KodaComplyHome care rules, state by state, in plain EnglishDocuments collected September 22, 2026

Massachusetts home care rules

Massachusetts pays for home care for older adults through the state Home Care Program and the Frail Elder Waiver, which the Executive Office of Aging & Independence (AGE) runs through local Aging Services Access Points (ASAPs); waiver participants 65 and older can instead get their services through a Senior Care Options (SCO) health plan. Massachusetts has no home care agency license yet, but Chapter 180 of the Acts of 2026 (approved August 6, 2026) creates a home care agency license from the Executive Office of Health and Human Services (EOHHS); agencies must be licensed by a date EOHHS will set, no later than 1 year after it adopts its rules. MassHealth plans to deny fee-for-service home health, group adult foster care and ABI/MFP waiver claims that do not match an electronic visit verification (EVV) record; the start date is still to be confirmed.

64 official documents·collected September 23, 2026·checked against them September 23, 2026
License for non-medical home care?Not yet — new law passedChapter 180 of the Acts of 2026 (approved August 6, 2026) will require home care agencies to hold a 3-year license from EOHHS. EOHHS must adopt rules within 1 year of the Act's effective date and then set the date, no more than 1 year later, by which agencies must be licensed. Today the Department of Labor Standards does not license agencies that employ their own workers.
License for home health?No DPH license; Medicare certification to bill MassHealthThe Department of Public Health (DPH) does not license home health agencies, and Medicare certification is optional. But to bill MassHealth, a Massachusetts home health agency must be Medicare-certified through DPH (130 CMR 403.405).
EVV50% auto-verified; denials TBCSandata or a registered alternate system. Since April 1, 2026, fee-for-service home health, group adult foster care (GAFC) and ABI/MFP waiver providers must have at least 50% of visits auto-verified. MassHealth will deny claims that don't match a visit; the start date is to be confirmed.
Medicaid health plansSCO, One Care and ACO plansMassHealth lists 6 Senior Care Options plans for 2026. The state's EVV specification also lists 5 One Care plans, plus MassHealth accountable care organization (ACO) and managed care organization (MCO) plans that pay for home health and GAFC.

What changed, and what to do about it

Red means act now, amber means read it this month, grey is for the record.

Act nowCheckpoint 3 since April 1, 2026 · MassHealth EVV webinar, July 27, 2026

Keep 50% of EVV visits auto-verified and get claims matching — denials are coming

Fee-for-service home health, GAFC and ABI/MFP waiver providers must have at least 50% of visits auto-verified (no manual changes) until claim edits start; a second miss brings a formal notice of sanction. MassHealth will then deny claims that don't match a Verified EVV visit. The bulletins say "no earlier than July 2026"; the July 27 webinar lists the date as "TBC" and says unmatched claims will first be suspended for 30 days.

What to do: Check your auto-verified rate in the Aggregator, look for EOB 784 and EVV edit codes (such as 2106, 2108, 2109, 2127 and 2128) on your remittance advice, and make sure visits are Verified before you bill.
Read this monthApproved Aug. 6, 2026 · rules due within 1 year of the effective date

Massachusetts will license home care agencies — Chapter 180 approved August 6, 2026

Home care agencies, including referral and matching services, will need a 3-year license from EOHHS. EOHHS must adopt rules within 1 year of the Act's effective date and issue temporary licenses within 180 days of it; EOHHS must give one to any applicant verified as currently contracted with an ASAP or MassHealth. The deadline to be licensed is a date EOHHS sets, no later than 1 year after the rules. The rules will cover background checks, service contracts, insurance, training, emergency plans and yearly reporting.

What to do: Read Sections 1 and 5–7 of the Act, check your background check, training and insurance records against the list, and watch for EOHHS's draft rules.
Read this monthHearing April 3, 2026 · effective no sooner than Aug. 1, 2026

Home health rule changes proposed: EVV requirements, fiscal soundness statement removed

MassHealth proposed adding EVV requirements for all home health services and a value-based payment service to 130 CMR 403, and removing the statement of fiscal soundness. The current home health manual we hold (HHA-55, July 1, 2022) does not yet show these changes.

What to do: Keep filing your fiscal soundness statement until MassHealth publishes the final rule.
Read this monthv1.9.1 June 1 · v1.9.2 July 24 · v1.9.3 Aug. 20, 2026

Alternate EVV specification updated three times since June

The state's alternate EVV specification changed its payer, program and service code combinations and added a new Mass General Brigham SCO ASAP program. The July webinar says visits with a service code that is not on the in-scope list do not import, so they cannot match a claim.

What to do: If you use your own EVV vendor, ask them to confirm they are on v1.9.3.
For the recordEffective July 3, 2026 (Transmittal Letter PCA-27)

PCA program: 60-hour weekly cap and seven-hour meal preparation cap

MassHealth no longer covers services by any one PCA over 60 hours a week, and caps authorized meal preparation at seven hours a week unless more is authorized.

What to do: If you are a personal care management agency, check schedules and evaluations against the new caps.

Deadlines coming up

Dates taken from the rules and notices as we read them.

250days
May 31, 2027

Home health agencies: annual statement of fiscal soundness due to MassHealth

Due by the end of May each year (130 CMR 403.419(E)). MassHealth has proposed removing this requirement; it applies until a final rule says otherwise.