173-40-02 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