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

Last reviewed: 2026-08-16

Personal Emergency Response System (PERS) in New York is a Medicaid service providing installed or wearable monitoring equipment with two-way voice communication and 24-hour response for individuals who live alone and are at risk of falls. The service is primarily utilized by elderly and disabled beneficiaries enrolled in Managed Long-Term Care (MLTC) plans or Home and Community-Based Services (HCBS) waivers such as the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waivers.

The single biggest structural barrier to entry for a new PERS provider in New York is the dual-enrollment mandate. Because the vast majority of NY Medicaid beneficiaries receive long-term care through managed care, a provider cannot survive on fee-for-service alone; they must first secure active state enrollment through the eMedNY Provider Services Portal (PSP) and then successfully navigate the often closed-network credentialing processes of regional MLTCs and Managed Care Organizations (MCOs).

1. Service Definition and Scope

In New York, PERS is defined as an electronic device that enables high-risk individuals to secure help in an emergency. The system connects to a 24-hour call center that can dispatch emergency medical services or contact designated family members and caregivers.

The service is designed to maintain the independence of Medicaid beneficiaries who live alone, or who are alone for significant parts of the day, and have medical conditions that put them at risk of falls or other emergencies. It is a standard benefit under MLTC and specific HCBS waivers.

• Target Population: Medicaid beneficiaries living alone or without regular caregiver presence who are at high risk of falls or medical emergencies.
• Core Components: A base communication unit connected to a landline or cellular network, paired with a wearable, waterproof help button (pendant or wristband).
• Service Delivery: A 24/7 monitoring center capable of two-way voice communication, assessing emergencies, and dispatching appropriate responders.
• Maintenance Requirements: Providers must ensure monthly testing of the system, battery replacements, and equipment repair or replacement within 24 hours of a reported malfunction.
• Exclusions: PERS is generally not authorized for individuals receiving 24-hour personal care services or those residing in residential care facilities where staff are present.

2. Regulatory and Oversight Agencies

New York does not issue a standalone "PERS license" through a specific licensing board. Instead, oversight is managed through the state's Medicaid provider enrollment process and subsequent managed care contracting.

Providers must comply with the rules set by the state's health department, the Medicaid fiscal agent, and the state's Medicaid integrity office to maintain their billing privileges.

• NYS Department of Health (DOH): Administers the overall Medicaid program, sets PERS service standards, and oversees HCBS waiver programs.
• eMedNY: The New York State Medicaid fiscal agent that operates the Provider Services Portal (PSP) for enrollment and processes fee-for-service claims.
• Office of the Medicaid Inspector General (OMIG): Enforces Medicaid integrity, conducts audits, and mandates compliance programs under Social Services Law Section 363-d.
• Managed Care Organizations (MCOs) / MLTCs: Regional health plans (e.g., Fidelis Care, Healthfirst) that credential providers, authorize PERS for their members, and process the majority of claims.
• NYS Department of State (DOS): Registers the corporate entity, allowing it to legally operate and conduct business within New York State.

3. Gatekeeping Prerequisites: Who Can Even Apply

Before a PERS provider can successfully operate in New York, they must clear several structural preconditions. The most critical is the sequencing of enrollment: state fee-for-service enrollment must be completed before managed care contracting can begin.

Because the state has carved most long-term care into managed care, providers face a significant barrier if regional MCOs have closed their networks to new PERS vendors.

• 21st Century Cures Act Mandate: Providers must be fully enrolled in NYS Medicaid via the eMedNY PSP before any MCO or MLTC will finalize a network contract.
• MCO Network Access: While the state does not impose a moratorium on PERS enrollment, individual MLTCs and MCOs frequently operate closed networks, meaning state-enrolled providers must wait for specific procurement windows to secure contracts.
• Corporate Registration: The applicant must be registered and in good standing with the NYS Department of State; out-of-state call centers must register as foreign entities authorized to do business in NY.
• OMIG Compliance Attestation: Providers must attest to having an active compliance program meeting 18 NYCRR Subpart 521-1 standards, which is mandatory for entities billing over $1 million annually but required by attestation for all.
• Federal Identifiers: The entity must possess an active Employer Identification Number (EIN) and a National Provider Identifier (NPI) registered to the business.

4. Licensure and Certification Requirements

Because New York DOH does not issue a distinct facility or agency license for PERS, approval is achieved strictly through Medicaid provider enrollment and meeting equipment standards.

Providers must demonstrate that their hardware and monitoring centers meet industry-standard safety and operational certifications.

• State Licensure: No distinct NYS DOH license is required for PERS equipment providers; authorization is granted via eMedNY enrollment.
• Call Center Certification: Monitoring centers typically must hold Underwriters Laboratories (UL) certification for health care signaling equipment or an equivalent industry standard.
• Business Authorization: A Certificate of Incorporation or Articles of Organization must be filed and active with the NYS DOS.
• Local Permits: The provider must hold any required local municipal alarm, business, or zoning permits for their physical operating location.
• Out-of-State Providers: Out-of-state monitoring centers may enroll if they serve NY Medicaid members, provided they meet all NYS DOS foreign entity registration requirements.

5. Medicaid Provider Enrollment

Enrollment is processed entirely online through the eMedNY Provider Services Portal (PSP). Paper applications are no longer accepted for initial enrollment.

Providers must submit specific state forms to link their banking information and authorize electronic claim submissions.

• Enrollment Portal: All applications and supporting documents must be uploaded and submitted electronically via the eMedNY PSP.
• Application Fee: Providers must pay the federal Medicaid application fee (currently $732 for 2024) or provide proof of payment to Medicare or another state's Medicaid program.
• ETIN Certification: Providers must submit the Certification Statement for Provider Billing Medicaid (Form EMEDNY-490601) to obtain and link an Electronic Transmitter Identification Number (ETIN).
• EFT Authorization: A mandatory Electronic Funds Transfer (EFT) form must be completed and uploaded in PSP to receive payments.
• Category of Service: Applicants must select the appropriate PERS provider type and Category of Service (COS) code during the PSP enrollment process.
• Revalidation: Enrolled providers must revalidate their Medicaid enrollment through PSP every five years based on their enrollment anniversary.

6. Staffing, Training and Background Checks

While PERS is primarily an equipment and technology service, the staff interacting with beneficiaries and handling emergency calls must meet strict state and federal screening requirements.

Call center dispatchers and field installation technicians must be trained to handle the specific needs of elderly and disabled populations.

• Exclusion Screening: All owners, managing employees, and staff must be screened monthly against the NYS OMIG Exclusion List and the federal LEIE.
• Call Center Staff: Dispatchers must be trained in emergency response protocols, triage, and communicating with individuals who may have cognitive or hearing impairments.
• Installation Technicians: Field staff must be trained on equipment setup, signal testing, and instructing beneficiaries on proper device usage.
• Background Checks: Field staff entering beneficiary homes typically require criminal history record checks in accordance with MCO contract requirements.
• Language Access: Call centers must have protocols and resources (such as third-party translation services) to assist non-English speaking beneficiaries 24/7.

7. Documentation, Policies and Records

PERS providers must maintain meticulous records of equipment deployment, monthly testing, and emergency incidents. These records are the primary focus of OMIG audits.

Failure to produce signed service agreements or testing logs can result in significant Medicaid recoupments.

• Service Agreements: Providers must maintain signed agreements with the beneficiary or authorized representative acknowledging receipt of the equipment and training.
• Testing Logs: Providers must document monthly system tests, noting the date, time, and result, as well as any equipment malfunctions or replacements.
• Incident Reports: The call center must log all emergency button presses, recording the response time, the action taken, and the outcome (e.g., EMS dispatched, false alarm).
• OMIG Compliance Plan: Providers must maintain written policies, procedures, and a designated compliance officer meeting the requirements of Social Services Law Section 363-d.
• Record Retention: All Medicaid billing, service, and testing records must be retained for a minimum of six years from the date of payment.

8. Billing, Rates and Claims

PERS is billed using specific HCPCS codes for the initial installation and the ongoing monthly monitoring. Because most beneficiaries are in managed care, billing is primarily routed through MCO clearinghouses rather than eMedNY.

Prior authorization is strictly required before any equipment is installed or billed.

• HCPCS Codes: Services are typically billed using S5160 (Emergency response system; installation and testing) and S5161 (Emergency response system; service fee, per month).
• Fee-for-Service Rates: NYS DOH sets baseline FFS rates, but reimbursement rates for managed care members are negotiated individually with each MCO.
• Prior Authorization: MLTCs and waiver programs require prior authorization, and PERS must be explicitly included in the member's Person-Centered Service Plan.
• FFS Claim Submission: Fee-for-service claims are submitted to eMedNY via 837I/837P electronic transactions or the ePACES web portal.
• MCO Billing: Claims for managed care members must be submitted directly to the respective MCO's clearinghouse according to their specific timely filing limits.

9. Approval Sequence and Timeline

Becoming a fully operational PERS provider in New York requires sequential approvals. Providers cannot begin MCO credentialing until their eMedNY enrollment is fully approved.

The entire process from corporate formation to billing the first managed care claim typically takes over half a year.

• Corporate Setup: 2 to 4 weeks to register with NYS DOS, obtain an EIN, and secure an NPI.
• eMedNY PSP Enrollment: 60 to 90 days for the state to process and approve the Medicaid enrollment application.
• ETIN Processing: 30 to 60 days to process the ETIN certification (Form EMEDNY-490601) and EFT authorization, which runs concurrently with enrollment.
• MCO Credentialing: 90 to 120 days per health plan to complete network credentialing and contracting after eMedNY enrollment is active.
• Total Timeline: 6 to 8 months from initial corporate setup to being fully authorized to bill MCOs for PERS services.

10. Common Denials and Survey Findings

Initial applications are frequently rejected for administrative errors within the Provider Services Portal. Post-enrollment, providers face financial penalties during OMIG audits for documentation lapses.

Strict adherence to signature rules and monthly testing protocols is essential to avoid claim denials and recoupments.

• PSP Signature Rejections: Applications submitted by office staff or billing agents instead of the authorized owner or managing employee trigger automatic signature rejections.
• Missing ETIN: Submitting claims before the ETIN (Form EMEDNY-490601) is fully linked results in automatic claim denials.
• Unreported Ownership: Failure to disclose all individuals or entities with 5% or more ownership or managing control causes enrollment denial.
• Testing Failures: OMIG audits frequently penalize providers and recoup funds for missing documentation of mandatory monthly equipment tests.
• Exclusion Check Lapses: Fines are levied for failing to conduct and document monthly OMIG and LEIE exclusion checks on all staff and owners.

11. Key Contacts and Resources

Providers must utilize state portals and official manuals for accurate enrollment instructions and compliance guidance.

Maintaining access to these resources is critical for staying updated on Medicaid Redesign Team (MRT) changes and OMIG requirements.

• eMedNY Provider Enrollment: Visit emedny.org or call 1-800-343-9000 for PSP support and to access the PERS Provider Manual.
• NYS DOH Medicaid: Visit health.ny.gov for policy updates, MLTC guidelines, and HCBS waiver information.
• NYS OMIG: Visit omig.ny.gov for compliance program self-assessments, mandatory certifications, and the Medicaid Exclusion List.
• NYS Department of State: Visit dos.ny.gov for corporate registration, entity searches, and foreign entity authorization.
• ePACES: The electronic portal accessed via emedny.org used for verifying FFS eligibility and submitting FFS claims.

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