CurrentCareSource GeorgiaPolicy MP-MM-1425

Personal Emergency Response Systems

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This policy governs coverage of Personal Emergency Response Systems (PERS) used in a member's home. Coverage may be medically necessary when specified clinical, functional, living-arrangement, equipment-use, telephone-support, and CareSource Case Management criteria are met.

Policy Summary

PayerCareSource Georgia

PolicyPersonal Emergency Response Systems

Policy CodePolicy MP-MM-1425

Change TypeAnnual reviewminor updates

Effective DateSeptember 1, 2026

Last ReviewMay 20, 2026

Next Review DateN/A

Key ActionDocument the member’s specific clinical diagnoses or physical-functional limitations and explain how the PERS will improve safety and support continued residence at home.

SourceLink

POLICY UPDATE CHANGES

Annual review with minor background and definition updates.

2Provider documentation elements required

4Case Management eligibility conditions

3Core PERS components

2Excluded system types

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CurrentCareSource GeorgiaPolicy MP-MM-1425

Personal Emergency Response Systems

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Sign up for CareSource Georgia Policy MP-MM-1425 alerts

Get alerted when Policy MP-MM-1425 changes without checking for updates manually.

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Policy Summary

PayerCareSource Georgia

PolicyPersonal Emergency Response Systems

Policy CodePolicy MP-MM-1425

Change TypeAnnual reviewminor updates

Effective DateSeptember 1, 2026

Last ReviewMay 20, 2026

Next Review DateN/A

Key ActionDocument the member’s specific clinical diagnoses or physical-functional limitations and explain how the PERS will improve safety and support continued residence at home.

SourceLink

POLICY UPDATE CHANGES

Annual review with minor background and definition updates.

2Provider documentation elements required

4Case Management eligibility conditions

3Core PERS components

2Excluded system types

Coverage Criteria

Medically Necessary PERS in the Home

PERS use in a member's home may be medically necessary when all of the following are met.

All PERS home-use criteria

Provider documentation
- Indication: Specific clinical diagnoses and/or physical-functional limitations serve as an indication for a PERS.
- Expected benefit: The provider documents how the PERS will specifically improve member safety and facilitate continued residence in the home setting.
Telephone support: The member retains an appropriate mobile or landline phone system that will support the PERS device.
CareSource Case Management assessment
- Frailty and functional impairment: The member is frail and functionally impaired.
- Living arrangement: The member lives alone or with another functionally impaired person.
- Telephone arrangement: The member is willing to arrange private line telephone service if private line service is not currently in place, or is willing to sign a form stating that the member has accepted a wireless cellular device as an alternative.
- Ability to use equipment: The member is mentally and physically able to use the equipment appropriately.

Remote video monitoring of the individual in the home and systems that only connect to emergency service personnel are excluded from the definition of a Personal Emergency Response System (PERS).

Medical Necessity Requirements

PERS Home-Use Criteria

PERS use in the member's home may be medically necessary when all criteria are met.

PERS medical necessity

CareSource Case Management eligibility conditions
- Frailty and functional impairment: The member is frail and functionally impaired.
- Living arrangement: The member lives alone or with another functionally impaired person.
- Telephone arrangement: The member is willing to arrange private line telephone service if it is not currently in place, or is willing to sign a form accepting a wireless cellular device as an alternative.

Provider Actions and Denial Risks

Documentation Required

Medical-Necessity Documentation Required

Before requesting PERS, the provider must document all of the following: the member’s specific clinical diagnoses and/or physical-functional limitations that indicate a need for PERS, and how PERS will specifically improve member safety and facilitate continued residence in the home setting.

Document the applicable clinical diagnoses and/or physical-functional limitations.
Explain the member-specific need for PERS, including how it will improve safety and support continued residence at home.

Denial Risk

Failure to Meet Eligibility Criteria May Result in Denial

PERS may be denied when any eligibility requirement is not met, including medical-necessity documentation, an appropriate telephone system to support the device, or CareSource Case Management’s eligibility assessment.

Documentation Requirements

Documentation Required

Support medical necessity in the record

Documentation must identify the specific clinical diagnoses and/or physical-functional limitations indicating a PERS and describe how the device will improve safety and support continued residence in the home.

Documentation Required

Confirm telephone-system support

The member must retain an appropriate mobile or landline phone system that supports the PERS device.

Personal Emergency Response System Definition

Personal Emergency Response System (PERS)

Core equipmentTelecommunications equipment

Monitoring serviceA central monitoring station

Communication capabilityTwo-way, hands-free communication between the individual and the station

Excluded systemsDoes not include remote video monitoring of the individual in the home or systems that only connect to emergency service personnel

Policy Background

A Personal Emergency Response System (PERS) is a device with an integrated service that can secure help during an emergency. Depending on the device, PERS may enable communication between the member and responders and include additional services or alarms. Trained personnel at a remote monitoring station respond to the member’s alarm signal. When included in the physician’s prescribed treatment plan, PERS may support safety, medication adherence, and independent living.

Excluded Systems and Services

The following are not covered as PERS: remote video monitoring of the individual in the home and systems that only connect to emergency service personnel.