Revision 06-2; Effective June 9, 2006

 

 

5100 Overview

Revision 06-1; Effective April 10, 2006

 

This section describes the interaction between the Department of Aging and Disability Services (DADS) and the Emergency Response Services (ERS) staff. This material is presented in a routine and chronological sequence of events, following the individual from initial application for services through service delivery and suspension/termination of services.

 

5110 Forms Needed

Revision 06-1; Effective April 10, 2006

 

  • Form 2059, Summary of Client's Need for Service
  • Form 2067, Case Information (The provider may use this form to meet Chapter 52, Contracting to Provide Emergency Response Services, requirements, as long as the provider ensures that the required information is documented on or attached to the form.)
  • Form 2101, Authorization for Community Care Services
  • Form 2110, Community Care Intake

 

5120 Referrals to Facility

Revision 06-1; Effective April 10, 2006

 

An applicant may be referred to an Emergency Response Services provider by the case manager. Section 5200, Provider Response to Case Manager Referral, describes the process you follow to initiate services for an individual referred through the case manager.

 

5130 Case Manager Service Planning Process

Revision 06-1; Effective April 10, 2006

 

Applicants/individuals apply for services by contacting a Community Care for Aged and Disabled (CCAD) case manager. The case manager conducts face-to-face interviews to determine if applicants meet eligibility criteria for the service. The case manager may authorize services for up to one year.

The case manager gives eligible applicants an explanation of the service. The applicants/individuals are advised that they are required to:

  • participate in the service delivery requirements; and
  • sign a release statement allowing the responder to enter the individual's home by force, if necessary, to assist the individual.

 

 

5140 Referral Process

Revision 06-1; Effective April 10, 2006

 

The region maintains a list of all Emergency Response Services providers. The list includes:

  • vendor number,
  • geographic areas served, and
  • rate(s).

This information is provided to the individual to assist in making an informed choice. If the individual has no preference of providers, a referral will be made to the provider with the lowest rate. If more than one provider has the same lowest unit rate, referrals to individuals will be made on a rotating basis.

The case manager gives verbal approval when the individual needs an immediate response to the request for services. The service begin date is negotiated between the provider and case manager.

Providers will receive the referral packet within seven days from the verbally approved date.

 

5150 Interest Lists

Revision 06-1; Effective April 10, 2006

 

If, due to fiscal constraints, the Department of Aging and Disability Services initiates an interest list, the case manager explains to the individual that the service is not currently available, and a referral will be made to the provider originally selected by the individual when intake is opened.

 

5200 Provider Response to Case Manager Referral

Revision 06-2; Effective June 9, 2006

 

When Form 2101, Authorization for Community Care Services, is received, the provider:

  • contacts the individual to make an appointment to install the emergency response home unit equipment; and
  • prepares a file on the individual, which includes applicable provider forms (individual information, home entry release statement, ownership of equipment statement and complaint procedure).

 

 

5210 Securing Responders

Revision 06-1; Effective April 10, 2006

 

The provider refers to the Comments section of Form 2101, Authorization for Community Care Services, to determine if the case manager identified potential responders for the individual. The provider begins to identify responders during the initial contacts while arranging for a home visit. The provider may ask the individual if there is a relative, friend or neighbor willing to participate. If one or more responders are identified for an individual, the provider may request that the person(s) be present on the day the equipment is to be installed to learn about the service and the responder's responsibilities. If the responders are unable to be present, the provider may orient the responders by telephone or in writing on or before the date the responder is first contacted and asked to respond to an alarm call. The provider must document the required information. More information regarding responder orientation can be found in Chapter 52 Contracting to Provide Emergency Response Services.

If two responders are not secured for the individual, the provider will:

  • identify the individual's sole responder and document the reason(s) why two responders were not secured for the individual; and
  • document the date the written procedures were mailed to the sole responder; or
  • designate public service personnel in place of the individual's responders; and
  • send written notification to the case manager of the inability to secure the names of any responders within 14 days after initiating services.

 

 

5220 Home Visit

Revision 06-1; Effective April 10, 2006

 

During the home visit, the installer connects the equipment and obtains the information needed to complete the applicable provider forms.

If the provider is unable to complete installation, document the reason for the delay, the anticipated date the equipment will be installed, and a description of ongoing efforts to install the equipment, if applicable.

After installing the equipment, the provider demonstrates the equipment and allows the individual to activate an alarm call to familiarize him with the equipment. The provider explains the individual is responsible for the following service delivery requirements:

  • participating in the monthly systems checks;
  • contacting the provider if he moves or has his telephone number changed; and
  • contacting the provider if he becomes aware of changes related to responder(s).

The installer provides the individual with a written copy and an explanation of the complaint procedures.

The case manager must discuss service delivery requirements with the individual. If the individual refuses to sign the release statement, the case manager must withdraw the referral.

 

5230 Provider Follow-Up Procedures

Revision 06-2; Effective June 9, 2006

 

The provider:

  • documents the day that services began.
  • maintains ongoing communication with the case manager and the regional contract manager by discussing:
    • individual-specific issues with the case manager; and
    • contract management issues (overall service delivery, policies and procedures) with the regional contract manager.

 

 

5300 Ongoing Service Delivery

Revision 06-1; Effective April 10, 2006

 

 

 

5310 Alarm Calls

Revision 06-1; Effective April 10, 2006

 

Activated alarms received at the response center are responded to within 60 seconds. The provider keeps track of an incident from the time the alarm is activated to the time the individual receives assistance. Each activated alarm call must be considered an emergency, not an accident.

The provider immediately contacts the responder(s) and/or proper authorities when the individual activates an alarm. If the provider contacts the individual before a responder, the provider must talk to the individual to verify that an emergency exists.

Providers contact a responder whenever an alarm call is activated and the provider is unable to reach the individual.

A provider must document an alarm call at the time the call is received and after it is resolved. Documentation requirements are outlined in Chapter 52, Contracting to Provide Emergency Response Services.

A provider must submit written notification to the case manager by the next workday after an alarm call that results in aresponder being dispatched to an individual's home.

 

5320 Monthly System Checks

Revision 06-1; Effective April 10, 2006

 

The provider conducts monthly checks during normal working hours, unless otherwise negotiated with the individual. The purpose of the monthly system check is to:

  • ensure the individual can successfully make an alarm call;
  • ensure that the equipment is working properly; and
  • remind the individual how the system works and how to activate an alarm in an emergency.

The test involves contacting the individual and instructing him to press the call button to activate the alarm call.

If two individuals live in the same residence, the provider conducts a monthly system check for each individual. Be sure to document the system check. Documentation requirements are outlined in Chapter 52, Contracting to Provide Emergency Response Services.

The following procedures apply when the provider is unable to reach the individual to conduct a monthly system check.

Calendar Procedures
For three consecutive months
  1. Try to reach the individual at least three times on three different days during the month.
  2. After three attempts, contact a responder and try to find out why the individual is unable to participate in the test.
  3. If a provider is unable to complete a system check during a calendar month, the provider must provide written notification to the case manager as outlined in Chapter 52, Contracting to Provider Emergency Response Services.
- Note: If within three consecutive months a monthly system check is not successful, the provider may continue to receive payments if attempts to conduct system checks and convene an IDT meeting continue.

 

Note: In each of the three months, the provider is eligible for payment if all the requirements are met. The provider is not eligible for partial payment for partial completion of procedures.

The provider documents the reasons why the individual is unable to participate in the monthly system check. The provider will contact the responder if no documented reason why the system checks have not been completed exists. The provider must ask the responder to find out why the individual is unable to complete the system check. The information must be documented in the individual's case folder or the monthly log of systems checks. Written notification is provided to the case manager as outlined in Chapter 52, Contracting to Provide Emergency Response Services.

 

5330 Service Breaks

Revision 06-1; Effective April 10, 2006

 

The provider must ensure that the equipment remains functional and that each individual receives services during the entire authorization period.

The following persons may report equipment malfunctions to the provider:

  • individual;
  • individual's family members;
  • individual's responders;
  • case managers; or
  • providers (subcontractors or provider staff).

As equipment malfunctions are reported, the provider sends the installer to the individual's home to repair or replace the equipment.

The provider documents each equipment failure and low battery signal in the provider files.

 

5400 Notification Requirements

Revision 06-1; Effective April 10, 2006

 

 

5410 Changes and Serious Incidents

Revision 06-1; Effective April 10, 2006

 

A change is an event in the individual's status or condition that may require a change in the individual's service authorization. Events include:

  • hospitalization;
  • changes in functional abilities (or ability to operate unit);
  • complaints of pain;
  • change of address;
  • changes in the household composition;
  • an emergency involving the individual that receives a response; and
  • three unsuccessful attempts to contact the individual for the monthly systems test.

The provider notifies the case manager in writing of changes. An interdisciplinary team may need to be called if monthly system checks are unsuccessful or an individual or someone in the home engages in illegal discrimination against a provider staff or a Department of Aging and Disabilty Services employee. The case manager notifies the provider if services should continue or be terminated.

The case manager and provider will ensure that both parties are aware of any changes involving an individual (examples: hospitalization, change of residence or visits with relatives).

 

5420 Interdisciplinary Team (IDT) Meetings

Revision 06-1; Effective April 10, 2006

 

The provider will convene an IDT meeting when the need arises. A meeting is called for situations in which the provider is unable to resolve issues with the individual. IDT requirements are outlined in Chapter 52, Contracting to Provide Emergency Response Services.

 

5430 Provider Changes

Revision 06-1; Effective April 10, 2006

 

The provider sends Form 2067, Case Information, to the regional contract manager to notify him of a change in the provider address or telephone number.

 

5440 Client Rights and Responsibilities

Revision 06-1; Effective April 10, 2006

 

For information regarding an individual's rights and responsibilities, see Chapter 49, Contracting for Community Care Services.

 

5500 Suspension and Termination of Services

Revision 06-1; Effective April 10, 2006

 

 

5510 Suspension of Services

Revision 06-1; Effective April 10, 2006

 

The provider will suspend services if the individual:

  • permanently leaves the state or moves to a county in which the provider does not have an Emergency Response Services (ERS) contract;
  • permanently moves to a location where ERS is not provided;
  • dies;
  • is admitted to an institution for more than 120 consecutive days; or
  • is no longer mentally alert enough operate the equipment properly.

Detailed information regarding the suspension of ERS can be found in Chapter 52, Contracting to Provide Emergency Response Services.

 

5520 Termination of Services

Revision 06-1; Effective April 10, 2006

 

The individual's right to appeal if services are terminated is governed by the Fair and Fraud Hearings Handbook.

If the Department of Aging and Disabilty Services terminates Emergency Response Services (ERS), a provider may be paid for the last month of service, regardless of how many days of service were provided that month, if the provider has complied with the requirements outlined in Chapter 52, Contracting to Provide Emergency Response Services.

The provider requests termination of services when the individual is no longer mentally alert enough to operate the equipment properly. Situations include, but are not limited to, when the inidividual:

  • damages the equipment;
  • disconnects the equipment and has previously received two warnings that are documented in the case record; or
  • refuses to participate in the monthly systems checks.

The provider requests that the installer remove the equipment from the individual's home after the interdisciplinary team meeting and the case manager authorizes that services be terminated.

A provider may leave ERS equipment in an individual's home and continue services until the end of the month the service authorization expires. The provider receives payment for the month the service authorization ends, as long as:

  • monitoring continues until the equipment is picked up; and
  • the equipment is tested during the same calendar month or at the time of pickup.

The provider notifies the individual by telephone before discontinuing service, and follows up in writing to the individual and the case manager.

If the suspension results in case closure or termination of ERS, the case manager coordinates closure and the termination date with the provider to allow time for individual notification of the right to appeal.

 

5530 Equipment Removal

Revision 06-1; Effective April 10, 2006

 

The provider documents staff's inability to test the home unit in the individual's case file.

The individual is not liable for payment for lost or damaged equipment.

 

5600 Reauthorization

Revision 06-1; Effective April 10, 2006

 

The individual's situation is reassessed annually. You will be notified by the case manager when the individual is reassessed and if services are terminated.