Providers should be aware of recent compliance details concerning EVV under MassHealth. The time period for providers to dispute any compliance letters received from the Executive Office of Health and Human Services (EOHHS) ended on October 5. Currently, MassHealth is reviewing a list of providers who appear not to be serving any MassHealth members, and thus may not have been appropriate recipients of a compliance notice. At this point, MassHealth does not intend to issue sanctions, but it remains essential that providers move toward compliance.

Specifically:

• Compliance Checkpoint 1: Providers are required to reach 30 percent of auto-verified visits (i.e., visits that did not require manual intervention) by December 5, 2025.
• Compliance Checkpoint 2: Providers will be expected to reach 40 percent of auto-verified visits by March 31, 2026.
• A future Checkpoint 3 (beginning April 1, 2026) will require 50 percent compliance, ahead of the implementation of claims edits.

In addition, the general EVV regime in Massachusetts specifies that providers must register either with the state’s system (vendor: Sandata Technologies) or choose an alternate EVV (“Alt-EVV”) system that integrates with the state’s data aggregator. Massachusetts Government All six federally required data elements (member identity, provider employee identity, service type, service location, date, start and end times) apply.

It is critically important for your organisation to assess where you stand in terms of auto-verified visits, to ensure tracking and reporting systems are fully operational and that you are working toward the benchmarks just described. If you were one of the providers who received a compliance letter, but believe you should not have, make sure your data and service delivery records are up to date and that you engage with MassHealth or EOHHS as needed.

EVV Compliance Checklist

1. Review Your Status

• Confirm whether your agency received a compliance letter from EOHHS.
• If you are not currently serving MassHealth members, ensure your records reflect this to avoid unnecessary compliance notices.

2. Meet Compliance Checkpoints

• Checkpoint 1: Reach 30% auto-verified visits by December 5, 2025.
• Checkpoint 2: Reach 40% auto-verified visits by March 31, 2026.
• Checkpoint 3: Reach 50% auto-verified visits by April 1, 2026, prior to claims edits taking effect.

3. Verify Your EVV System

• Register with the state’s EVV vendor (Sandata Technologies) or ensure your Alt-EVV system is fully integrated with the state’s data aggregator.

4. Confirm Required Data Elements
Each EVV record must include all six federally required elements:

• Member identity
• Provider employee identity
• Service type
• Service location
• Date of service
• Start and end times

5. Strengthen Internal Processes

• Audit visit data for manual overrides; increase auto-verification where possible.
• Train staff on accurate check-in/out procedures and device use.
• Monitor reports regularly to track compliance progress.

6. Follow Up if You Received a Compliance Letter

• Double-check your MassHealth member service data.
• Contact EOHHS if you believe your agency was incorrectly flagged.
• Keep written documentation of all correspondence and system reports.