High impact
Newsletter Vol. 36, No.09
New Jersey Medicaid·Effective Jan 1, 2027
New Jersey Medicaid/NJ FamilyCare mandates that Personal Care Assistance (PCA) and Home Health Services (HHS) providers must achieve 80% Electronic Visit Verification (EVV) compliance by January 1, 2027, with no more than 20% manual edits allowed. Providers failing to meet this threshold face progressive sanctions including loss of new referrals, contract termination, and one-year ineligibility. The policy includes a three-month compliance period (October 1 – December 31, 2026) and defines six required EVV data elements with specific edit reason codes.