998.1Medical alert devices and services include equipment, systems, and services which enable an individual to secure help in the event of an emergency or are used to provide an individual with reminders of medication or treatment schedules.
998.2Medical alert devices and services are subject to the relevant authorization, delivery, and service requirements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) set forth in 29 DCMR § 997, except as otherwise set forth in this section.
998.3Providers of medical alert devices and services shall be enrolled in the District Medicaid program in accordance with the Provider Screening and Enrollment requirements described at 29 DCMR § 9400, except that such providers shall not be required to furnish Medicare-covered items or submit evidence of enrollment in the Medicare program.
998.4Providers of medical alert devices and services shall comply with the requirements for DMEPOS set forth at 29 DCMR § 996, subject to the following exceptions:
(a) A provider of medical alert devices and services is not required to furnish Medicare-covered items; and(b) A provider of medical alert devices and services is not required to submit any evidence of enrollment in the Medicare program.998.5Providers enrolling as medical alert devices and services providers shall be required to demonstrate capacity to provide Personal Emergency Response System (PERS) services in accordance with the requirements set forth in § 998.7 as a condition of Medicaid enrollment.
998.6Medicaid coverage of medical alert devices and services include, but are not limited to, the following:
(b) Medication management devices.998.7PERS shall be provided in accordance with the following requirements:
(a) PERS is an electronic system that summons assistance for a beneficiary from a friend, relative, or an emergency services provider (police, fire department, or ambulance) and shall be available twenty-four (24) hours a day, seven (7) days a week.(b) Each PERS system shall be comprised of the following two (2) basic elements: (1) Equipment accessed or used by the beneficiary, including but not limited to a portable help button, motion detector; and(2) A response center or responder to monitor the notifications.(c) The PERS service shall be comprised of two (2) processes:(1) Installation of the service unit; and(2) On-going monitoring of the system;(d) The units of service shall be as follows: (1) One (1) unit per year for installation and testing of the PERS system; and(2) Twelve (12) units per year for monthly rental, maintenance, and service fee;(e) Each PERS provider shall: (1) Provide in-home installation of all equipment necessary to make the service fully operational (including batteries);(2) Provide beneficiary and representative instruction on usage, maintenance, and emergency protocol of the PERS;(3) Provide equipment maintenance (both in-home and response center);(4) Provide response center monitoring and support, staffed by trained attendants, twenty-four (24) hours per day, seven (7) days per week;(5) Conduct equipment testing, monitoring, and maintenance (both inhome and response center equipment);(6) Conduct monthly service checks;(7) Provide documentation of all services provided, beneficiary contacts, equipment and system checks, and equipment servicing;(8) Make available emergency equipment repairs to the beneficiary on a twenty-four (24) hours per day, seven (7) days per week basis;(9) Ensure that the beneficiary has functioning equipment within twenty-four (24) hours of notification of malfunction of the equipment;(10) Allow the beneficiary to designate responder(s) who will respond to emergency calls. Responders may be relatives, friends, neighbors, or medical personnel; and(11) Provide DHCF and beneficiary's direct care providers with reports in accordance with the manner and schedule determined by DHCF; and(f) Each PERS provider shall ensure that contractors are properly supervised and that the service provided is consistent with the beneficiary's personcentered service plan and plan of care.998.8Medicaid coverage of PERS shall be limited to beneficiaries who meet at least one of the following criteria:
(b) Are alone for significant parts of the day.998.9Medicaid coverage of PERS shall be available for beneficiaries who are able to understand and demonstrate proper use of the system, based on the information provided by the long term services and supports assessment.
998.10Medication management devices shall include locked medication storage dispensers and systems that meet the following criteria:
(a) Can be programmed to automatically dispense medications at predetermined times;(b) Include a reminder system to notify beneficiary when medication is to be taken, via audible alarms, lights, text messages, or voice messages;(c) Consist of a system designed to: (1) Store a beneficiary's prescribed medications in a delivery unit;(2) Permit a health care professional to remotely schedule the beneficiary's prescribed medications;(3) Notify the beneficiary when the prescribed medications are due to be taken;(4) Release the prescribed medications to a tray of the delivery unit accessible to the beneficiary on the beneficiary's command; and(5) Record a history of the event for the health care professional;(d) Include a remote medication management system composed of one (1) or more of the following: clinical and communications software, a medication delivery unit, and/or medication packaging; and(e) Provide equipment and supplies used in the administration or monitoring of medication prescribed or ordered for a beneficiary by a qualified District Medicaid provider.998.11Medicaid coverage for medication management devices shall be limited to beneficiaries who:
(a) Have one or more prescriptions for medication to be taken on an ongoing basis;(b) Require assistance with the management or administration of their prescribed medication(s);(c) Have sufficient physical and cognitive ability to take the medications at the prescribed time once dispensed from the device; and(d) Are not receiving the necessary medication management assistance from a Personal Care Aide, Adult Day Health Program, informal caregiver, or other in-person service provider.998.12Effective October 1, 2020, medical alert devices and service providers shall be reimbursed in accordance with the District of Columbia Medicaid Fee Schedule available online at www.dc-medicaid.com.
998.13All future updates to the reimbursement rates for medical alert devices and services shall comply with the public notice requirements set forth under § 988.4 of Chapter 9 of Title 29 of the District of Columbia Municipal Regulations and provide notice and an opportunity for meaningful comment.
D.C. Mun. Regs. tit. 29, r. 29-998
Final Rulemaking published at 69 DCR 11741 (9/30/2022)