Updated Electronic Visit Verification Requirements Will Improve Accountability and Help Ensure Medicaid Dollars Support Services to NJ FamilyCare Members

Sept. 24, 2026

(TRENTON) – New Jersey Human Services has announced strengthened oversight requirements for Medicaid-funded Personal Care Assistance and Home Health Services, reinforcing the State’s commitment to program integrity and responsible stewardship of taxpayer dollars.

Beginning January 1, healthcare providers serving NJ FamilyCare members through Managed Care will be required to meet updated Electronic Visit Verification (EVV) standards. These requirements ensure that providers accurately verify and document services and that Medicaid payments cover only services that providers actually deliver.

“New Jersey is committed to protecting the integrity of NJ FamilyCare and making sure every Medicaid dollar is used as intended to provide care to the people who need it,” Commissioner Stephen Cha said. “Strengthening Electronic Visit Verification gives us another important tool to ensure services are being delivered, properly documented, and appropriately paid for.”

EVV is a web-based system that helps confirm that authorized NJ FamilyCare services are provided as scheduled. It records basic information about each visit, including what service was provided, who received and provided the service, the date and location, and the time the service started and ended. Providers can use a phone call, smartphone app, or a free EVV device in the home to record this information.

EVV has been used for all personal care services since January 2021 and for all home health care services since January 2023.

Since implementing EVV, the Department has identified providers who manually edit a high volume of visits, raising program integrity concerns. Under the updated requirements, providers must electronically verify at least 80 percent of visits requiring EVV, with certain circumstances identified by the State as excluded from the compliance calculation.

“Program integrity is about accountability to our NJ FamilyCare members, to providers who follow the rules, and to New Jersey taxpayers,” Deputy Commissioner Valerie Mielke said. “These requirements are intended to strengthen the accuracy of Medicaid billing and create greater confidence that the services being paid for are the services being provided.”

Providers will have a three-month introductory period from October 1 through December 31 to prepare for the updated requirements. Beginning January 1, providers that manually edit or confirm more than 20 percent of EVV-required visits will not meet compliance requirements.

The State will use a progressive approach to address continued noncompliance. Providers may first receive notice of noncompliance and, if the issue continues, may not receive new referrals. Continued noncompliance can ultimately result in termination of a provider’s Managed Care contract.

“Strong program integrity protects everyone who depends on Medicaid, especially the individuals receiving care in their homes,” Division of Medical Assistance and Health Services Greg Woods said. “We want providers to succeed, and this implementation period gives them time to understand the requirements and make sure their systems and practices are ready. At the same time, we must have appropriate safeguards in place when Medicaid services are billed and paid.”

The Department will measure EVV compliance on a monthly basis. Managed Care Organizations will report providers that exceed the allowable level of manual edits. The State will also conduct periodic reconciliation of service units billed against confirmed EVV visits. The Department may recoup reimbursed service units when providers do not record a corresponding confirmed visit in the EVV system.

Providers must meet EVV requirements in addition to existing documentation requirements. Providers must continue to maintain documentation supporting the services that they provide and bill.

The updated requirements apply to Personal Care Assistance and Home Health Services covered by the federal EVV mandate under Section 12006(a) of the 21st Century Cures Act.

For additional information, including how the Department protects patient data, providers can visit the Division of Medical Assistance and Health Services’ EVV webpage here.