Electronic Visit Verification (EVV) Authorization Guardrails

January 30, 2026

Dear Home Care Providers,

As we enter the new year, Fidelis Care is reminding home care providers of the mandatory federal and state regulatory requirements governing the delivery and documentation of Home and Community Based Services (HCBS) and Personal Care Services (PCS). Compliance with these requirements is a condition of participation in the Fidelis Care network and a requirement of our state and federal contracts.

Federal CMS Requirements

Under applicable CMS regulations, providers must comply with the following standards:

1. Services Must Be Tied to a Person-Centered Service Plan (PCSP)
Pursuant to 42 CFR 441.301, all HCBS services:

• must be delivered “under a written, person-centered service plan…based on a person-centered approach.”
• must “reflect clinical and support needs as identified through an assessment.”

This requirement establishes that services must reflect current assessed needs, not fixed weekly service allotments or bankable hours.

2. Services Must Be Reasonable, Necessary, and Needed at the Time Delivered
Under 42 CFR 424.22, HCBS services:     

• must be “reasonableand necessary
• must be delivered according to the plan of care at the time the service is performed.

If needs do not occur on a given day or week, services may not be deferred, banked, or rescheduled for later use, as they would no longer meet the “reasonable and necessary” standard.

3. Federal Requirements Do Not Permit Banking or Make-Up Hours

CMS regulations require that each service reflects the individual member’s goals, needs, and preferences—not unused capacity or a fixed entitlement to weekly hours. Providers are therefore prohibited from carrying forward, accruing, or making up hours in future weeks or months.

New Jersey regulations align with this requirement. Under N.J.A.C. 10:60-3.8(i), unused PCA units of service, including those missed due to illness, hospitalization, or other causes, may not be saved, banked, or carried over for use at a later date.

Upcoming Billing Guardrails

To ensure full alignment with federal and state standards, Fidelis Care has contracted with HHAeXchange to implement enhanced billing guardrails effective March 1, 2026. These guardrails will ensure that services are delivered in accordance with each member’s PCSP, and that billing practices are compliant with CMS and State rules prohibiting banking and non-aligned utilization.

This notice serves as formal written notification consistent with the applicable provider agreements. Providers are responsible for ensuring compliance and for participating in all required training and operational readiness activities in advance of the March 1 implementation.

Additional Guidance

To support operational readiness, we have included examples of allowable service schedule adjustments that do not violate Federal or State requirements.

We appreciate your cooperation and ongoing commitment to compliance and to the delivery of high-quality, person-centered care to Fidelis Care members.

Download a copy of this EVV Authorization Guardrails notification (PDF)