Personal Emergency Response System (PERS)

(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-day-per-week basis.