US Care Provider Compliance Hub

Section 12006 of the 21st Century Cures Act mandates that states require EVV for all Medicaid-funded Personal Care Services (PCS) and Home Health Care Services (HHCS). EVV systems must capture six core data points: service type, individual receiving care, date of service, service location via GPS geofence, individual providing care, and exact arrival/departure timestamps.

Healthcare employers cannot bill Medicaid or Medicare for any service ordered, furnished, or prescribed by an individual on the OIG List of Excluded Individuals and Entities (LEIE). Employing an excluded caregiver can trigger Civil Monetary Penalties (CMP) of over $20,000 per billable service plus treble damages.

Under the Application of the Fair Labor Standards Act to Domestic Service, third-party home care agencies cannot claim the companionship services exemption. Caregivers must receive at least minimum wage for all hours worked and 1.5x their regular rate for hours worked beyond 40 in a workweek.

• Blended Overtime: Caregivers working at multiple bill rates must be paid overtime based on the weighted regular rate.
• Travel Time: Time spent traveling between clients during the workday is compensable work time.
• Daily Overtime: In states like California, overtime applies after 8 hours in a single workday.

Home health agencies delivering skilled care must comply with CMS Conditions of Participation covering patient rights, comprehensive clinical assessments (OASIS), care coordination, and continuous Quality Assessment and Performance Improvement (QAPI) programs.