D.C. Mun. Regs. tit. 29, r. 29-9020
This section establishes the conditions of participation for Medicaid providers enumerated in §§ 9027.7 and 9027.8 ("Medicaid Providers") to provide Personal Emergency Response System (PERS) services for persons enrolled in the Home and Community-Based Services Individual and Family Supports (IFS) Waiver.
PERS is an electronic device that enables certain individuals at high risk for institutionalization to secure help in emergency situations by activating a system connected to the person's phone that is programmed to signal a response when a portable "help" button is activated.
In order to be eligible for reimbursement, each Medicaid provider must obtain prior authorization from the DDS prior to providing PERS services. The request for prior authorization shall include a written justification demonstrating how the services will aid the person in requesting emergency assistance because the person lives alone or is alone for significant parts of the day, or the person has no regular caregiver for extended periods of time and would otherwise require extensive routine supervision without the provision of the service.
Medicaid reimbursable PERS services shall consist of the following activities:
The PERS electronic device consists of a console or receiving base, which is connected to the person's telephone, a portable emergency response activator or "help" button, and a response center that monitors calls.
The PERS electronic device shall:
Each provider of Medicaid reimbursable PERS services shall be an approved home and community-based services provider such as an emergency response center and shall comply with Section 9004 (Provider Qualifications) and Section 9005 (Provider Enrollment Process) of Chapter 90 of Title 29 DCMR.
Each provider of Medicaid reimbursable PERS services shall have a current license, certification or registration with the District of Columbia as appropriate for the electronic system being purchased. Each provider shall also demonstrate knowledge of applicable standards of manufacture, design and installation.
In order to be eligible for Medicaid reimbursement, the twenty-four (24) hour seven (7) day a week emergency response center shall be monitored by trained operators capable of determining if an emergency exists and notifying emergency services and the person's responder.
The person for whom PERS services are provided shall choose the responder who will answer emergency calls through the PERS. Responders may be relatives, friends, neighbors, or medical personnel.
If the responder who will be in direct contact with the person is an employee of a Medicaid Waiver provider agency, he or she shall meet all of the requirements set forth in Section 9006 (Requirements for Direct Support Professionals) of Chapter 90 of Title 29 DCMR.
Each responder who will be in direct contact with the person shall have the language and communication skills to respond to emergency contacts (i.e., calling 911 on behalf of the person).
If the person chooses a medical professional to serve as a responder, the professional shall be licensed to practice medicine, registered nursing, practical nursing, or as a physician assistant in accordance with the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1205.01) , or be licensed to practice their respective profession within the jurisdiction where they provide service.
Each provider of Medicaid reimbursable PERS services shall follow the DDS Developmental Disabilities Administration (DDA) incident reporting process within twenty-four (24) hours of an emergency response. Emergency responses shall not include test signals or activations made by a person.
In order to be eligible for Medicaid, all PERS equipment shall comply with applicable Federal Communication Commission laws, rules, and the applicable underwriter's Laboratories, Inc. Standards.
Each provider of Medicaid reimbursable PERS services shall maintain the following documents for monitoring and audit reviews:
Each provider of Medicaid reimbursable PERS services shall comply with Section 9008 (Reporting Requirements) and Section 9011 (Individual Rights) under Chapter 90 of Title 29 DCMR.
Medicaid reimbursable PERS services shall only be provided in a person's personal residence. PERS shall not be provided to persons receiving Residential Habilitation services, Supported Living or Supported Living with Transportation services, with the exception of Supported Living Periodic and Supported Living with Transportation Periodic services.
The billable units for PERS services shall be:
There shall be a Medicaid reimbursement rate for PERS services as follows:
D.C. Mun. Regs. tit. 29, r. 29-9020