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

Last reviewed: 2026-08-16

In Ohio, a Personal Emergency Response System (PERS) is defined under Ohio Administrative Code (OAC) 5160-44-16 as a service providing a direct telephonic or electronic communications link between a waiver participant and a 24-hour response center. This service includes the installation, testing, and monthly monitoring of wearable or installed equipment designed to secure immediate assistance for individuals who live alone or are at high risk of falls.

The single biggest structural barrier to entry for a new PERS provider in Ohio is securing dual approval through both the Ohio Department of Aging (ODA) for certification and the Ohio Department of Medicaid (ODM) for financial enrollment, followed immediately by the mandatory requirement to credential and contract with regional MyCare Ohio managed care plans. Without active contracts with these managed care organizations, a fully licensed and enrolled provider will receive virtually no referrals in most regions of the state.

1. Service Definition and Scope

Under Ohio Administrative Code (OAC) 5160-44-16, PERS is an authorized Home and Community-Based Services (HCBS) waiver service. It provides a continuous electronic communications link to a response center for individuals enrolled in waivers such as PASSPORT, the Ohio Home Care Waiver, or MyCare Ohio.

The scope of the service mandates that providers not only supply the equipment but also manage the installation, ongoing maintenance, monthly testing, and the execution of a personalized written response plan for every participant.

2. Regulatory and Oversight Agencies

PERS providers in Ohio are jointly overseen by the Ohio Department of Medicaid (ODM) and the Ohio Department of Aging (ODA). ODM handles the overarching Medicaid enrollment and the Ohio Home Care Waiver, while ODA specifically certifies providers for the PASSPORT waiver.

Additionally, ODM contracts with a third-party vendor to process HCBS applications, and delegates day-to-day care management for dual-eligible individuals to regional managed care plans.

3. Gatekeeping Prerequisites: Who Can Even Apply

Ohio does not require a Certificate of Need (CON), Facility Need Review, or a competitive Request for Proposals (RFP) to become a PERS provider. The state operates an open enrollment network for Medicaid fee-for-service.

However, strict structural prerequisites exist before an application can be successfully processed, primarily revolving around equipment certification and managed care network access.

4. Licensure and Certification Requirements

Ohio does not issue a distinct "PERS License" through the Department of Health. Instead, providers must obtain ODA Certification to serve older adults and ODM approval to serve the broader waiver population.

This certification process requires attesting to specific administrative rules and defining the exact geographic footprint the provider intends to serve.

5. Medicaid Provider Enrollment

All enrollment is conducted electronically through the Provider Network Management (PNM) system. Ohio does not accept paper applications for Medicaid enrollment.

The application routes through Public Consulting Group (PCG) for HCBS compliance verification before final approval by ODM.

6. Staffing, Training and Background Checks

While PERS does not require in-home nursing or direct personal care staff, the personnel installing the equipment and operating the 24-hour response center must meet strict background and training standards.

Ohio mandates specific routing for criminal background checks to ensure state oversight of all waiver service personnel.

7. Documentation, Policies and Records

Providers must maintain comprehensive records for each waiver participant, subject to audit by ODM, ODA, PCG, or managed care designees.

Failure to maintain these records, particularly the testing logs and response plans, is a primary cause for recoupment of funds.

8. Billing, Rates and Claims

PERS is reimbursed on a fee-for-service basis for traditional waiver participants or via contracted rates with MyCare Ohio plans. Claims are processed through the Ohio Medicaid Enterprise System (OMES).

Because PERS is an equipment and monitoring service rather than an in-home personal care service, it is generally exempt from Electronic Visit Verification (EVV) requirements.

9. Approval Sequence and Timeline

The end-to-end process from application to active billing status typically takes 3 to 6 months. This timeline is heavily dependent on the completeness of the initial application and the speed of managed care credentialing.

Providers cannot bill for services provided prior to their official Medicaid effective date and the authorization date on the participant's care plan.

10. Common Denials and Survey Findings

Applications and ongoing certifications are frequently delayed or denied due to administrative errors or failure to maintain required documentation.

State surveyors and PCG reviewers strictly enforce the monthly testing and background check routing rules.

11. Key Contacts and Resources

Prospective providers should utilize the following official state resources for application submission, regulatory guidance, and technical support.

Always ensure you are accessing the official .gov or state-contracted vendor portals when submitting sensitive business information.

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