specifically. Some clients may be willing to receive services but uncomfortable with a caregiver using a GPS-enabled application in their home.
Agencies should review whether their state or payer permits another approved verification method.
A client may be objecting to GPS rather than to electronic verification altogether.
3. Unwillingness to Use a Personal Phone
Some clients believe they must provide their own smartphone, landline, or internet connection for EVV.
However, federal guidance recognizes that EVV can be implemented without requiring Medicaid beneficiaries to supply their own technology.
An agency should explain the actual equipment requirements for its approved EVV system.
4. Difficulty Understanding the Technology
Older adults and individuals with certain disabilities may find unfamiliar technology confusing or uncomfortable.
Clients may also misunderstand what information the system collects or whether they are required to interact with it. Clear explanations, accessible communication, and appropriate assistance can help address these concerns.
5. Concerns About Signatures or Verification Requests
Some EVV systems or agency workflows may request a client signature or another form of confirmation.
A client may be uncomfortable signing electronically or may be unable to complete the requested step.
Agencies should determine whether that particular action is required under the applicable program and whether an approved alternative exists.
A client signature is not one of the six federally specified EVV data elements, although additional state or payer requirements may apply.
Does Refusing EVV Mean the Client Loses Home Care Services?
Not automatically.
There is an important difference between refusing a particular EVV technology and refusing the actual home care service. A client may want to continue receiving authorized care while objecting to GPS, a device, or a particular verification procedure.
Federal law establishes EVV requirements for covered services, but the response to an individual refusal depends on the state’s implementation rules and the relevant payer.
Agencies should not assume that every refusal requires immediate service termination.
Instead, they should contact the appropriate supervisor, EVV administrator, state Medicaid program, or managed care organization to determine the permitted next steps.
If service delivery may be interrupted, agencies should follow applicable notification, escalation, and continuity-of-care procedures.
What Should Home Care Agencies Do When a Client Refuses EVV?
A structured response can help agencies manage the situation without creating unnecessary conflict or inaccurate documentation.
Step 1: Understand the Reason for Refusal
The caregiver or appropriate agency representative should first determine what the client is refusing.
Is the concern related to GPS?
Does the client object to using their own phone?
Are they uncomfortable with electronic signatures?
Do they believe EVV tracks their activities outside scheduled visits?
Understanding the concern helps the agency determine whether clarification or an alternative verification method may resolve the issue.
Step 2: Explain EVV in Simple Language
Agencies should explain why EVV is used and what information must be verified.
The explanation should be straightforward and avoid unnecessary technical language.
For example:
“EVV helps record when your scheduled care visit takes place, who provides the service, and other required visit details. We can review the verification options permitted by your Medicaid program if you have concerns about the method being used.”
This approach helps distinguish required service verification from assumptions about continuous personal monitoring.
Step 3: Check Approved Alternative Methods
Depending on the state and payer, an EVV program may support different methods of capturing visit information.
These might include mobile applications, telephony-based verification, fixed devices, or other approved methods.
However, not every method is available in every program.
Agencies should confirm which alternatives are authorized rather than creating an informal workaround.
A paper timesheet or manual note should not be treated as an automatically acceptable replacement for required EVV.
Step 4: Notify the Appropriate Supervisor
Caregivers should not be expected to independently interpret Medicaid requirements during a disagreement.
If the client continues to refuse the required verification method, the caregiver should follow agency procedures and notify the appropriate supervisor.
The supervisor can review the situation, identify permitted options, and contact the payer or state EVV support team when necessary.
This also helps ensure that the caregiver receives consistent instructions.
Step 5: Document the Refusal Accurately
The agency should maintain an objective record of the situation.
Relevant information may include the visit date, verification method involved, client’s stated concern, staff actions, supervisor notification, and any approved alternative or exception process.
Documentation should distinguish between a client declining a particular technology and a client declining the actual service.
Staff should never create a false check-in, enter fabricated visit times, or record a service as completed when it was not provided.
Step 6: Follow the State’s Exception Procedures
Some EVV programs have procedures for handling missing or incomplete verification information.
These may involve documented corrections, reason codes, supervisor review, or other permitted processes.
A refusal does not automatically qualify for a particular exception.
The agency should verify whether the applicable state or payer permits an exception and what supporting documentation is required.
Step 7: Review the Visit Before Billing
If EVV information is incomplete, the billing team should determine whether the visit satisfies applicable documentation and claim requirements.
Depending on the program, unresolved EVV discrepancies may affect claim submission or payment.
The agency should not assume that a manually documented visit can always be billed without an accepted EVV record.
Before submitting the claim, staff should verify the applicable rules and resolve any outstanding issues through authorized procedures.
Example: A Client Refuses GPS Verification
Consider a hypothetical Medicaid home care client who receives personal care services several times per week.
The assigned caregiver uses a mobile EVV application that captures location information at check-in and check-out.
During a visit, the client expresses concern about GPS and asks the caregiver not to use the application.
The caregiver explains the purpose of EVV but does not pressure the client into accepting the technology.
The caregiver contacts the agency supervisor and follows the agency’s instructions regarding service delivery and documentation.
The supervisor reviews whether the client’s Medicaid program permits another verification method or a specific exception process.
If an alternative is approved, the agency provides instructions for future visits.
If the issue remains unresolved, the agency coordinates with the appropriate payer or program representative.
The billing team also reviews any affected visit records before claim submission.
This example demonstrates how agencies can address client concerns while maintaining a structured compliance process.
How EVV Refusals Can Affect Medicaid Billing
EVV refusals can create billing challenges when required visit information is missing or cannot be validated.
Depending on the applicable program, an agency may encounter:
- Visits requiring manual review.
- Unresolved verification exceptions.
- Delays in preparing or submitting claims.
- Claims held or rejected under payer-specific rules.
- Additional documentation requests.
- Post-payment review questions.
These outcomes are not automatic consequences of every EVV refusal.
They depend on the state’s EVV implementation, the service involved, the payer’s billing rules, and whether an authorized resolution is available.
Maintaining accurate records helps billing teams determine what needs to be addressed.
How Can Agencies Reduce EVV Refusals?
Some concerns can be addressed before the first home care visit.
Explain EVV During Client Onboarding
Agencies can introduce EVV during intake rather than waiting until a caregiver arrives for the first assignment.
This gives clients and authorized representatives an opportunity to ask questions about verification procedures.
Provide Clear Privacy Information
Clients should understand what data the applicable EVV system collects, how it is used, and who may access it.
Agencies should use accurate information from the state program and technology provider.
Train Caregivers to Respond Appropriately
Caregivers should know how to explain basic EVV procedures, respond respectfully to concerns, and escalate unresolved issues.
Training should also address accurate documentation and prohibited practices such as fabricated visit records.
Review Available Verification Methods
Agencies should understand the methods permitted by each relevant state and payer.
Where options exist, selecting an appropriate approved method may reduce avoidable difficulties.
Monitor Recurring Issues
If clients frequently object to a particular verification method, the agency may need to review its onboarding materials, staff training, or technology workflow.
Tracking the reasons for refusals can help managers identify where clearer communication is needed.
How Home Care Software Helps Manage EVV Refusals
Managing EVV refusals can become complicated when client records, caregiver schedules, visit documentation, and billing information are maintained in separate systems.
Home Care Software with appropriate EVV capabilities can help agencies organize the information needed to investigate and resolve verification problems.
Depending on the platform, useful capabilities may include visit status tracking, EVV exception reporting, documentation records, supervisor review workflows, and billing-related validation.
A connected environment can help authorized staff identify affected visits and determine which issues require follow-up.
However, software does not automatically authorize exceptions, override Medicaid rules, or guarantee claim payment.
Agencies must still follow the requirements of the applicable EVV program.
How myEZcare Can Help Home Care Agencies
Managing Medicaid-funded home care services requires coordination between caregivers, supervisors, scheduling teams, and billing staff.
myEZcare helps home care agencies organize connected operational workflows involving client information, caregiver scheduling, attendance, EVV-related processes, visit documentation, billing, and reporting.
By maintaining relevant information in a more organized environment, agencies can improve visibility into scheduled and completed visits and identify records that may require additional review.
For agencies dealing with EVV-related concerns, connected workflows can support more consistent documentation and coordination between operational teams.
Agencies should verify the EVV methods, state-specific integrations, and exception-management capabilities supported by their myEZcare configuration.
Looking to simplify EVV-related workflows and Medicaid home care operations? Explore myEZcare and discover how connected Home Care Software can help your agency manage caregiver visits, documentation, and billing information more efficiently.
Conclusion
When a client refuses Electronic Visit Verification, home care agencies should not immediately assume that the client has refused services or that the visit cannot be completed.
The appropriate response begins with understanding the concern, explaining the verification requirements, checking permitted alternatives, and documenting the situation accurately.
Agencies should also involve supervisors, follow state-specific exception procedures, and review affected visits before billing.
Home Care Software can help organize EVV-related records, caregiver schedules, documentation, and operational follow-ups.
Ultimately, the goal is to respect client concerns while maintaining accurate service records, appropriate care coordination, and compliance with applicable Medicaid requirements.
