Body
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 Texas Health and Human Services Commission (HHSC) 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 individual:
- 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.