Current through Register 1531, September 27, 2024
(A)
Requirements for
Coverage. PERS is indicated for the personal use of a member with
medical conditions that cause significant functional limitations or
incapacitation and prevents the member from using other methods of summoning
assistance in an emergency. The member must
(1) have a functioning landline phone that
can accommodate a PERS;
(2) live
alone or be routinely alone for extended periods of time such that the member's
safety would be compromised without the availability of a PERS unit in the
home;
(3) be able to independently
use the PERS to summon help;
(4)
understand when and how to appropriately use the PERS; and
(5) be at risk of moving to a more structured
residential setting, or be at significant risk for falls or other medical
complications that may result in an emergency situation.
(B)
Mandated PERS
Inclusion. PERS must meet the definition in
130 CMR 409.402 and
must include all of the following:
(1) a
communications transceiver;
(2) a
remote, portable activator;
(3) the
capacity to respond to all incoming emergency signals;
(4) the ability to receive multiple signals
simultaneously and ensure that calls are not disconnected or put in a first
come, first serve rotation;
(5) the
ability to routinely send a signal to the central monitoring system to test the
device and ensure the unit is working properly; and
(6) a central monitoring station with back-up
systems, staffed by trained attendants 24-hours per-day,
seven-days-per-week.
(C)
PERS Compliance with Underwriter Laboratories (UL)
Standards. The PERS must meet Underwriter laboratories (UL)
Standards 1637 - Home Health Care Signaling Equipment. Providers of PERS must
provide documentation upon request to the MassHealth agency demonstrating
compliance with these standards.
(D)
Other PERS
Requirements. In addition to the provider responsibilities
described in
130 CMR
409.405 and the requirements of 130 CMR
409.429, a MassHealth provider of PERS must
(1) include options such as TDD and TTY
capability to meet the needs of those members who are hearing
impaired;
(2) provide PERS that can
accommodate the needs of non-English speaking members;
(3) provide PERS that can accommodate the
needs of members who are physically disabled (for example, providing
"Sip-n-Puff" systems);
(4) maintain
current data files at the central monitoring station and at each service
facility that contain preestablished response protocols, and personal, medical,
and emergency information for each member served; and
(5) assess the member's need for in-home
installation of PERS at the time the provider receives a referral for PERS. The
MassHealth agency will pay a DME PERS provider for installation of PERS only if
the DME PERS provider's assessment determines that there is no one else
available to install the PERS in the member's home, such as the member, the
member's authorized caregiver, or a family member. The DME PERS provider must
maintain documentation of such assessment in the member's record. If other
options exist for members to install PERS, providers may deliver the PERS to
the member by mail. Return receipt is required. If PERS is delivered by mail,
the provider must not submit a claim to the MassHealth agency for the PERS
installation.
(E)
Documentation of Medical Necessity. Providers must
ensure that PERS is medically necessary. In addition to the applicable record
requirements under
130 CMR
409.430, the provider must complete the
MassHealth Personal Emergency Response System (PERS) General Prescription Form
in accordance with the instructions on the form, including obtaining the
member's ordering practitioner's prescription and medical justification for
PERS, and maintain such documentation in the member's record.
(1) The PERS General Prescription form must
be completed, dated, and signed by the member's ordering practitioners before
the installment of PERS.
(2) The
form must be renewed and signed by the member's ordering practitioner in the
event that the member's medical condition or living situation changes such that
the member may no longer meet the requirements of coverage of PERS under 130
CMR 409.429(A).
(3) The DME
provider must maintain the PERS General Prescription Form in the member's
record and make it available to the MassHealth agency upon request.
(F)
Reasons for
Non-coverage. MassHealth does not pay for PERS when the following
conditions apply:
(1) the PERS duplicates
equipment already available to the member in an emergency
(e.g., emergency call buttons, or other electronic means of
calling for help); or
(2) the
member has access to help on a 24-hour-per-day, seven-days-per-week
basis.
