Idaho - Personal Emergency Response System — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Idaho Department of Health and Welfare (DHW) Bureau of Long Term Care (BLTC) approves Personal Emergency Response System (PERS) providers to deliver services under the state's Aged and Disabled (A&D) Waiver. Before an enrollment application can even be approved, prospective PERS providers must complete the Prospective Home and Community Based Services (HCBS) Provider Toolkit and attend a mandatory training session conducted by a BLTC Quality Assurance Specialist.

Idaho does not issue a distinct facility or agency license for PERS providers; instead, operating authority is granted directly through Medicaid provider certification and enrollment. Providers must establish a Trading Partner Account (TPA) through the Health PAS OnLine portal managed by Gainwell Technologies to submit their enrollment application and execute the Medicaid Provider Enrollment Agreement.

1. Service Definition and Scope

Under the Idaho Aged and Disabled (A&D) Waiver, a Personal Emergency Response System (PERS) is defined as an electronic device that enables individuals at high risk of institutionalization to secure help in an emergency. The system is connected to the participant's telephone and programmed to signal a response center once a portable "help" button is pressed.

The service is limited to participants who live alone, or who are alone for significant parts of the day, and have no regular caregiver for extended periods. It includes the initial installation of the equipment, monthly rental and monitoring, and the maintenance of the devices.

• Target Population: A&D Waiver participants who live alone or are alone for significant periods and are at risk of falls or medical emergencies.
• Equipment Types: Base units connected to a landline or cellular network, paired with wearable waterproof pendants or wristbands.
• Service Components: Initial installation, monthly monitoring, equipment maintenance, and battery replacement.
• Response Center: Must operate 24 hours a day, 7 days a week, 365 days a year to receive signals and dispatch appropriate assistance.
• Exclusions: PERS is not authorized for participants who have a full-time live-in caregiver or reside in a 24-hour supported living environment.

2. Regulatory and Oversight Agencies

The Idaho Department of Health and Welfare (DHW) is the single state Medicaid agency. Within DHW, the Bureau of Long Term Care (BLTC) is responsible for the programmatic oversight, quality assurance, and policy development for the A&D Waiver, including PERS services.

Gainwell Technologies operates as the fiscal agent for Idaho Medicaid. They manage the Health PAS OnLine portal, process provider enrollment applications, and handle claims adjudication through the Medicaid Management Information System (MMIS).

• Idaho Department of Health and Welfare (DHW): The overarching state agency administering Medicaid (https://healthandwelfare.idaho.gov).
• Bureau of Long Term Care (BLTC): Manages HCBS waivers and conducts mandatory QA training (https://healthandwelfare.idaho.gov/providers/home-and-community-based-long-term-care/long-term-care-provider-enrollment-and-general).
• Gainwell Technologies: The fiscal agent managing the Health PAS OnLine portal and provider enrollment (https://www.idmedicaid.com).
• Idaho Criminal History Unit (CHU): Processes mandatory background checks for provider staff (https://chu.dhw.idaho.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Idaho does not require a Certificate of Need (CON) or a competitive procurement (RFP) process to become a PERS provider. The network is open to any qualified entity that meets the state's HCBS standards.

However, Idaho enforces a strict pre-application gate: prospective PERS providers must complete the Prospective HCBS Provider Toolkit and subsequently schedule and complete a mandatory training with a BLTC Quality Assurance Specialist. An application submitted to Gainwell without this prior BLTC training approval will not be processed.

• Prospective HCBS Provider Toolkit: Must be reviewed and completed prior to initiating the enrollment process.
• Mandatory BLTC QA Training: Prospective providers must call 877-799-4430 or email [email protected] to be trained by a Quality Assurance Specialist before application approval.
• Business Registration: Must be registered and in good standing with the Idaho Secretary of State.
• National Provider Identifier (NPI): Must obtain an NPI from the NPPES registry prior to creating a Trading Partner Account.
• No Certificate of Need: Idaho does not require a CON for PERS agencies.

4. Licensure and Certification Requirements

The State of Idaho does not have a specific statutory license category for Personal Emergency Response System agencies. Because there is no state license, the "licensure" equivalent is the Medicaid certification process managed by the BLTC.

To meet certification standards, the provider's equipment must comply with federal and industry safety standards. The response center must demonstrate the technical capacity to handle emergency signals without interruption.

• State Licensure: None required; operates under Medicaid HCBS certification.
• Equipment Certification: Devices must meet Underwriters Laboratories (UL) safety standards for home healthcare signaling equipment.
• FCC Compliance: All wireless and cellular communication devices must comply with Federal Communications Commission (FCC) regulations.
• Power Backup: The base unit must have a battery backup system capable of operating during power outages.
• HCBS Settings Rule: Must comply with the federal Home and Community-Based Services settings requirements, ensuring participant privacy and autonomy.

5. Medicaid Provider Enrollment

Provider enrollment is conducted entirely online through the Idaho Medicaid Health PAS OnLine portal. Applicants must first register for a Trading Partner Account (TPA) to access the secure enrollment application.

The effective date of enrollment is typically the date the completed and acceptable application is received by DHW or Gainwell, provided the BLTC QA training prerequisite has been met.

• Trading Partner Account (TPA): Required initial registration step at www.idmedicaid.com.
• Provider Enrollment Application: Completed electronically via the Health PAS OnLine portal after TPA creation.
• Medicaid Provider Agreement: Must be signed and submitted as part of the application packet.
• W-9 Form: Required for tax identification and payment processing.
• Application Fee: Subject to the ACA institutional provider application fee unless enrolled in Medicare or another state's Medicaid program (fee varies annually, approx. $709 for 2024).
• Effective Date: Deemed to be the date the completed application is received by Gainwell.

6. Staffing, Training and Background Checks

PERS providers must ensure that all staff who interact with participants or have access to their personal information undergo strict background screening. This includes installation technicians and response center operators.

Response center staff must be trained in emergency dispatch protocols, customer service for older adults and individuals with disabilities, and the specific operational procedures of the monitoring software.

• Criminal History Check: All personnel with direct participant contact must clear an Idaho DHW Criminal History Unit (CHU) background check.
• Response Center Staffing: Must maintain 24/7/365 staffing levels sufficient to answer emergency signals immediately.
• Operator Training: Staff must be trained in emergency triage, contacting first responders, and notifying designated emergency contacts.
• Installer Qualifications: Technicians must be trained in the proper installation, testing, and troubleshooting of the specific PERS equipment used.
• OIG Exclusion Check: Providers must verify monthly that no staff or owners appear on the federal OIG List of Excluded Individuals/Entities (LEIE).

7. Documentation, Policies and Records

Providers must maintain comprehensive records for each A&D Waiver participant served. These records are subject to periodic quality assurance reviews by the BLTC to ensure compliance with waiver standards.

Documentation must clearly show that the equipment was installed, tested, and is functioning correctly, and that all emergency signals were handled according to policy.

• Service Authorization: Must maintain a copy of the approved A&D Waiver service plan authorizing PERS.
• Installation Records: Signed documentation confirming the date of installation and that the participant was trained on how to use the device.
• Testing Logs: Records of monthly equipment tests to ensure the base unit and pendants are communicating with the response center.
• Incident Reports: Detailed logs of every emergency button press, including the time, nature of the emergency, and the outcome/dispatch action taken.
• Record Retention: All Medicaid records must be retained for a minimum of five years from the date of service.

8. Billing, Rates and Claims

PERS services are billed to Idaho Medicaid using standard HCPCS codes via the Health PAS OnLine portal. Providers are reimbursed at the maximum allowable fee established by the DHW Division of Medicaid, or the billed amount, whichever is lower.

Claims must be submitted within the state's timely filing limits to be considered for payment. Providers must ensure they only bill for months where the service was actively monitored and authorized.

• Billing Portal: Claims are submitted electronically through the Health PAS OnLine MMIS.
• Installation Code: S5160 (Emergency response system; installation and testing).
• Monthly Monitoring Code: S5161 (Emergency response system; service fee, per month).
• Timely Filing Limit: All claims must be submitted within 365 days from the date of service.
• Prior Authorization: Services must be prior-authorized by the participant's A&D Waiver Case Manager before billing.
• Dual Eligible Members: For members enrolled in a Medicare-Medicaid coordinated plan (e.g., Molina or UnitedHealthcare), authorizations and claims route through the health plan's Utilization Management Team.

9. Approval Sequence and Timeline

The approval process begins with the provider's self-education using the state's toolkit, followed by mandatory state-led training, and concludes with the fiscal agent's enrollment processing.

Because the BLTC QA training must be scheduled based on state staff availability, prospective providers should account for this scheduling lead time when planning their operational launch.

• Step 1: Download and review the Prospective HCBS Provider Toolkit.
• Step 2: Contact [email protected] to schedule and attend the mandatory Quality Assurance training.
• Step 3: Register for a Trading Partner Account (TPA) on idmedicaid.com.
• Step 4: Submit the electronic Provider Enrollment Application and upload the signed Provider Agreement and W-9.
• Step 5: Gainwell processes the application (typically 30-60 days if complete).
• Step 6: Receive the Medicaid Welcome Letter and active Provider ID.

10. Common Denials and Survey Findings

Enrollment applications are most frequently denied or delayed because the applicant bypassed the mandatory BLTC QA training or failed to submit a complete W-9. Gainwell will not backdate effective dates for applications delayed by missing attachments.

During periodic BLTC quality assurance reviews, active providers are commonly cited for failing to maintain documentation of monthly equipment testing or failing to report critical incidents to the waiver case manager.

• Missing QA Training: Application rejected because the provider did not complete the BLTC QA training prior to submission.
• Incomplete Attachments: Delays caused by missing signatures on the Provider Agreement or an incorrect W-9.
• Testing Failures: Survey citations for lacking documentation that the PERS equipment is tested monthly.
• Incident Reporting: Citations for failing to notify the participant's case manager following a dispatch for a fall or medical emergency.
• Background Check Lapses: Citations for allowing installation technicians to enter participant homes before their CHU background check cleared.

11. Key Contacts and Resources

Prospective providers should utilize the DHW public document libraries and the Health PAS OnLine portal for the most current forms, toolkits, and fee schedules.

For questions regarding the mandatory training or waiver standards, the BLTC Quality Assurance team is the primary point of contact.

• BLTC Quality Assurance Team: 877-799-4430 or [email protected] (for mandatory pre-application training).
• Gainwell Provider Enrollment Assistance: 866-686-4272 (for help with the Health PAS OnLine application).
• Health PAS OnLine Portal: https://www.idmedicaid.com (for TPA registration and claims).
• Prospective HCBS Provider Toolkit: https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=36260&dbid=0&repo=PUBLIC-DOCUMENTS
• Idaho DHW Criminal History Unit: https://chu.dhw.idaho.gov (for staff background checks).

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