EVV Exemption Form
As legislated in the federal 21st Century Cures Act, home care agencies providing Medicaid-funded personal care or home health services are required to use Electronic Visit Verification (EVV). This digital system captures six specific details for each home care appointment: the type of service, the individual receiving care, the provider’s name, the location of service delivery, the date, and the start and end times of the visit.
Its primary function is to help reduce fraud, waste, and abuse in Medicaid-funded services, while also offering agencies an easier, more unified way to track key operational data.
An EVV exemption form documents state-approved exceptions to standard EVV capture requirements. Using our tailor-made template, agencies can practically document such exceptions. Please note that it is not a federal form and does not constitute legal advice.
In this article, we’ll describe why EVV exemption forms matter, where they are required, and how to fill one out.
Why EVV Exemptions Matter for Home Care Agencies
In scenarios where digital tracking is impractical or unsafe, exemption forms help maintain consistent documentation and care. A live-in caregiver, for example, does not need to log visit times, but the agency still needs a record of the services provided. That’s where an EVV exemption form comes in handy.
Another scenario that may require EVV exemption involves GPS technology. If a client lives in a more rural area with weak or nonexistent cellular connectivity, caregivers won’t be able to capture EVV data digitally. And for clients in situations where GPS tracking can be a liability, an EVV exemption can keep them safe.
As long as every caregiver uses the same standardized document, they can easily fill the information gaps that arise in these unique situations.
Consistent forms give in-office staff a clear overview of each appointment. Checkboxes and required fields prevent the omission of critical details, enabling quick transcription and faster approvals.
During an audit, a well-maintained exemption paper trail is essential for validating manual, non-EVV entries and avoiding noncompliance fines.
Where Are EVV Exemption Forms Required?
While the federal government mandates EVV use, individual states have the flexibility to determine their own exemption rules.
Some states, like California or Ohio, recognize that situations like live-in caregiving make digital check-ins unnecessary. With proper approval and documentation, agencies may follow the state’s permitted alternative process instead of standard EVV capture.
Other states do not allow exemptions under any circumstances, so check with your local regulatory bodies for more information.
In states that allow exemptions, proper documentation is essential for maintaining EVV compliance and should be treated accordingly. Without the required documentation for each visit, the state can refuse to pay an agency for services rendered.
In the event of an audit, the first thing the auditor will ask for when they notice missing EVV is the exemption form. If the agency cannot produce the required document, it may be subject to fines or be required to return past reimbursements.
Read more: EVV Training Requirements Checklist for Caregivers
Download the Free EVV Exemption Form
Get your free EVV exemption template designed for home care agencies and providers. Print it for in-office use or fill it out on any device to suit your preferred workflow. Save it, reuse it, and share it internally.
How to Complete the EVV Exemption Form
It should only take a couple of minutes to fill out this exemption form. Just like EVV, it’s not meant to burden caregivers with extensive paperwork. It’s a simple, straightforward sheet that can have a significant impact.
Step-by-Step Instructions
- Enter the client and agency information, including the name of the client, ID numbers, and contact details.
- Specify the reason for the EVV exemption by checking the appropriate box and providing any additional information.
- List any relevant supporting information or documents that will be attached to the form, such as approvals, safety notes, or other paperwork.
- Add contact and follow‑up details in case further clarification is needed.
- Review the form for accuracy and completeness to avoid input issues down the road.
- Enter the current date, sign the form, and obtain any required internal approvals.
Simplify EVV Exemptions With AxisCare
AxisCare’s home care platform includes EVV compliance tools designed to support documentation and audit readiness. Home care agencies across the United States, including multi-location businesses, trust our software to simplify their tracking, documentation, and compliance.
Download your free exemption template today, then request a free demo with our team to find out how we can help unlock personalized, consistent care organization-wide.
