(i.e., HCBS Elderly and/or Physically Disabled Adult Waivers)
KS Physical Disability (for physically disabled individuals ages 16-64)
Types of Technology Reimbursed/Definition (i.e., Personal Emergency Response System (PERS), Medication Dispensing, Home Telehealth, Remote Monitoring, etc.)
PERS Service: Personal Emergency Response Systems (PERS) involve the use of electronic devices which enable certain consumers at high risk of institutionalization to secure help in an emergency. The consumer may also wear a portable "help" button to allow for mobility. The system is connected to the consumer's telephone and programmed to signal a response center once the "help" button is activated. PERS is limited to those individuals who live alone, or who are alone for significant parts of the day, and have no regular attendant (formal or informal) for extended periods of time, and who would otherwise require extensive routine supervision.
PERS Installation: The placement of electronic PERS devices in a consumer's residence. PERS installation is for those certain consumers at high risk of institutionalization to secure help in an emergency. These consumers have met the assessed need of a Personal Emergency Response System.
To avoid any overlap of services, PERS is limited to those services not covered through regular State Plan Medicaid and which cannot be procured from other formal or informal resources. HCBS-PD waiver funding is used as the funding source of last resort and requires prior authorization from the PD Program Manager.
- Maintenance of rental equipment is the responsibility of the provider.
- Repair/replacement of equipment is not covered.
- Rental of the PERS System is covered; purchase is not.
- Call lights do not meet this definition.
- Maximum of two PERS Installations per calendar year.
Reimbursement Rates
- PERS Service: $35.00/month
- PERS Installation: $50/unit (max two/year)
Home and Community Based Services for the Frail Elderly (for older individuals ages 65 - no max age)
Types of Technology Reimbursed/Definition (i.e., Personal Emergency Response System (PERS), Medication Dispensing, Home Telehealth, Remote Monitoring, etc.)
PERS Services: (Same as KS Physical Disability definition above)
Reimbursement Rates
- PERS Service: $26.52/month
- PERS Installation: $56.25/unit (max two/year)
Home Telehealth: Home telehealth is a remote monitoring system provided to a customer that enables the customer to effectively manage one or more diseases and catch early signs of trouble so intervention can occur before the customer’s health declines. The provision of home telehealth entails customer education specific to one or more diseases,counseling, and nursing supervision. Customers qualify for this service if the customer: is in need of disease management consultation and education; and has had two or more hospitalizations, including ER visits, within the previous year related to one or more diseases; or is using Money Follows the Person to move from a nursing facility back into the community. HCBS/FE home telehealth services is not a duplication of Medicare telehealth services.
While the Kansas Legislature calls this service home telehealth, the actual service follows the CMS telemonitoring definition which Medicare does not cover. HCBS/FE home telehealth is a daily monitoring of the customer’s vital sign measurements from the customer’s home setting to prevent a crisis episode; whereas Medicare telehealth includes specific planned contacts for professional consultations, office visits, and office psychiatry services, usually through video contact. During KDOA’s plan of care approval process, KDOA will confirm there is no prior authorization for Medicaid home telehealth skilled nursing visits in the Medicaid Management Information System (MMIS). If a prior authorization is identified, HCBS/FE home telehealth services will be denied.
Limitations:
- Registered Nurse (RN) or licensed practical nurse with RN supervision to set up/supervises/provide customer conseling.
- Customer must have a landline or wireless connection.
- Installation required within 10 working days of approval.
- Maximum of two installations per calendar year.
- Monthly status reports to the physician and case manager.
- Minimum monthly customer contact to reinforce positive self-management behaviors.
- If customer fails to perform daily monitoring for seven (7) consecutive days, case manager must be notified to determine if continuation of the service is appropriate.
- Customers living in an Assisted Living Facility, Residential Health Care Facility, or a Home Plus are not eligible for this service.
Enrollment:
- County Health Departments
- The following entities licensed by KDHE:
- Medicare Certified Home Health Agencies
- State Licensed Home Health Agencies
Reimbursement:
- Rental:
One unit = one day
Unit Cost = $6.00
Procedure code = S0317 - Install:
One unit = installation (maximum of two installations per calendar year)
Maximum cost = $70.00
Procedure code = S0315
Medication Reminder: A Medication Reminder System provides a scheduled reminder to a customer when it’s time for him/her to take medications. The reminder may be a phone call, an automated recording or an automated alarm, depending on the provider’s system. This service does not duplicate other waiver services.
Limitations:
- Maintenance of rental equipment is the responsibility of the provider.
- Repair/Replacement of rental equipment is not covered.
- Rental, but not purchase, of this service is covered.
- This service is limited to those customers who live alone, or who are alone a significant portion of the day and have no regular caretaker for extended periods of time, and who otherwise require extensive routine supervision.
- These systems may be maintained on a monthly rental basis even if a customer is admitted to a nursing facility or acute care facility for a planned brief stay period not to exceed the two months following the month of admission in accordance with public assistance policy.
- This service is available in the customer’s place of residence, excluding adult care homes.
Enrolement
Any company providing medication reminder services is eligible to enroll. Adult Care Homes are excluded from this service.
Reimbursement
- One unit = one month
- Unit Cost = $15.91
- Procedure Code = S5185