Chapter 173-40 State-Funded PASSPORT Program

173-40-01 [Effective Until 12/29/2011] Introduction and definitions.

(A) Introduction: This chapter establishes the eligibility criteria and disenrollment procedures for individuals presently enrolled in the nonwaiver-funded PASSPORT program (aka, the “state-funded PASSPORT program” or the “PASSPORT grandparented eligibility home care program”), to establish criteria for assistance to individuals who have reached loss-of-medicaid-eligibility status, and to establish the criteria for receivership of a PAA.

(B) Definitions for this chapter:

(1) “CDJFS” means “county department of job and family services.”

(2) “Grandparented consumer” means an individual who is enrolled in the nonwaiver-funded PASSPORT program currently known as the “PASSPORT grandparented home care program” and formerly known as the “PASSPORT state home care program” who was transferred to PASSPORT grandparented home care, pursuant to rule 173-40-03 of the Administrative Code, as a result of a denial of his/her eligibility for either the PASSPORT HCBS program or the Ohio home care waiver program.

(3) “Loss-of-medicaid-eligibility status” means the status given to an applicant who is denied enrollment into the PASSPORT HCBS program or an individual who is disenrolled from the PASSPORT HCBS program because he/she no longer meets the medicaid financial eligibility requirements for the PASSPORT HCBS program.

(4) “ODA” means “the Ohio department of aging.”

(5) “ODJFS” means “the Ohio department of job and family services.”

(6) “Ohio home care waiver” means the particular medicaid home and community-based services medicaid waiver program which is separate from the PASSPORT home care program, and which provides home and community based services to individuals under the age of sixty who have disabilities and who would require the level of care provided by a nursing facility if the waiver program were not available. Eligibility criteria, enrollment procedures, services to be provided, and service provider qualifications are described in Chapter 5101:3-12 of the Administrative Code.

(7) “PASSPORT administrative agency” (“PAA”) means a public or non-profit entity that has entered into a contract with ODA to provide administrative services on behalf of ODA within a particular PSA for medicaid waiver programs under the authority of ODA, the nonwaiver-funded PASSPORT program, and the RSS program.

(8) “PASSPORT home and community-based services program” (“PASSPORT HCBS”) means the particular medicaid HCBS waiver program which provides home and community-based services as part of the PASSPORT home care program to individuals aged sixty and over who, due to having disabilities and being elderly, would require the level of care provided in a nursing facility if the waiver program were not available. Eligibility criteria and services available for the PASSPORT HCBS program are described in Chapter 5101:3-31 of the Administrative Code. Enrollment procedures for the PASSPORT HCBS program are described in rule 173-42-01 of the Administrative Code. Provider certification and service specification rules for the PASSPORT HCBS program are found in Chapter 173-39 of the Administrative Code.

(9) “Plan of care” means written documentation of the specific tasks and activities to be carried out by a service provider, including, but not limited to consumer-specific goals and objectives, detailed description of the interventions, frequency, and time frames for ongoing services.

(10) “Representative” means an adult eighteen years of age or older who is familiar enough with a consumer’s circumstances to act on behalf of the enrollee, including signing the plan of care or assisting with a medicaid application. The representative may be, but shall not be limited to, a parent of a minor child, a spouse, a relative, a personal friend, or a representative from a public or private agency who has been authorized by the consumer or his/her legal guardian to act as his/her representative.

Effective: 05/07/2009 R.C. 119.032 review dates: 02/18/2009 and 05/06/2013 Promulgated Under: 119.03 Statutory Authority: 173.02, uncodified section 213.20 of Am. Sub. H. B. No. 119 (127th G. A.) Rule Amplifies: Uncodified section 213.20 of Am. Sub. H. B. No. 119 (127th G. A.) Prior Effective Dates: 6/11/1991 (Emer.), 9/13/1991, 11/9/1998, 4/17/2003, 1/1/2008

173-40-01 [Effective 12/29/2011] Introduction and definitions

(A) Introduction: Chapter 173-40 of the Administrative Code regulates the state-funded component of the PASSPORT program, , and establishes the criteria for receivership of ODA’s designee. (See Chapter 173-42 of the Administrative Code for rules on the medicaid-funded component of the PASSPORT program.)

(B) Definitions for Chapter 173-40 of the Administrative Code:

(1) “Authorized representative” means a person, eighteen years of age or older, who is chosen by, and acts on behalf of, an individual who is applying for, or receiving, medical assistance. In accordance with rule 5101:1-38-01.2 of the Administrative Code, the individual must provide a written statement naming the authorized representative and the duties that the named authorized representative may perform on the individual’s behalf.

(2) “CDJFS” means “county department of job and family services.”

(3) “Form JFS02399” means “form JFS02399 ‘Request for Medicaid Home and Community-Based Services (HCBS).’”

(4) “Form JFS07200” means “form JFS07200 ‘Request for Cash, Food and Medical Assistance.’”

(5) “Form ODA1115” means “form ODA1115 ‘Financial Assessment Worksheet.’” The form is readily available on http://www.aging.ohio.gov/information/rules/forms.aspx.

(6) “Form ODA1116” means “form ODA1116 ‘Enrollment Agreement.’” The form is readily available on http://www.aging.ohio.gov/information/rules/forms.aspx.

(7) “Nursing facility” has the same meaning as in section 5111.20 of the Revised Code.

(8) “ODA” means “the Ohio department of aging.”

(9) “ODA’s designee” has the same meaning as “PASSPORT administrative agency” in section 173.42 of the Revised Code. The current PASSPORT administrative agencies are the area agencies on aging listed in rule 173-2-04 of the Administrative Code plus”Catholic Social Services of the Miami Valley.”

(10) “ODJFS” means “the Ohio department of job and family services.”

(11) “Service plan” means written documentation of the specific tasks and activities to be carried out by a service provider, including, but not limited to, consumer-specific goals and objectives, detailed description of the interventions, frequency, and time frames for ongoing services.

Effective: 12/29/2011 R.C. 119.032 review dates: 07/13/2011 and 12/29/2016 Promulgated Under: 111.15 Statutory Authority: 173.01, 173.02, 173.40 Rule Amplifies: 173.40 Prior Effective Dates: 06/11/1991 (Emer.), 09/13/1991, 11/09/1998, 04/17/2003, 01/01/2008, 05/07/2009

173-40-02 [Effective Until 12/29/2011] Eligibility for PASSPORT grandparented home care program.

Only an individual who meets all the following criteria is eligible for the PASSPORT grandparented home care program:

(A) The individual is enrolled in the nonwaiver-funded PASSPORT home care program formerly known as the “PASSPORT state home care program” at the time the program was renamed the “PASSPORT grandparented home care program;”

(B) Prior to initial enrollment in the PASSPORT grandparented home care program, and at least once every twelve months of enrollment thereafter, the individual has applied for and was denied eligibility for either the PASSPORT HCBS program or the Ohio home care waiver described in Chapter 5101:3-12 of the Administrative Code, and also one of the following:

(1) If the individual is at least sixty years of age, the individual has fully complied with the application and enrollment procedures for the PASSPORT HCBS program and was determined to be ineligible for the PASSPORT HCBS program. The PAA shall disenroll any such individual from the PASSPORT grandparented home care program who is found to be eligible for enrollment in the PASSPORT HCBS program. An individual’s failure or refusal to cooperate in providing either the PAA or a CDJFS with the information and documentation necessary to establish the individual’s eligibility for the PASSPORT HCBS program constitutes a failure to meet this eligibility criterion; or,

(2) If the individual is no older than fifty-nine years of age, the individual has fully complied with the application and enrollment procedures for Ohio home care waiver services and was determined to be ineligible for the Ohio home care waiver program. The PAA shall disenroll any individual from the PASSPORT grandparented home care program who is found to be eligible for the Ohio home care waiver program. An individual’s failure or refusal to cooperate in providing ODJFS or a CDJFS with the information and the documentation necessary to establish the individual’s eligibility for the Ohio home care waiver constitutes a failure to meet this eligibility criterion.

(C) The PAA and a physician have determined that the individual needs an intermediate level of care, as defined in rule 5101:3-3-06 of the Administrative Code, or a skilled level of care, as defined in rule 5101:3-3-05 of the Administrative Code;

(D) The individual is financially eligible for the PASSPORT grandparented home care program based upon a documented inability of the individual to pay for nursing facility care without assistance from the medicaid program. The PAA shall only consider the individual’s income and assets when determining the individual’s financial eligibility for the PASSPORT grandparented home care program. Countable income and assets are determined pursuant to Chapter 5101:1-39 of the Administrative Code and the medicaid eligibility manual. The PAA shall calculate the inability to pay for nursing facility care in accordance with one of the following:

(1) If the most recent period of continuous enrolment in the PASSPORT grandparented home care program for the individual began prior to April 1, 1988, the individual shall document that the individual lacks eleven thousand, seven hundred, and nine dollars in income and assets available within a ninety-day period to pay for nursing facility care without assistance from the medicaid program; or,

(2) If the most recent period of continuous enrollment in the PASSPORT grandparented home care program for the individual began on or after April 1, 1988, the individual shall document that the individual lacks five thousand, eight hundred, fifty-four dollars, and fifty cents in income and assets available within a forty-five day period to pay for nursing facility care without assistance from the medicaid program.

(E) The individual has an approved plan of care developed by the PAA that serves the county of the individual’s residence, that is signed by the individual’s physician, and that is approved by the PAA;

(F) The individual’s approved plan of care indicates that the total projected cost of services counted in the care plan cost cap calculation is less than six thousand dollars for a six-month period;

(G) The individual agrees to receive PASSPORT-funded services only from approved PASSPORT providers, and agrees to cooperate with the PAA in establishing and re-establishing eligibility for the PASSPORT HCBS program, the Ohio home care program; and/or the PASSPORT grandparented home care program, when requested by the PAA; and,

(H) The participation of the individual in the PASSPORT grandparented home care program, as an alternative to nursing facility placement, does not present, in the professional judgment of the PAA, a threat to the health and safety of the individual.

Replaces: 173-40-03

Effective: 01/01/2008 R.C. 119.032 review dates: 10/15/2011 Promulgated Under: 111.15 Statutory Authority: 173.02, uncodified section 213.20 of Am. Sub. H. B. No. 119 (127th G. A.) Rule Amplifies: Uncodified section 213.20 of Am. Sub. H. B. No. 119 (127th G. A.) Prior Effective Dates: Eff. 6/11/91 (Emer.). 9/13/91, 11/9/98, 4/17/03

173-40-02 [Effective 12/29/2011] Eligibility criteria for the state-funded PASSPORT program

(A) Presumptive: Only an individual who meets all the following criteria is eligible for the state-funded component of the PASSPORT program on the basis of presumptive eligibility:

(1) The individual has participated in a long-term care consultation under section 173-42 of the Revised Code and Chapter 173.43 of the Administrative Code;

(2) The individual completes and submits forms JFS07200 and JFS02399 to the CDJFS;

(3) ODA’s designee and the individual complete form ODA1116, which indicates that the individual chooses to enroll in the state-funded component of the PASSPORT program, names the individual’s representative (if any), and indicates the individual’s authorization to release information;

(4) ODA’s designee has determined that the individual meets the non-financial eligibility criteria for the medicaid-funded component of the PASSPORT program under rule 5101:3-31-03 of the Administrative Code;

(5) ODA’s designee completes form ODA1115 and the form indicates that the individual meets the financial eligibility criteria for the medicaid-funded component of the PASSPORT program under rules 5101:1-38-01.6 and 5101:1-38-01.8 of the Administrative Code; and,

(6) After ODA’s designee assesses the individual according to rule 5101:1-39-24 of the Administrative Code, the individual pays any patient liability amount that ODA’s designee determines the individual shall pay to the entity to which ODA’s designee instructs the individual to pay.

(B) Loss of medicaid financial eligibility: Only an individual who meets all the following criteria is eligible for the state-funded component of the PASSPORT program on the basis of losing medicaid financial eligibility:

(1) The individual has had his or her enrollment in the medicaid-funded component of the PASSPORT program terminated due to the loss of medicaid financial eligibility, as determined by the CDJFS;

(2) ODA’s designee has determined that the individual still needs the home and community-based services he or she received under the medicaid-funded component of the PASSPORT program because it is temporarily necessary to protect the individual’s health and safety until the individual transfers to other community-based long-term care services or to a nursing facility; and,

(3) After ODA’s designee assesses the individual according to rule 5101:1-39-24 of the Administrative Code, the individual pays any patient liability amount that ODA’s designee determines the individual shall pay to the entity to which ODA’s designee instructs the individual to pay.

(C) Grandparented: Only an individual who meets all the following criteria is eligible for the state-funded component of the PASSPORT program on the basis of a grandparented status:

(1) The individual has been enrolled in the state-funded component of the PASSPORT program on September 1, 1991. (For the individual enrolled in the state-funded component of the PASSPORT program on this basis, the program was formerly known as the “PASSPORT state home care program” and the “PASSPORT grandparented home care program;”)

(2) Before the individual’s initial enrollment in the state-funded component of the PASSPORT program, and at least once every twelve months of enrollment thereafter, the individual has applied for and was denied eligibility for either the medicaid-funded component of the PASSPORT program or the Ohio home care waiver program described in Chapter 5101:3-12 of the Administrative Code, and also one of the following:

(a) If the individual is at least sixty years of age, the individual has fully complied with the application and enrollment procedures for the medicaid-funded component of the PASSPORT program and was determined to be ineligible for the medicaid-funded component of the PASSPORT program. ODA’s designee shall disenroll any such individual from the state-funded component of the PASSPORT program who is found to be eligible for enrollment in the medicaid-funded component of the PASSPORT program. An individual’s failure or refusal to cooperate in providing either ODA’s designee or a CDJFS with the information and documentation necessary to establish the individual’s eligibility for the medicaid-funded component of the PASSPORT program constitutes a failure to meet this eligibility criterion; or,

(b) If the individual is no older than fifty-nine years of age, the individual has fully complied with the application and enrollment procedures for Ohio home care waiver program and was determined to be ineligible for the Ohio home care waiver program. ODA’s designee shall disenroll any individual from the state-funded component of the PASSPORT program who is found to be eligible for the Ohio home care waiver program. An individual’s failure or refusal to cooperate in providing ODJFS or a CDJFS with the information and the documentation necessary to establish the individual’s eligibility for the Ohio home care waiver program constitutes a failure to meet this eligibility criterion.

(3) ODA’s designee and a physician have determined that the individual needs an intermediate level of care, as defined in rule 5101:3-3-06 of the Administrative Code, or a skilled level of care, as defined in rule 5101:3-3-05 of the Administrative Code;

(4) The individual is financially eligible for the state-funded component of the PASSPORT program based upon a documented inability of the individual to pay for nursing facility care without assistance from the medicaid program. ODA’s designee shall only consider the individual’s income and assets when determining the individual’s financial eligibility for the state-funded component of the PASSPORT program. Countable income and assets are determined pursuant to rules 5101:1-38-01.6 and 5101:1-38-01.8 of the Administrative Code and the medicaid eligibility manual. ODA’s designee shall calculate the inability to pay for nursing facility care in accordance with one of the following:

(a) If the most recent period of continuous enrollment in the state-funded component of the PASSPORT program for the individual began before April 1, 1988, the individual shall document that the individual lacks eleven thousand, seven hundred, and nine dollars in income and assets available within a ninety-day period to pay for nursing facility care without assistance from the medicaid program; or,

(b) If the most recent period of continuous enrollment in the state-funded component of the PASSPORT program for the individual began on or after April 1, 1988, the individual shall document that the individual lacks five thousand, eight hundred, fifty-four dollars, and fifty cents in income and assets available within a forty-five day period to pay for nursing facility care without assistance from the medicaid program.

(5) ODA’s designee that serves the county of the individual’s residence has approved a service plan for the individual that is signed by the individual’s physician;

(6) The individual’s approved service plan indicates that the total projected cost of services counted in the service plan cost cap calculation is less than six thousand dollars for a six-month period;

(7) The individual agrees to receive home and community-based services only from ODA-certified providers, and agrees to cooperate with ODA’s designee in establishing and re-establishing eligibility for the medicaid-funded component of the PASSPORT program, the Ohio home care program, and/or the state-funded component of the PASSPORT program, when requested by ODA’s designee; and,

(8) The participation of the individual in the state-funded component of the PASSPORT program, as an alternative to admission to a nursing facility , does not present, in the professional judgment of ODA’s designee, a threat to the health and safety of the individual.

(D) If, at any time, a consumer enrolled in the state-funded component of the PASSPORT program on the basis of presumptive eligibility no longer meets all the criteria under paragraph (A) of this rule, the consumer is no longer eligible for the state-funded component of the PASSPORT program.

(E) If, at any time, a consumer enrolled in the state-funded component of the PASSPORT program on the basis of losing medicaid financial eligibility no longer meets all the criteria under paragraph (B) of this rule, the consumer is no longer eligible for the state-funded component of the PASSPORT program.

(F) An individual who is eligible for the state-funded component of the PASSPORT program because the individual meets all the criteria under paragraph (A) of this rule may not participate in the state-funded component of the PASSPORT program for more than three months.

(G) An individual who is eligible for the state-funded component of the PASSPORT program because the individual meets all the criteria under paragraph (B) of this rule may not participate in the state-funded component of the PASSPORT program for more than thirty days.

Replaces: 173-40-04

173-40-03 Disenrollment from the state-funded PASSPORT program.

(A) Presumptive: For each consumer who is enrolled in the state-funded component of the PASSPORT program on the basis of paragraph (A) of rule 173-40-02 of the Administrative Code:

(1) Disenrollment: ODA’s designee shall disenroll any consumer who no longer meets all the criteria under paragraph (A) of rule 173-40-02 of the Administrative Code.

(2) Appeals: ODA shall provide notice and an opportunity for a hearing in accordance with Chapter 119. of the Revised Code to any individual whose application for state-funded component of the PASSPORT program whose applications is denied, or whose participation in the state-funded component of the PASSPORT program is terminated before three months of enrollment has elapsed.

(3) Post-disenrollment prohibitions:

(a) After ODA’s designee disenrolls a consumer from the state-funded component of the PASSPORT program, ODA’s designee shall not subsequently re-enroll the consumer back into the state-funded component of the PASSPORT program on the basis of presumptive eligibility.

(b) After ODA’s designee disenrolls a consumer from the state-funded component of the PASSPORT program, ODA’s designee shall not subsequently enroll the consumer into the medicaid-funded component of the PASSPORT program until the CDJFS determines that the consumer meets the medicaid financial eligibility criteria and non-financial eligibility criteria under rule 5101:3-31-03 of the Administrative Code.

(c) After ODA’s designee disenrolls a consumer from the state-funded component of the PASSPORT program, ODA’s designee shall not subsequently enroll the consumer into the state-funded component of the assisted living program.

(B) Loss of medicaid financial eligibility: For each consumer who is enrolled in the state-funded component of the PASSPORT program on the basis of paragraph (B) of rule 173-40-02 of the Administrative Code:

(1) Disenrollment: ODA’s designee shall disenroll any consumer who no longer meets all the criteria under paragraph (B) of rule 173-40-02 of the Administrative Code.

(3) Post-disenrollment prohibitions:

(b) After ODA’s designee disenrolls a consumer from the state-funded component of the PASSPORT program, ODA’s designee shall not subsequently enroll the consumer into the state-funded component of the assisted living program.

(C) Grandparented: For a consumer who is enrolled in the state-funded component of the PASSPORT program on the basis of paragraph (C) of rule 173-40-02 of the Administrative Code:

(1) Reassessment:

(a) Whenever ODA’s designee reassesses the condition and service needs of a consumer , ODA’s designee shall verify if the consumer continues to meet all eligibility criteria under paragraph (C) of rule 173-40-02 of the Administrative Code.

(b) ODA’s designee shall reassess each consumer to assess the consumer’s condition and service needs at least once every twelve months or at any time the consumer’s condition or service needs change substantially.

(c) At least once every six months ODA’s designee shall develop and implement a revised service plan for each consumer so long as the consumer continues to meet all the eligibility criteria under paragraph (C) of rule 173-40-02 of the Administrative Code.

(d) If a consumer does not continue to meet all the eligibility criteria under paragraph (C) of rule 173-40-02 of the Administrative Code, ODA’s designee shall provide the consumer with a written notice of intent to disenroll the consumer from the state-funded component of the PASSPORT program.

(2) Disenrollment :

(a) ODA’s designee may propose that any consumer in the state-funded component of the PASSPORT program be disenrolled based upon any of the following:

(i) The consumer does not continue to meet all the eligibility criteria under paragraph (C) of rule 173-40-02 of the Administrative Code;

(ii) The consumer’s permanent relocation; or,

(iii) The consumer’s death.

(b) When a consumer’s services are suspended for any reason for sixty calendar days, ODA’s designee shall provide the consumer (or the consumer’s authorized representative, if any), with notice of disenrollment from the state-funded component of the PASSPORT program.

(c) Suspensions which ultimately result in disenrollment shall have a disenrollment date that is retroactive to the first day of the suspension of services.

(3) Appeals: Any consumer may appeal a reduction in, suspension of, or disenrollment from the services received as a consumer as follows:

(a) ODA’s designee shall explain any proposed reduction, suspension, or disenrollment action to the consumer (or to the consumer’s authorized representative, if any). ODA’s designee shall provide the explanation in writing and, when feasible, orally as well, at least fifteen calendar days before the effective date of the proposed action. ODA’s designee shall include in the written explanation an outline of the appeals process provided under this rule.

(b) The consumer (or the consumer’s authorized representative , if any) who wishes to appeal a proposed reduction in home and community-based services through the state-funded component of the PASSPORT program, or the suspension of, or disenrollment from, the state-funded component of the PASSPORT program shall provide ODA’s designee with written notice of his intent to appeal no more than fifteen calendar days after the mailing date appearing on the notice of the proposed action.

(c) If a written notice of intent to appeal has been properly received, ODA’s designee shall continue the consumer’s current service plan pending the outcome of the appeal process.

(d) No more than five working days after the date upon which ODA’s designee receives a timely written notice of appeal, ODA’s designee shall schedule an informal fact-finding meeting with the consumer (and/or the consumer’s authorized representative, if any). ODA’s designee shall notify the consumer (and/or the consumer’s authorized representative, if any) of the date, time, and place of the meeting. ODA’s designee shall conduct the fact-finding meeting no more than ten working days after the date on which ODA’s designee received the written notice of the intent to appeal.

(e) ODA’s designee’s PASSPORT site director (or the site director’s designee) shall chair the informal fact-finding meeting and shall attempt to reach agreement between the consumer (and/or the consumer’s authorized representative, if any) and any of ODA’s designee’s staff who are relevant to the consumer’s situation. The PASSPORT site director shall issue a written summary of the meeting to the consumer (and/or the consumer’s authorized representative, if any), in fewer than five working days after the date of the meeting.

(f) If the consumer (or the consumer’s authorized representative, if any) wishes to continue the appeal of the proposed action, the consumer shall notify the director of ODA in writing no more than fifteen working days after the mailing date on the PASSPORT site director’s written summary.

(g) No more than five working days after receiving a notice of intent to continue the appeal process, ODA shall schedule a formal appeal hearing and shall notify ODA’s designee and the consumer (and/or the consumer’s authorized representative, if any) of the date, time, and place of the appeal hearing. ODA shall hold the appeal hearing no more than ten working days after the date that ODA received the request to continue the appeal, unless otherwise agreed to by the parties involved.

(h) Upon notice of appeal to ODA, ODA’s designee shall immediately forward a copy of the written summary of the informal fact-finding meeting and any supporting documentation to ODA.

(i) An independent hearing officer who has been retained by ODA at ODA’s expense shall conduct the ODA appeal hearing. If possible, the hearing officer shall conduct the hearing in the consumer’s home.

(i) Any advocate or legal representative of the consumer’s choosing may accompany the consumer (or the consumer’s authorized representative, if any). Any of ODA’s designee’s relevant staff may represent ODA’s designee.

(ii) The independent hearing officer shall incorporate the following elements when conducting the appeal hearing:

(a) The hearing officer shall record the proceedings and any participant may record the proceedings;

(b) When convening the hearing, the hearing officer shall announce his name, his title, the date, the time, the location of the hearing, the appellant’s name, any of ODA’s designees affected and present at the hearing, and the stated action being appealed;

(c) The hearing officer shall outline the process through which the consumer (or the consumer’s authorized representative, if any), ODA’s designee, and any other relevant participant may introduce verbal and/or written evidence;

(d) The hearing officer may adjourn the appeal hearing at any time the participants become too disruptive to conduct a fair hearing, or at any time after all parties have been heard and the hearing officer determines that sufficient evidence exists to render a fair and appropriate recommendation.

(j) The independent hearing officer shall issue a written recommendation to the director of ODA. The recommendation shall either uphold ODA’s designee’s action being appealed or shall recommend that the action be amended. The director of ODA shall issue a final decision on the matter no more than thirty days after the date upon which the hearing was held and shall inform the complainant and ODA’s designee of the director’s decision by certified mail. The director’s decision shall be binding upon ODA’s designee. Whenever the decision is to resume, increase, or reduce home and community-based services through the state-funded component of the PASSPORT program, ODA’s designee shall implement the decision upon receipt of the director’s decision.

(4) Further appeals: If a consumer (or the consumer’s authorized representative, if any) wishes to contest the decision of the director of ODA, the consumer (or the consumer’s authorized representative, if any) may pursue the complaint in a court of common pleas.

(5) Post-disenrollment prohibitions:

Replaces: 173-40-04

Effective: 09/29/2011

R.C. 119.032 review dates: 07/13/2011 and 09/29/2016

Promulgated Under: 111.15

Statutory Authority: 173.01, 173.02, 173.40

Rule Amplifies: 173.40

Prior Effective Dates: 06/11/1991 (Emer.), 09/13/1991, 11/09/1998, 04/17/2003, 01/01/2008

173-40-04 [Rescinded] Loss-of-medicaid-eligibility status.

Effective: 09/29/2011

R.C. 119.032 review dates: 07/13/2011

Promulgated Under: 111.15

Statutory Authority: 173.01, 173.02, 173.40

Rule Amplifies: 173.40

Prior Effective Dates: 06/11/1991 (Emer.), 09/13/1991, 11/09/1998, 04/17/2003, 01/01/2008

173-40-05 [Rescinded] Receivership.

Effective: 12/29/2011

R.C. 119.032 review dates: 10/13/2011

Promulgated Under: 111.15

Statutory Authority: 173.01, 173.02, 173.40

Rule Amplifies: 143.40

Prior Effective Dates: 11/09/1998, 04/17/2003, 01/01/2008