7400, Emergency Response Services

Revision 18-2; Effective September 3, 2018

7410 Introduction to ERS

Revision 18-2; Effective September 3, 2018

Emergency response services (ERS) are provided through an electronic monitoring system and are used by functionally impaired adults who live alone or who are functionally isolated in the community. In an emergency, the member can press a call button to signal for help. The electronic monitoring system, which has a 24-hour, seven-days-a-week monitoring capability, helps to ensure the appropriate person or service provider responds to an alarm call from a member.

7420 ERS Program Purpose

Revision 18-2; Effective September 3, 2018

The purpose of emergency response services(ERS) under the STAR+PLUS Home and Community Based Services (HCBS) program is to:

  • enable aged and disabled persons to maintain dignity, independence, individuality, privacy, choice and decision-making ability; and
  • prevent or reduce inappropriate institutional care by providing home-based care and other forms of less intensive care.

7430 ERS Member Eligibility

Revision 23-2; Effective June 30, 2023

In order to be eligible for emergency response services (ERS) through the STAR+PLUS Home and Community Based Services (HCBS) program, a member must:

  • have been determined eligible for the STAR+PLUS HCBS program;
  • be mentally alert enough to operate the equipment properly, in the judgment of the managed care organization (MCO) service coordinator;
  • have a telephone with a private line, if the system requires a private line to function properly;
  • be willing to sign a release statement that allows the responder to make a forced entry into the member's home if he or she is asked to respond to an activated alarm call and has no other means of entering the home to respond; and
  • live in a place other than an assisted living facility (ALF) or adult foster care (AFC) setting, institution or any other setting where 24-hour supervision is available.

Members eligible for Community First Choice (CFC) must receive ERS through CFC, not through the STAR+PLUS HCBS program.

Program Support Unit (PSU) staff will not accept or approve an initial or reassessment ISP with a "From" date of January 1, 2016, or later that includes personal assistance services (PAS) or ERS for non-medical assistance only (MAO) STAR+PLUS HCBS program members.

MCOs must uploaded Form H2067-MC, Managed Care Programs Communication, to MCOHub to notify PSU if a member is receiving both STAR+PLUS HCBS program and CFC services concurrently. This is required for all non-MAO STAR+PLUS HCBS program members who also receive CFC, regardless of whether the individual service plan (ISP) is manually uploaded or electronically submitted.

7440 Referral and Selection of Providers

Revision 19-1; Effective June 3, 2019

If the member is considered eligible for emergency response services (ERS), the managed care organization (MCO) shares a contracted list of all ERS providers with the member, who selects a provider from the list. The member can request a provider change; however, the member must contact his or her MCO service coordinator to request the change.

The MCO follows the procedures in 3600, Ongoing Service Coordination, and gives members an explanation of the service and requirements.

7450 Duties Related to ERS

Revision 19-1; Effective June 3, 2019

If the member wants and appears to be in need of emergency response services (ERS), the managed care organization (MCO) service coordinator determines if the member meets the general criteria for participating in ERS, as described in 7430, Member Eligibility. The MCO may involve other members of the interdisciplinary team in the decision regarding the member's physical and mental ability to participate in the ERS program. ERS may be authorized through the STAR+PLUS Home and Community Based Services (HCBS) program when it appears the member may need the capability to notify a respondent of an emergency. ERS services are limited to those individuals who:

  • live alone;
  • are alone for significant parts of the day;
  • have no regular primary caregiver for extended periods of time and who would otherwise require extensive supervision; or
  • live with someone who is too incapacitated to call for help should the need arise.

During the course of the services, the MCO and the provider have the joint responsibility of keeping each other informed of changes or problems.

7460 Provider Duties

Revision 19-1; Effective June 3, 2019

Managed care organization (MCO) contracted providers' duties specific to emergency response services (ERS) are described in Texas Administrative Code, Part 1, Chapter 52, Subchapter D.