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

Last reviewed: 2026-09-10

The Utah Department of Health and Human Services (DHHS) Division of Integrated Healthcare covers Personal Emergency Response Systems (PERS) through multiple Home and Community-Based Services (HCBS) programs, including the Aging Waiver, the Community Supports Waiver, and the New Choices Waiver. The service provides installed or wearable monitoring equipment with 24-hour response capabilities for Medicaid members who live alone or are at risk of falls, ensuring they can immediately contact a designated responder or call center in an emergency.

Approval to bill for this service requires the applicant to first enroll as a Medicaid provider through the Provider Reimbursement Information System for Medicaid (PRISM) and subsequently secure a contract or authorization from the specific waiver operating agency, such as the Division of Services for People with Disabilities (DSPD) or a local Area Agency on Aging (AAA). Utah does not issue a distinct facility or agency license specifically for PERS vendors; instead, providers must maintain a standard commercial business license and meet the operational standards defined in the Utah Medicaid Provider Manual for HCBS Waivers.

1. Service Definition and Scope

In Utah, the Personal Emergency Response System (PERS) is defined as an electronic device that enables a waiver participant to secure help in an emergency. The system is connected to the participant's phone line or operates via cellular signal and is programmed to signal a response center once a portable "help" button is pressed.

The service scope includes the initial installation of the equipment, monthly rental and monitoring, and ongoing maintenance. PERS is limited to individuals who live alone, or who are alone for significant parts of the day, and have no regular caregiver for extended periods, making them vulnerable to institutionalization without this continuous monitoring.

• Service Components: Initial installation, monthly monitoring, and equipment maintenance.
• Target Population: Waiver participants who live alone or are alone for significant portions of the day.
• Operational Requirement: Must provide 24-hour, 7-day-a-week monitoring and response.
• Equipment Types: Landline-connected base units, cellular base units, and wearable pendants or wristbands.
• Exclusions: Cannot be authorized for individuals receiving 24-hour residential habilitation or living in provider-owned settings.
• Maintenance Standard: Providers must replace malfunctioning devices within 24 hours of notification.

2. Regulatory and Oversight Agencies

The Utah Department of Health and Human Services (DHHS) oversees all Medicaid operations through its Division of Integrated Healthcare (DIH). DIH manages the state's Medicaid plan, operates the PRISM enrollment system, and holds the ultimate administrative authority over all HCBS waivers.

Day-to-day operational authority for specific waivers is delegated to other divisions. The Division of Services for People with Disabilities (DSPD) operates the Community Supports Waiver, while the Division of Aging and Adult Services (DAAS) oversees the Aging Waiver in conjunction with local Area Agencies on Aging (AAAs).

• Medicaid Authority: Utah DHHS Division of Integrated Healthcare (https://medicaid.utah.gov/)
• Waiver Operations (Disabilities): Division of Services for People with Disabilities (https://dspd.utah.gov/)
• Waiver Operations (Aging): Division of Aging and Adult Services (https://daas.utah.gov/)
• Enrollment Portal: PRISM (Provider Reimbursement Information System for Medicaid) (https://medicaid.utah.gov/prism/)
• Background Checks: Direct Access Clearance System (DACS) (https://dhhs.utah.gov/providers/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Utah does not require a Certificate of Need or a distinct state-issued health facility license to operate as a PERS vendor. However, providers cannot simply enroll in Medicaid and begin billing; they must be selected and authorized by the specific waiver operating agency managing the participant's care.

For the Aging Waiver, providers must establish contracts or agreements with the local Area Agencies on Aging (AAAs) that administer the waiver regionally. For DSPD waivers, providers must respond to open enrollment periods or Requests for Qualifications (RFQs) issued by DSPD to be added to the approved provider network.

• Business Licensure: Must hold a valid Utah local business license or registration with the Utah Department of Commerce.
• Medicaid Enrollment: Must successfully enroll as an atypical or typical provider in the PRISM system.
• DSPD Contracting: Must complete the DSPD Request for Qualifications (RFQ) process to serve Community Supports Waiver participants.
• AAA Contracting: Must secure agreements with regional Area Agencies on Aging to serve Aging Waiver participants.
• Out-of-State Providers: Permitted if they meet all Utah Medicaid enrollment criteria and can guarantee the required 24/7 response and 24-hour equipment replacement standards.

4. Licensure and Certification Requirements

Because PERS is an equipment and monitoring service rather than direct hands-on medical care, the Utah DHHS Health Facility Licensing and Certification unit does not issue a specific license for PERS agencies. Providers operate under standard commercial business regulations.

Certification to provide the service is achieved through the Medicaid enrollment process and the subsequent execution of a Provider Agreement with the Division of Integrated Healthcare and the respective waiver operating division. Providers must attest to meeting the service standards outlined in the Utah Medicaid Provider Manual for HCBS Waivers.

• State License: No specific DHHS health facility license is required for PERS.
• Commercial Registration: Must be registered and in good standing with the Utah Division of Corporations and Commercial Code.
• Waiver Certification: Achieved by signing the Medicaid Provider Agreement and specific waiver addenda.
• Operational Standard: Must maintain a UL-listed or equivalent certified monitoring center.
• Testing Protocol: Must conduct and document monthly testing of the PERS devices with participants.

5. Medicaid Provider Enrollment

All prospective PERS providers must apply through the Provider Reimbursement Information System for Medicaid (PRISM). The application requires the submission of business details, ownership disclosures, and a signed Medicaid Provider Agreement.

Providers typically enroll using a National Provider Identifier (NPI) if they are a medical equipment supplier, or as an atypical provider if they solely provide waiver-based monitoring services. The PRISM system requires the upload of W-9 forms, business licenses, and banking information for Electronic Funds Transfer (EFT).

• Enrollment Portal: PRISM online application system.
• Provider Type: Typically enrolled under Provider Type 65 (Medical Equipment/Supplies) or a specific HCBS Waiver vendor type.
• Required Form: W-9 Request for Taxpayer Identification Number and Certification.
• Required Form: Ownership and Control Disclosure Form (integrated into PRISM).
• Payment Setup: Electronic Funds Transfer (EFT) authorization is mandatory.
• Application Fee: Subject to the federal Medicaid institutional provider application fee unless enrolled in Medicare or another state's Medicaid program.

6. Staffing, Training and Background Checks

While PERS is primarily an equipment-based service, any staff member who enters a waiver participant's home for installation or maintenance must pass a background check. Utah utilizes the Direct Access Clearance System (DACS) for this purpose.

Response center staff must be trained in emergency protocols, including how to triage signals, contact local emergency services (911), and notify the participant's designated emergency contacts. The provider must maintain documentation of this training.

• Background Checks: Required via DACS for any employee conducting in-home installations or maintenance.
• Response Center Staff: Must be trained in emergency dispatch and triage protocols.
• Participant Instruction: Installers must be trained to instruct the participant and their family on how to use and test the device.
• Contact Updates: Staff must update the participant's list of responders and contact names at least twice a year.
• Language Capacity: The response center must have access to translation services for non-English speaking participants.

7. Documentation, Policies and Records

PERS providers must maintain comprehensive records to support all claims billed to Utah Medicaid. This includes documentation of the initial installation, signed receipts from the participant, and logs of all monthly tests and emergency signals.

Providers must also maintain written policies regarding equipment maintenance, response center protocols, and participant confidentiality (HIPAA compliance). Records must be retained for a minimum of five years from the date of service.

• Installation Record: Must obtain the participant's or authorized representative's signature verifying receipt and instruction of the PERS unit.
• Testing Logs: Must maintain records of the required monthly system performance checks.
• Incident Logs: Must document every emergency signal received, the action taken, and the outcome.
• Maintenance Records: Must log any equipment malfunctions and document that replacement occurred within 24 hours.
• Record Retention: All service and billing records must be kept for at least five years.
• Care Plan Alignment: Services must be explicitly documented and authorized in the participant's Person-Centered Support Plan.

8. Billing, Rates and Claims

Billing for PERS in Utah is conducted through the PRISM system using standard Healthcare Common Procedure Coding System (HCPCS) codes. Services must be prior-authorized by the participant's waiver case manager or support coordinator before billing can occur.

Reimbursement is typically divided into a one-time installation fee and a recurring monthly rental/monitoring fee. Providers cannot charge Medicaid more than their usual and customary rate charged to the general public.

• Billing System: Claims are submitted electronically via the PRISM portal.
• Installation Code: S5160 (Emergency response system; installation and testing).
• Monthly Code: S5161 (Emergency response system; service fee, per month).
• Prior Authorization: Mandatory; claims will deny if the service is not authorized in the PRISM system by the case manager.
• Rate Limitation: Providers cannot charge Medicaid more than their standard public rate.
• Payment Cycle: Utah Medicaid typically processes clean claims and issues EFT payments weekly.

9. Approval Sequence and Timeline

The approval process begins with securing a standard business license and, if applicable, an NPI. The provider then submits a complete enrollment application through the PRISM portal, which includes the Medicaid Provider Agreement and ownership disclosures.

Once PRISM enrollment is approved (which can take 30 to 60 days), the provider must contact the specific waiver operating agencies (such as DSPD or local AAAs) to execute contracts or be added to the approved vendor lists. Only after these contracts are in place can case managers authorize services for individual participants.

• Step 1: Obtain local business license and NPI (if applicable).
• Step 2: Submit Medicaid enrollment application via PRISM.
• Step 3: Pay the application fee or submit proof of exemption.
• Step 4: Await PRISM approval (typically 30-60 days).
• Step 5: Apply for contracting/credentialing with DSPD or regional AAAs.
• Step 6: Receive prior authorizations from case managers and commence service.

10. Common Denials and Survey Findings

Medicaid enrollment applications for PERS providers are most frequently denied due to incomplete ownership disclosures or failure to pay the required application fee. In PRISM, missing W-9 forms or mismatched tax identification data will cause immediate suspension of the application.

During post-payment reviews or audits, providers often face recoupment if they cannot produce the signed installation receipt or the logs demonstrating that monthly testing was conducted. Billing for months where the participant was hospitalized or in a nursing facility for the entire month is also a common audit finding.

• Enrollment Denial: Incomplete Ownership and Control Disclosure forms in PRISM.
• Enrollment Denial: Failure to submit the required application fee or Medicare exemption proof.
• Audit Finding: Missing participant signatures verifying initial installation and training.
• Audit Finding: Lack of documentation proving monthly system tests were completed.
• Claim Denial: Billing without a valid prior authorization on file from the waiver case manager.
• Recoupment: Billing the monthly fee when the participant was institutionalized for the entire calendar month.

11. Key Contacts and Resources

Prospective providers should utilize the Utah Medicaid website and the PRISM portal for all enrollment activities. The Division of Integrated Healthcare provides provider relations support for billing and enrollment questions.

For waiver-specific contracting questions, providers must contact the Division of Services for People with Disabilities (DSPD) or the Division of Aging and Adult Services (DAAS) directly.

• Utah Medicaid Provider Enrollment: https://medicaid.utah.gov/provider-enrollment/
• PRISM Portal: https://medicaid.utah.gov/prism/
• Medicaid Provider Relations: (801) 538-6155 or (800) 662-9651
• Division of Services for People with Disabilities (DSPD): https://dspd.utah.gov/
• Division of Aging and Adult Services (DAAS): https://daas.utah.gov/
• Utah Medicaid Provider Manuals: https://medicaid.utah.gov/utah-medicaid-official-publications/

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