Lawriter - OAC - 173-42-03 PASSPORT program (medicaid-funded component): enrollment and reassessment of individuals.

173-42-03 PASSPORT program (medicaid-funded component): enrollment and reassessment of individuals.

(A) Initial contact: To determine if an individual who applies for the medicaid-funded component of the PASSPORT program meets all eligibility requirements for the program under rule 5160-31-03 of the Administrative Code, ODM's administrative agency shall determine if the individual meets all medicaid financial eligibility requirements required by that rule and ODA's designee shall determine if the individual meets all non-financial eligibility requirements required by that rule. An individual may contact either ODM's administrative agency or ODA's designee to start the enrollment process. The two agencies shall coordinate processing the request for enrollment into the medicaid-funded component of the PASSPORT program.

(1) ODM's administrative agency: An individual who makes initial contact with ODM's administrative agency shall apply for medicaid (unless already enrolled in medicaid) and for the medicaid-funded component of the PASSPORT program. ODM's administrative agency shall determine if the individual meets all financial eligibility requirements and shall notify ODA's designee of the application. In response, ODA's designee shall initiate contact with the individual to conduct an in-person assessment to determine if the individual meets all non-financial eligibility requirements.

(2) ODA's designee:

(a) An individual who makes initial contact with ODA's designee shall apply for medicaid (unless already enrolled in medicaid) and for the medicaid-funded component of the PASSPORT program with the assistance of ODA's designee. ODA's designee shall conduct an in-person assessment to determine if the individual meets all non-financial eligibility requirements.

(b) After the individual applies for the medicaid-funded component of the PASSPORT program, ODA or its designee shall notify the individual of the existence of the state-funded component of the PASSPORT program in Chapter 173-40 of the Administrative Code and offer the individual an opportunity to apply for enrollment in the state-funded component of the program.

(B) If determined ineligible: If ODM's administrative agency or ODA's designee determines the individual does not meet all eligibility requirements for the program under rule 5160-31-03 of the Administrative Code, ODA's designee shall not enroll the individual in the program.

(1) ODM's administrative agency: If ODM's administrative agency determines the individual does not meet all financial eligibility requirements, it shall notify ODA's designee and send the individual a notice of denial and hearing rights under section 5101.35 of the Revised Code and division 5101:6 of the Administrative Code.

(2) ODA's designee: If ODA's designee determines the individual does not meet all non-financial eligibility requirements, it shall send the individual a notice of denial and hearing rights under section 5101.35 of the Revised Code and division 5101:6 of the Administrative Code.

(C) If determined eligible: If ODM's administrative agency or ODA's designee determine the individual meets all eligibility requirements for the program under rule 5160-31-03 of the Administrative Code, ODA's designee shall notify the individual that he or she meets all eligibility requirements and enroll the individual into the program according to paragraph (C)(1) or (C)(2) of this rule.

(1) Available slot: If a waiver slot in the medicaid-funded component of the PASSPORT program is available, ODA's designee shall enroll the individual into the program, if the individual continues to meet the eligibility requirements for the program and continues to want to enroll into the program. ODA's designee shall not place the individual on the unified waiting list.

(2) No available slot: If a waiver slot is not available in the medicaid-funded component of the PASSPORT program, ODA's designee may enroll the individual when a waiver slot does become available by one of two means: the unified waiting list or the home-first component of the medicaid-funded component of the PASSPORT program.

(a) Unified waiting list: If an individual meets all the non-financial eligibility requirements, but a slot is not available in the PASSPORT program, ODA's designee shall place the individual on the unified waiting list according to rule 173-44-04 of the Administrative Code, unless the individual qualifies for the home first component of the PASSPORT program, as addressed in paragraph (C)(2)(b) of this rule.

(b) Home first: If an individual meets all requirements for the home first component of the PASSPORT program in section 173.521 of the Revised Code, ODA's designee shall enroll the individual before enrolling any individual from the unified waiting list.

(D) Reassessment: ODA's designee shall reassess each individual enrolled into the medicaid-funded component of the assisted living program no less often than one time each year after the date the individual enrolled into the program. After ODA's designee conducts each reassessment, if the individual continues to qualify for the medicaid-funded component of the program, the individual shall decide if he or she wishes to remain in the program. If the individual wishes to remain, the individual shall sign form ODA1044 as a condition of continued enrollment. As used in this paragraph, "ODA1044" means "ODA1044 'Annual Enrollment Agreement' (March, 2014)."

(E) An authorized representative may represent an individual in the enrollment and reassessment processes.

Replaces: 173-42-03


Effective: 11/1/2018
Five Year Review (FYR) Dates: 11/01/2023
Promulgated Under: 119.03
Statutory Authority: 173.52, 173.02, 173.01
Rule Amplifies: 173.52, 173.521, 173.55 ; 42 C.F.R. 441.352
Prior Effective Dates: 02/22/2001, 10/03/2005 (Emer.), 01/13/2006, 01/14/2010, 03/12/2011, 09/29/2011, 03/01/2014