173-40-03 Disenrollment and other adverse actions regarding 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 (or 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 unless the only criterion the consumer no longer meets is the patient-liability criterion listed in paragraph (A)(5) of the rule.

(2) No appeals: ODA (or ODA's designee) shall not provide the consumer with an opportunity for a hearing in accordance with Chapter 119. of the Revised Code if ODA (or ODA's designee) disenrolls a consumer for any of the following reasons:

(a) The consumer has been enrolled in the state-funded component of the PASSPORT program under the criteria of paragraph (A) of rule 173-40-02 of the Administrative Code for the maximum enrollment period of ninety days; or,

(b) The consumer voluntarily disenrolled from the state-funded component of the PASSPORT program under the criteria of paragraph (A) of rule 173-40-02 of the Administrative Code before reaching the maximum enrollment period of ninety days.

(3) Post-disenrollment prohibitions:

(a) After ODA (or ODA's designee) disenrolls a consumer from the state-funded component of the PASSPORT program, ODA (or 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 (or ODA's designee) disenrolls a consumer from the state-funded component of the PASSPORT program, ODA (or 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 ODA (or ODA's designee) determines that the consumer meets the non-financial eligibility criteria under rule 5101:3-31-03 of the Administrative Code.

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

(4) Appeals:

(a) ODA (or ODA's designee) shall provide form ODA1117 to an individual as a notice of a proposed adverse action against the individual, if ODA (or ODA's designee) proposes any of the following:

(i) To deny the individual's enrollment into the state-funded component of the PASSPORT program under the criteria of paragraph (A) of rule 173-40-02 of the Administrative Code;

(ii) To require the consumer to pay a specified patient-liability amount each month;

(iii) To change the services the consumer receives through the program; or,

(iv) To disenroll the consumer from the program before the consumer reaches the maximum enrollment period of ninety days, unless the consumer voluntarily disenrolls from the program.

(b) On form ODA1117, ODA (or ODA's designee) shall provide notice of an individual's opportunity to appeal the proposed adverse action by requesting a hearing in accordance with Chapter 119. of the Revised Code. ODA (or ODA's designee) shall also print a mailing date on the form.

(c) If an individual wishes to appeal ODA's (or ODA's designee's) proposed adverse action, the individual shall request a hearing. To request a hearing, the individual shall sign form ODA1117 and mail the signed form to ODA, addressed as follows:

"Director

Ohio Dept. of Aging

50 W. Broad St., 9th Floor

Columbus, OH 43215"

(d) In order for ODA to accept the request for a hearing, ODA must receive the original signed form ODA1117 in its office before five p.m. on or before the thirtieth day after ODA (or ODA's designee) mailed form ODA1117 to the individual. If ODA does not receive the original signed form on or before the thirtieth day, ODA will proceed with a final order that contains findings.

(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 (or 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 unless the only criterion the consumer no longer meets is the patient-liability criterion listed in paragraph (B)(3) of the rule.

(2) No appeals: ODA (or ODA's designee) shall not provide the consumer with an opportunity for a hearing in accordance with Chapter 119. of the Revised Code if ODA (or ODA's designee) disenrolls a consumer for any of the following reasons:

(a) The consumer has been enrolled in the state-funded component of the PASSPORT program under the criteria of paragraph (B) of rule 173-40-02 of the Administrative Code for the maximum enrollment period of ninety days; or,

(b) The consumer voluntarily disenrolled from the state-funded component of the PASSPORT program under the criteria of paragraph (B) of rule 173-40-02 of the Administrative Code before reaching the maximum enrollment period of ninety days.

(3) Post-disenrollment prohibitions:

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

(4) Appeals:

(a) ODA (or ODA's designee) shall provide form ODA1117 to an individual as a notice of a proposed adverse action against the individual, if ODA (or ODA's designee) proposes any of the following:

(i) To deny the individual's enrollment into the state-funded component of the PASSPORT program under the criteria of paragraph (B) of rule 173-40-02 of the Administrative Code;

(ii) To require the consumer to pay a specified patient-liability amount each month;

(iii) To change the services the consumer receives through the program; or,

(iv) To disenroll the consumer from the program before the consumer reaches the maximum enrollment period of ninety days, unless the consumer voluntarily disenrolls from the program.

(b) On form ODA1117, ODA (or ODA's designee) shall provide notice of an individual's opportunity to appeal the proposed adverse action by requesting a hearing in accordance with Chapter 119. of the Revised Code. ODA (or ODA's designee) shall also print a mailing date on the form.

(c) If an individual wishes to appeal ODA's (or ODA's designee's) proposed adverse action, the individual shall request a hearing. To request a hearing, the individual shall sign form ODA1117 and mail the signed form to ODA, addressed as follows:

"Director

Ohio Dept. of Aging

50 W. Broad St., 9th Floor

Columbus, OH 43215"

(d) In order for ODA to accept the request for a hearing, ODA must receive the original signed form ODA1117 in its office before five p.m. on or before the thirtieth day after ODA (or ODA's designee) mailed form ODA1117 to the individual. If ODA does not receive the original signed form on or before the thirtieth day, ODA will proceed with a final order that contains findings.

(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 (or ODA's designee) reassesses the condition and service needs of a consumer, ODA (or 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 (or 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 (or 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 (or 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 (or 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 (or 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) No appeals: ODA (or ODA's designee) shall not provide the consumer with an opportunity for a hearing in accordance with Chapter 119. of the Revised Code if ODA (or ODA's designee) disenrolls a consumer if the consumer voluntarily disenrolled from the state-funded component of the PASSPORT program under the criteria of paragraph (C) of rule 173-40-02 of the Administrative Code.

(4) Post-disenrollment prohibitions:

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

(5) Appeals:

(a) ODA (or ODA's designee) shall provide form ODA1117 to an individual as a notice of a proposed adverse action against the individual, if ODA (or ODA's designee) proposes any of the following:

(i) To deny the individual's enrollment into the state-funded component of the PASSPORT program under the criteria of paragraph (C) of rule 173-40-02 of the Administrative Code;

(ii) To require the consumer to pay a specified patient-liability amount each month; or,

(iii) To change the services the consumer receives through the program.

(b) On form ODA1117, ODA (or ODA's designee) shall provide notice of an individual's opportunity to appeal the proposed adverse action by requesting a hearing in accordance with Chapter 119. of the Revised Code. ODA (or ODA's designee) shall also print a mailing date on the form.

(c) If an individual wishes to appeal ODA's (or ODA's designee's) proposed adverse action, the individual shall request a hearing. To request a hearing, the individual shall sign form ODA1117 and mail the signed form to ODA, addressed as follows:

"Director

Ohio Dept. of Aging

50 W. Broad St., 9th Floor

Columbus, OH 43215"

(d) In order for ODA to accept the request for a hearing, ODA must receive the original signed form ODA1117 in its office before five p.m. on or before the thirtieth day after ODA (or ODA's designee) mailed form ODA1117 to the individual. If ODA does not receive the original signed form on or before the thirtieth day, ODA will proceed with a final order that contains findings.

Effective: 09/10/2012
R.C. 119.032 review dates: 06/11/2012 and 09/10/2017
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, 09/29/2011