12 Va. Admin. Code § 30-122-470 - Personal emergency response system service
A. Service description. Personal emergency
response system (PERS) service is an electronic device and monitoring service
that enables certain individuals to secure help in an emergency. PERS service
shall be limited to those individuals who live alone or are alone for
significant parts of the day and who have no regular caregiver for extended
periods of time and who would otherwise require supervision. PERS service shall
be covered in the FIS, CL, and BI waivers.
B. Criteria. PERS may be authorized when
there is no one else in the home with the individual enrolled in the waiver who
is competent or continuously available to call for help in an
emergency.
C. Service units and
service limitations.
1. The one-time
installation of the unit shall include installation, account activation,
individual and caregiver instruction, and removal of PERS equipment. A unit of
service is the one-month rental price set by DMAS.
2. PERS service shall be capable of being
activated by a remote wireless device and shall be connected to the
individual's telephone system. The PERS console unit shall provide hands-free
voice-to-voice communication with the response center. The activating device
shall be waterproof, automatically transmit to the response center an activator
low battery alert signal prior to the battery losing power, and be able to be
worn by the individual.
3. PERS
service shall not be used as a substitute for providing adequate supervision
for the individual enrolled in the waiver.
4. Physician-ordered medication monitoring
units shall be provided simultaneously with PERS service.
5. PERS service shall not be covered for
individuals who are simultaneously receiving group home residential service,
sponsored residential service, or supported living residential
service.
D. Provider
requirements.
2. Providers shall be either a (i) licensed
home health or personal care agency, (ii) a durable medical equipment provider,
(iii) a hospital, or (iv) a PERS manufacturer that has the ability to provide
PERS equipment, direct services (i.e., installation, equipment maintenance, and
service calls), and PERS monitoring.
3. Providers shall have a current, signed
provider participation agreement with DMAS. This agreement shall be renewed
promptly when requested by DMAS. The provider named on the participation
agreement shall directly render the PERS service and shall submit his claims to
DMAS for reimbursement.
4.
Providers shall provide an emergency response center staff with fully trained
operators who are capable of (i) receiving signals for help from an
individual's PERS equipment 24 hours a day, 365 or 366, as appropriate, days
per year; (ii) determining whether an emergency exists; and (iii) notifying an
emergency response organization or an emergency responder that the individual
needs emergency help.
5. Providers
shall comply with all applicable federal and state laws and regulations, all
applicable regulations of DMAS, and all other governmental agencies having
jurisdiction over the service to be performed.
6. Providers shall have the primary
responsibility to furnish, install, maintain, test, and service the PERS
equipment, as required to keep it fully operational. The provider shall replace
or repair the PERS device within 24 hours of the individual's or
family/caregiver's notification of a malfunction of the console unit,
activating devices, or medication-monitoring unit while the original equipment
is being repaired.
7. Providers
shall properly install all PERS equipment into the functioning telephone line
or cellular system of an individual receiving PERS and shall furnish all
supplies necessary to ensure that the system is installed and working
properly.
8. The PERS installation
shall include local seize line circuitry, which guarantees that the unit will
have priority over the telephone connected to the console unit should the phone
be off the hook or in use when the unit is activated.
9. Providers shall install, test, and
demonstrate to the individual and the individual's family/caregiver, as
appropriate, the PERS system before submitting the claim for reimbursement to
DMAS.
10. Providers shall maintain
all installed PERS equipment in proper working order.
11. Providers shall maintain a data record
for each individual receiving PERS service at no additional cost to DMAS. The
record shall document all of the following:
a. Delivery date and installation date of the
PERS;
b. The signature of the
individual or the individual's family/caregiver, as appropriate, verifying
receipt of PERS device;
c.
Verification by a test that the PERS device is operational, monthly or more
frequently as needed;
d. Updated
and current individual responder and contact information, as provided by the
individual or the individual's care provider, or support coordinator/case
manager; and
e. A case log
documenting the individual's utilization of the system and contacts and
communications with the individual or the individual's family/caregiver, as
appropriate, support coordinator/case manager, or responder.
12. Providers shall have back-up
monitoring capacity in case the primary system cannot handle incoming emergency
signals.
13. All PERS equipment
shall be approved by the Federal Communications Commission and meet the
Underwriters' Laboratories, Inc. (UL) safety standard Number 1635 for Digital
Alarm Communicator System Units and Number 1637, which is the UL safety
standard for home health care signaling equipment. The UL listing mark on the
equipment will be accepted as evidence of the equipment's compliance with such
standard. The PERS device shall be automatically reset by the response center
after every activation ensuring that subsequent signals can be transmitted
without requiring manual reset by the individual enrolled in the waiver or
family/caregiver, as appropriate.
14. Providers shall instruct the individual,
his family/caregiver, as appropriate, and responders in the use of the
PERS.
15. The emergency response
activator shall be activated either by breath, by touch, or by some other means
and shall be usable by persons who have visual or hearing impairments or
physical disabilities. The emergency response communicator shall be capable of
operating without external power during a power failure at the individual's
home for a minimum period of 24 hours and automatically transmit a low battery
alert signal to the response center if the back-up battery is low. The
emergency response console unit shall also be able to self-disconnect and
redial the back-up monitoring site without the individual resetting the system
in the event the unit cannot get its signal accepted at the response
center.
16. Monitoring agencies
shall be capable of continuously monitoring and responding to emergencies under
all conditions, including power failures and mechanical malfunctions. The
provider is responsible for ensuring that the monitoring agency and the
agency's equipment meet the requirements of this section. The monitoring agency
shall be capable of simultaneously responding to multiple signals for help from
multiple individuals' PERS equipment. The monitoring agency's equipment shall
include the following:
a. A primary receiver
and a back-up receiver, which shall be independent and
interchangeable;
b. A back-up
information retrieval system;
c. A
clock printer, which shall print out the time and date of the emergency signal,
the PERS individual's identification code, and the emergency code that
indicates whether the signal is active, passive, or a responder test;
d. A back-up power supply;
e. A separate telephone service;
f. A toll-free number to be used by the PERS
equipment in order to contact the primary or back-up response center;
and
g. A telephone line monitor,
which shall give visual and audible signals when the incoming telephone line is
disconnected for more than 10 seconds.
17. The monitoring agency shall maintain
detailed technical and operations manuals that describe PERS service elements,
including the installation, functioning, and testing of PERS equipment;
emergency response protocols; and recordkeeping and reporting
procedures.
18. Providers shall
document and furnish within 30 calendar days of the action taken a written
report to the support coordinator/case manager for each emergency signal that
results in action being taken on behalf of the individual. This excludes test
signals or activations made in error.
E. Service documentation and requirements:
1. Providers shall include signed and dated
documentation of the following in each individual's record:
a. The appropriate service authorization to
be completed by the support coordinator may serve as the plan for supports for
the provision of PERS service. A rehabilitation engineer may be involved for
PERS service if disability expertise is required that a general contractor may
not have. The plan for supports and service authorization shall include
justification and explanation if a rehabilitation engineer is needed. The
service authorization request shall be submitted to the state-designated agency
or its designee in order for service authorization to occur;
b. For PERS service, written documentation
regarding the process and results of ensuring that the item is not covered by
the State Plan for Medical Assistance as durable medical equipment (DME) and
supplies, and that the item is not available from a DME provider;
c. Documentation of the recommendation for
the item by an independent professional consultant and the amount of service
that is needed;
d. Documentation of
the date the service is rendered;
e. Any other relevant information regarding
the device or modification;
f.
Documentation in the support coordination record of notification by the
designated individual or the individual's representative or family/caregiver of
satisfactory completion or receipt of the service or item; and
g. Instructions regarding any warranty,
repairs, complaints, or servicing that may be needed.
2. Provider documentation shall support all
claims submitted for DMAS reimbursement. Claims for payment that are not
supported by supporting documentation shall be subject to recovery by DMAS or
its designee as a result of utilization reviews or audits.
Notes
Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
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