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MassHealth Home Health Agency Bulletin 94 - Electronic Visit Verification Registration and Compliance for Home Health Agency Services (citing 130 CMR 450.238 & 450.239)

Massachusettssub-regulatoryMassachusetts Executive Office of Health and Human Services (MassHealth)

What this rule requires your agency to do

  • 1The provider must, if a currently enrolled provider, register with Sandata (either through the state-sponsored EVV system or a registered Alt-EVV system) within 30 days of the bulletin issuance (Phase 1). (Home Health Agency Bulletin 94, Phase 1 - Registration)(Home Health Agency Bulletin 94, Phase 1 - Registration)
  • 2The provider must meet the percentage threshold of auto-approved verified visits over the period of time designated by MassHealth (Phase 2 compliance monitoring). (Home Health Agency Bulletin 94, Phase 2 - Compliance Monitoring)(Home Health Agency Bulletin 94, Phase 2 - Compliance Monitoring)
  • 3The provider must electronically document and verify service delivery information through EVV for all MassHealth home health agency services that require an in-home visit, as mandated by Section 12006 of the 21st Century Cures Act. (Home Health Agency Bulletin 94; Section 12006 of the 21st Century Cures Act)(Home Health Agency Bulletin 94; Section 12006 of the 21st Century Cures Act)
  • 4The provider must correctly enter each corresponding visit into the EVV system, because no earlier than July 2026 MassHealth will implement billing-system edits allowing claims to pay only when a corresponding visit is correctly recorded in EVV (Phase 3). (Home Health Agency Bulletin 94, Phase 3 - Claims Processing)(Home Health Agency Bulletin 94, Phase 3 - Claims Processing)
  • 5The provider must comply with EVV requirements or be subject to progressive sanctions ranging from a Notice of Noncompliance to a formal Notice of Sanction and potential provider contract termination. (130 CMR 450.238; 130 CMR 450.239)(MassHealth Home Health Agency Bulletin 94 - Electronic Visit Verification Registration and Compliance for Home Health Agency Services (citing 130 CMR 450.238 & 450.239))

Applies to: home health

MassHealth Home Health Agency Bulletin 94 implements the federal 21st Century Cures Act EVV mandate for home health agency services requiring an in-home visit. It phases in provider registration with Sandata (or an Alt-EVV system), auto-approved verified-visit compliance thresholds, and eventual claims edits that pay only visits captured in EVV, backed by the sanction framework at 130 CMR 450.238 and 450.239.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.