4310 Introduction
Revision 24-4; Effective Sept. 1, 2024
Emergency Response Services (ERS) are provided through an electronic monitoring system. This system is for use by people who live alone or with someone who is incapacitated and unable to help if needed. In an emergency, the person can press a call button for help. The electronic monitoring system, which has a 24-hour, seven-day-a-week monitoring capability, helps ensure that the appropriate person or service agency responds to a person’s alarm call.
ERS can be delivered to people with a landline phone and may be available to people with cellular phone service or Voice Over Internet Protocol (VOIP) in some areas. The provider agency choice list designates which ERS providers in the contracted service area can accommodate applicants who choose to receive ERS without a landline phone. The rates for the service are the same regardless of the ERS delivery mechanism, cellular, landline and VOIP.
Refer to 4312.1 Eligibility
4311 Program Definitions
Revision 17-1; Effective March 15, 2017
The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:
Alarm call — A signal transmitted from the equipment to the provider's response center indicating that the individual needs immediate assistance.
Call button — An electronic device that, when pressed, triggers an alarm to the response center to alert the provider that an individual needs immediate assistance. The device may be held in the hand, worn around the neck, hung on a garment or kept within the individual's reach.
Installer — A volunteer, a subcontractor or an employee of a provider who connects, maintains or repairs the equipment.
Monitor — A volunteer, subcontractor or an employee of a provider who monitors Emergency Response Services (ERS) and ensures that an alarm call is responded to immediately.
Responder — A person designated by an individual to respond to an emergency call activated by the individual. A responder may be a relative, neighbor or a volunteer.
Response center — The site where a provider's ERS monitoring system is located.
Subcontractor — An organization or individual who delivers a component of ERS for the provider for a fee and is not an employee or volunteer of the provider.
4312 Eligibility and Referral Procedures
Revision 17-1; Effective March 15, 2017
4312.1 Eligibility
Revision 24-4; Effective Sept. 1, 2024
To be eligible for Emergency Response Services, a person must meet the functional need criteria set by the Texas Health and Human Service Commission (HHSC) and meet the following requirements:
- live alone, be alone routinely for eight or more hours each day, or live with an incapacitated person who could not call for help or otherwise help the client in an emergency;
- be mentally alert enough to operate the equipment properly, in the judgment of the HHSC caseworker;
- be willing to sign a release statement that allows the responder to make a forced entry into the person’s home if asked to respond to an activated alarm call with no other means of entering the home to respond; and
- live in a place other than a skilled institution, assisted living facility, foster care setting, or any other setting where 24-hour supervision is available.
The eight hours mentioned in the rule’s requirement above do not have to be continuous, if the person is alone at least eight hours in each 24-hour period. Even if the person has an attendant, consider the person alone.
If the provider cannot complete installation, inform the person that installation of ERS equipment is pending for the reasons the provider stated. If the person is unable or unwilling to make the needed modifications, explore other community resources to determine if these could be used to complete the needed modifications. If none are available, services may then be denied using termination code other. Document the reason in the case record.
Review 3000, Eligibility for Services, for more eligibility requirements.
The person is not eligible for Emergency Response Services if they:
- abuse the service by activating:
- four false alarms which result in a response by fire department, police or sheriff, or ambulance personnel within a six-month period; or
- twenty false alarms of any kind within a six-month period; or
- are admitted to a skilled institution, personal care home, foster care setting, or any other setting where 24-hour supervision is available; and
- in the caseworker's judgment, is no longer mentally alert enough to operate the equipment properly in situations including but not limited to:
- damages the equipment;
- disconnects the equipment and has received two warnings that are documented in the case record; or
- refuses to participate in the monthly systems checks; or
- is away from the home or cannot participate in the service delivery for a period of three consecutive months or more.
Related Policy
26 Texas Administrative Code (TAC) Section 271.95
26 TAC Section 271.155(d)
4312.2 Referral Process
Revision 24-4; Effective Sept. 1, 2024
A provider must accept all HHSC referrals. A caseworker makes a routine referral on Form 2101, Authorization for Community Care Services (PDF), or makes a negotiated referral by phone and Form 2101.
The caseworker gives eligible applicants an explanation of the services. They explain that applicants or people must:
- participate in the service delivery requirements; and
- have the caseworker review Attachment 2307-B, Emergency Response Services Rights and Responsibilities, with the person, which includes a statement to let the responder enter the participant's home, by force if necessary, to help the participant.
The caseworker follows procedures outlined in 3000, Eligibility for Services.
4313 Case Management Duties Related to Emergency Response Services (ERS)
Revision 24-4; Effective Sept. 1, 2024
If the applicant or person appears to need and also wants to receive ERS, the caseworker determines if the applicant or person meets the criteria for ERS participation.
If eligible for ERS, the caseworker shares the regional list of all ERS providers and the applicant or person selects a provider from this list. If the applicant or person has no preference, the caseworker makes the referral by rotation of providers.
The caseworker may help the person or the provider identify potential responders, and periodically update the information the provider maintains in its files on responders and other emergency numbers. The caseworker must not be an emergency responder for the person.
HHSC rules require the ERS provider notify the caseworker by the next HHSC workday of alarms, other individual emergencies, or changes in the person's behavior or condition that preclude ERS.
At least annually, the caseworker must review the list of responders given to the provider to ensure the list is current. During the services, the caseworker and the provider have the joint responsibility of keeping each other informed of changes or problems.
Report to the contract manager any provider tendency or pattern of designation of emergency personnel as respondents. Advise the person that they are responsible for any charges assessed by emergency personnel if they are summoned to the person's home for a non-medical emergency.
4320 Service Delivery Requirements
Revision 17-1; Effective March 15, 2017
4321 Service Initiation
Revision 21-2; Effective June 1, 2021
When an Emergency Response Service (ERS) provider receives a copy of Form 2101, Authorization for Community Care Services, and the provider packet, they will initiate services.
After receiving the packet, the ERS provider will:
- contact the participant to make an appointment to install the emergency response home unit equipment; and
- prepare a participant file, which includes applicable provider agency forms.
Note: In addition to requesting the applicant’s or recipient’s information, the provider will also complete a home entry release statement, ownership of equipment statement, and complaint procedure form.
If a different service initiation date is required, the provider must contact Community Care Services Eligibility (CCSE) staff to negotiate the new service initiation date by which services must begin.
Evaluate if an alternative service or other resources are available to meet the person’s needs. Instruct the provider to retain the authorization and initiate services as soon as possible or request the return of the written referral packet.
Related Policy
Content of Referral Packets, Appendix XIII
4322 Reserved for Future Use
Revision 22-2; Effective June 1, 2022
4323 Reserved for Future Use
Revision 22-2; Effective June 1, 2022
4324 Provider Follow-Up Procedures
Revision 17-1; Effective March 15, 2017
The provider notifies the case worker of service initiation as outlined in 4321, Service Initiation.
The provider maintains ongoing communication with the case workers and the regional contract manager. He discusses individual-specific issues with the case worker, and contract management issues (overall service delivery, policies and procedures) with the regional contract manager.
4325 Selection of Providers and Provider Changes
Revision 24-4; Effective Sept. 1, 2024
Each region maintains a list of all Emergency Response Services (ERS) providers. The list includes:
- vendor number;
- geographic areas served.
This information is given to the recipient to help make an informed choice. The recipient must select an ERS provider from the regional list. If the recipient does not have a preference, refer to the next provider on a rotating basis.
The recipient must contact Community Care Eligibility Services (CCSE) staff to request a provider change. CCSE staff determine:
- the issue or reason for the change request;
- if the issue can be addressed without changing providers; and
- if the provider will agree to the transfer.
Before processing a transfer, try to resolve the recipient’s concerns with the current provider.
If the issue with the provider is based on the recipient's failure to comply with the service plan, convene an interdisciplinary team (IDT) meeting to discuss the issues. If services are not terminated due to the recipient’s failure to comply with the service plan, authorize a transfer if necessary to address the recipient's concerns or if the recipient insists on changing providers.
Have the recipient select another provider and process the transfer. Coordinate the date the current provider ends services and the date the new provider begins services. An ERS provider may receive payment for the month of service regardless of the number of days services were provided in the month services were terminated. During a transfer of ERS services, make every effort to end the service of the first provider on the last day of the month and begin service of the second provider on the first day of the following month. Coordination of the end and begin dates reduces the need for payment of services to a second ERS provider for the same calendar month.
Related Policy
Suspension and Termination of Services, 4340
4330 Service Delivery
Revision 17-1; Effective March 15, 2017
4331 Reserved for Future Use
Revision 22-2; Effective June 1, 2022
4332 System Checks
Revision 24-4; Effective Sept. 1, 2024
An ERS recipient must be able to participate in monthly system checks. The monthly system check ensures that the recipient can successfully make an alarm call and that the equipment works properly.
If a provider cannot complete a system check during a calendar month, they must notify CCSE staff in writing.
Once notified that the provider cannot complete a system check, convene an IDT to evaluate the situation. Determine if the recipient continues to be appropriate for the service. If continuing services, complete and return Form 2067, Case Information (PDF). If terminating services, complete Form 2101, Authorization for Community Care Services (PDF).
Allow the authorization for ERS to remain effective if the recipient is still eligible for the service but cannot participate in a monthly system check.
Ensure the recipient's authorization does not exceed three consecutive billing months in which the recipient cannot participate in the monthly system checks.
4333 Equipment Malfunction
Revision 22-2; Effective June 1, 2022
A provider must contact the recipient by the next day after learning of any equipment failure. They must replace the equipment if the recipient is available within one working day or by the end of the third day if the recipient is not available the first working day.
The provider must ensure the equipment is functioning properly and that each recipient receives services during the entire authorization period.
The following people may report equipment malfunctions to the provider:
- recipient;
- recipient's family members;
- recipient's responders;
- CCSE staff; and
- monitors.
Providers:
- Send the installer to the recipient's home to repair or replace the equipment as equipment malfunctions are reported.
- Keep a record of each equipment malfunction in the provider's files.
- Must visit a recipient's home to check the equipment within five working days after the equipment has registered five or more "low battery" signals in a 72-hour period.
- They must replace a defective battery during the visit.
- Must respond to "low battery" signals received from the recipient's equipment.
- Provider staff must contact the recipient by phone after receiving a "low battery" signal to determine if the "low battery" could be caused by an accident, such as the unit having been unplugged.
- If the "low battery" signals continue, the provider must send a staff member to check, and repair or replace the recipient's ERS equipment within five working days after the receipt of the fifth "low battery" signal.
4340 Suspension and Termination of Services
Revision 24-4; Effective Sept. 1, 2024
An interdisciplinary team (IDT) meeting may be called by Community Care Services Eligibility (CCSE) staff or provider staff, if monthly system checks are unsuccessful or a recipient or someone in their home engages in illegal discrimination against a provider staff or Texas Health and Human Services Commission (HHSC) staff. Send Form 2067, Case Information (PDF), to notify the provider, if services continue. Send Form 2101, Authorization for Community Care Services (PDF) to terminate services, if services are terminated because of the IDT.
Report any changes involving the recipient to the provider. Example: hospitalization, change of residence, or visits with relatives.
A provider may leave ERS equipment in a recipient's home and continue service delivery when the recipient has temporarily entered an institution. The provider must suspend services if the recipient has been in the institution for more than 120 consecutive days. The provider is eligible for payment if the system checks are conducted during the 120-day period.
The provider must request termination of services when the recipient is no longer competent enough to operate the equipment properly. Situations include, but are not limited to, when the recipient:
- damages the equipment;
- disconnects the equipment and has received two warnings that are documented in the case record; or
- refuses to participate in the monthly system checks.
Providers:
- Must document the inability to test the home unit in the recipient’s case file.
- Request the installer remove the equipment from the recipient’s home after CCSE staff authorize service termination.
- May leave ERS equipment in a recipient’s home and continue services until the end of the month the service authorization expires.
- Receives payment for the month the service authorization ends, if:
- monitoring continues until the equipment is picked up; and
- the equipment is tested during the same calendar month or at the time of pickup.
- May be paid for the last month of service if ERS is terminated, regardless of how many days of service were provided in that month, if the provider has complied with ERS requirements.
The recipient is not responsible for payment for lost or damaged equipment.
4341 Interdisciplinary Team (IDT) Meeting
Revision 24-4; Effective Sept. 1, 2024
CCSE staff or the provider staff will set up an IDT meeting as needed. Call a meeting for situations where the provider cannot resolve issues with the recipient. CCSE staff must participate in the IDT meeting to help resolve issues. The IDT meeting could result in the continuation or discontinuation of services. If applicable, policy relating to failure to comply with the service plan must be considered.
4350 Reserved for Future Use
Revision 22-2; Effective June 1, 2022
4351 Advertising and Solicitation
Revision 24-4; Effective Sept. 1, 2024
HHSC may investigate complaints of solicitation or coercion of people. Validated complaints may lead to adverse actions or termination of contracts. The ERS provider is in violation of the ERS contract if the provider employs a person:
- who is paid money each time they recruit a new Medicaid recipient; or
- whose sole responsibility is recruitment, regardless of how they are compensated.
The ERS provider may have an employee responsible for recruitment and other assignments, if they are paid a regular salary and do not receive bonuses or anything that could be construed as a bonus for recruitment of Medicaid recipients.
4352 Disclosure of Previous Employment and Certification
Revision 24-4 Effective Sept. 1, 2024
The commissioner of Texas Health and Human Services Commission (HHSC) or designee must approve the contract or contract renewal if a former or current HHSC employee, former or current council member, or their relatives are an officer, director, owner or employee.
4353 Reserved for Future Use
Revision 22-2; Effective June 1, 2022
4360 Reassessment
Revision 24-4; Effective Sept. 1, 2024
Reassess eligibility within 12 months of the last functional assessment for services. Call or make a home visit to re-determine the person's eligibility for ERS. During the visit, ask the person to explain how to initiate an alarm call. Evaluate if the person continues to be sufficiently mentally alert to operate the equipment. Review 4312.1, Eligibility.
If the person continues to be eligible and with no changes, do not send anything to the provider. If services are terminated, coordinate the effective date of termination to match on Form 2065-A, Notification of Community Care Services (PDF), and Form 2101, Authorization for Community Care Services (PDF), to allow the person 12 calendar days prior notice.