Chapter 5160-31 Medicaid Home and Community Based Services Waiver Portion of the PASSPORT Program

5160-31-02 PASSPORT HCBS waiver program definitions.

(A) The purpose of this rule is to define the terms used in Chapter 5101:3-31 of the Administrative Code governing the preadmission screening system providing options and resources today (PASSPORT) home and community based services (HCBS) waiver program.

As used in this chapter:

(B) "ADL" means activities of daily living including bathing; grooming; toileting; dressing; eating; and mobility which refers to bed mobility, transfer, and locomotion as defined in rules 5101:3-3-06 and 5101:3-3-08 of the Administrative Code.

(C) "Assessment" means a face-to-face evaluation used to obtain information about an individual including his or her condition, personal goals and preferences, functional limitations, health status and other factors that are relevant to the authorization and provision of services. Assessment information supports the determination that an individual requires waiver services as well as the development of the service plan.

(D) "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.

(E) "Caregiver" means relatives, friend, and/or significant others who voluntarily provide assistance to the consumer and are responsible for the consumer's care on a continuing basis.

(F) "Case management" means a set of person centered activities provided by the PASSPORT administrative agency (PAA) that are undertaken to ensure that the waiver consumer receives appropriate and necessary services. Under a HCBS waiver, these activities may include, but are not necessarily limited to, assessment, service plan development, service plan implementation and service monitoring as well as assistance in accessing waiver, state plan, and other services and resources as needed.

(G) "CDJFS" means a county department of job and family services.

(H) "Certification" means providers are certified by the Ohio department of aging (ODA) to provide services for PASSPORT as established in Chapter 173-39 of the Administrative Code.

(I) "Consumer" means an individual who has been accepted for enrollment and is receiving PASSPORT services. Consumer includes the consumer's legal representative and/or authorized representative, as applicable.

(J) "HCBS" or "home and community-based services" means services furnished under the provisions set forth in 42 C.F.R. 441 Subpart G (October 1, 2009) that permit individuals to live in a home setting rather than a nursing facility (NF) or hospital. HCBS waiver services are approved by CMS for specific populations and are not otherwise available under the medicaid state plan.

(K) "CMS" means the centers for medicare and medicaid services (CMS), a federal agency that is part of the U.S. department of health and human services, and administers the medicaid program and approves home and community-based services waivers.

(L) "FMS" or "financial management service" is a support provided to waiver participants who direct some or all of their waiver services. In the PASSPORT waiver, this support is conducted as an administrative activity through an entity under contract with the ODA. When used in conjunction with the employer authority available to consumers in PASSPORT, this support includes operating a payroll service for participant-employed workers and making required payroll withholdings.

(M) "Home first" means the component of the PASSPORT HCBS waiver program that offers priority enrollment in the waiver for certain individuals in accordance with section 173.401 of the Revised Code.

(N) "IADL" means an instrumental activity of daily living as defined in rule 5101:3-3-08 of the Administrative Code and includes shopping; meal preparation; laundry; community access activities including telephoning, transportation, legal or financial; and environmental activities including house cleaning, heavy chores, yard work or maintenance.

(O) "Individual" means a medicaid recipient or person with pending medicaid eligibility who is applying to a NF or intermediate care facility for the mentally retarded (ICF-MR); or is applying for HCBS waiver enrollment; or is applying for residential state supplement (RSS) funded placement; or is seeking long-term care services.

(P) "Keys amendment facility", as found in section 1616(e) of the Social Security Act, means an institution, foster home or group living arrangement in which a significant number of recipients of supplemental security income benefits are residing or are likely to reside. Keys amendment facilities include:

(1) Adult foster homes certified under section 5119.362 of the Revised Code;

(2) Adult family homes or adult group homes as defined in section 3722.01 of the Revised Code, that is licensed as an adult care facility under section 3722.04 of the Revised Code;

(3) Residential care facility as defined in section 3721.02 of the Revised Code;

(4) Community alternative homes as defined in section 3724.01 of the Revised Code, that are licensed under section 3724.03 of the Revised Code;

(5) Residential facilities of the type defined in division (A)(1)(d)(ii) of section 5119.22 of the Revised Code, that are licensed by the Ohio department of mental health (ODMH); or,

(6) An apartment or room that is used to provide community mental health housing services, is certified by the ODMH under section 5119.611 of the Revised Code, and is approved by a board of alcohol, drug addiction, and mental health services in accordance with division (A)(14) of section 340.03 of the Revised Code.

(Q) "Level of care" (LOC) means the designation describing a person's functional levels and nursing needs pursuant to the criteria set forth in rules 5101:3-3-05, 5105:3-3-06, 5101:3-3-07 and 5101:3-3-08 of the Administrative Code.

(R) "NF" means a nursing facility as defined in section 5111.20 of the Revised Code.

(S) "ODA" means the Ohio department of aging.

(T) "ODJFS" means the Ohio department of job and family services.

(U) "PAA" means PASSPORT administrative agency.

(V) "PASSPORT" or "PASSPORT HCBS waiver program" means an HCBS waiver program that serves individuals who are aged sixty and over who have a LOC required for placement in a NF if the waiver program were not available, and meet the PASSPORT eligibility criteria and enrollment requirements in Chapter 5101:3-31 of the Administrative Code.

(W) "Region" means the geographic area in which a PAA administers the PASSPORT program.

(X) "Service plan" means a written, person centered plan between the consumer, the consumer's case manager at the PAA and, as applicable, the consumer's caregiver(s). The service plan specifies the services that are provided to the consumer, regardless of funding source, to address the consumer's individual care needs as identified in the consumer's assessment.

(Y) "Subregion" means a geographic area located within a PAA region for the purpose of establishing PASSPORT unit rates as set forth in rule 5101:3-31-07 of the Administrative Code.

(Z) "Waiver service provider" means an agency or person with a signed medicaid provider agreement with ODJFS to provide HCBS waiver services, and who meets the PASSPORT conditions of participation set forth in rule 5101:3-31-06 of the Administrative Code.

Effective: 09/29/2011
R.C. 119.032 review dates: 03/01/2016
Promulgated Under: 119.03
Statutory Authority: 5111.85
Rule Amplifies: 5111.85
Prior Effective Dates: 7/16/84, 12/22/86 (Emer.), 3/23/87, 7/1/90, 1/14/96, 9/1/98, 3/1/00, 3/3/01, 7/1/06, 3/17/11

5160-31-03 Eligibility for enrollment in the PASSPORT HCBS waiver program.

(A) Before an individual can be eligible for enrollment in the pre-admission screening system providing options and resources today (PASSPORT) home and community based services (HCBS) waiver program, all of the following criteria must be met:

(1) A county department of job and family services (CDJFS) must have determined the individual to be eligible for medicaid in accordance with rules 5160:1-2- 01.6 and 5160:1-2- 01.8 of the Administrative Code.

(2) The waiver service cost of the twelve-month service plan does not exceed the individual cost limit. The individual cost limit is calculated by the Ohio department of aging (ODA) at least biennially. The cost limit is a dollar amount equal to sixty per cent of the total medicaid cost for nursing facility (NF) services. The total medicaid cost for NF services is obtained by multiplying the average annual medicaid NF per diem rate by the number of days in the most recent state fiscal year in which data is available.

(a) If the PASSPORT administrative agency (PAA) determines that the applicant's needs cannot be met within the cost limit, the individual shall not be enrolled. However, if an individual who has been enrolled and is receiving PASSPORT services experiences a change in his or her condition that causes the cost of care to exceed the cost limit, the individual may remain on the waiver at a higher cost not to exceed one hundred per cent of the total medicaid cost for NF services to avoid service disruption to the individual if the PAA grants approval to do so.

(b) If the individual's needs exceed one hundred per cent of the total medicaid cost for NF services, the individual shall be disenrolled from the waiver.

(3) The needed services are not readily available through another source at the level required to allow the individual to live in the community.

(4) The individual agrees to participate in PASSPORT and shall not be simultaneously enrolled in another HCBS medicaid waiver, the residential state supplement (RSS) program, or the program of all inclusive care for the elderly (PACE) while enrolled in PASSPORT.

(5) The individual's health related needs can be safely met in a home setting as determined by the PAA.

(6) Prior to PASSPORT enrollment, the attending physician must approve that the services are appropriate to meet the individual's needs. The physician's approval may be either verbal or written. If the approval is verbal, written approval must be obtained within thirty days of the enrollment date. The PAA shall be responsible for obtaining the physician's approval.

(7) While receiving PASSPORT, the individual must not be a resident of either a Keys Amendment Facility, a hospital or a NF as defined in rule 5160-31-02 of the Administrative Code. For purposes of this rule a resident of a "Keys Amendment facility" is an individual who receives services from the facility and is not a family member of the owner or operator of the facility.

(8) The individual is age sixty or older at the time of enrollment.

(9) The individual must be determined to meet the criteria for an intermediate or skilled level of care in accordance with rule 5160-3-05 or 5160-3-06 of the Administrative Code and, in the absence of PASSPORT, would require NF services as defined in 42 C.F.R. 440.40 and 42 C.F.R. 440.150 (dated October 1, 2007).

(10) PASSPORT has not reached the centers for medicare and medicaid services (CMS)-authorized limit on the number of individuals who may enroll on the waiver during the current year.

(11) An individual who has been enrolled in and is receiving PASSPORT services may subsequently be enrolled in and receive hospice services under medicaid or medicare. A person who is enrolled in hospice under medicaid or medicare is not eligible to enroll in PASSPORT if that hospice enrollment occurred prior to PASSPORT enrollment.

(12) The individual must require the provision of at least one waiver service on a monthly basis as documented in the individual's approved service plan.

(B) If, at any time, the individual fails or ceases to meet any of the eligibility criteria identified in this rule, the individual shall be denied or disenrolled from PASSPORT. In such instances, the individual shall be notified by the CDJFS and entitled to hearing rights in accordance with Chapters 5101:6-1 to 5101:6-9 of the Administrative Code.

Effective: 03/01/2014
R.C. 119.032 review dates: 11/29/2013 and 03/01/2019
Promulgated Under: 119.03
Statutory Authority: 5166.02
Rule Amplifies: 5166.02 , 173.52
Prior Effective Dates: 12/22/86 (Emer.), 3/23/87, 1/14/96, 2/22/01, 1/31/05, 7/1/08, 3/17/11

5160-31-04 Enrollment process for the pre-admission screening system providing options and resources today (PASSPORT) HCBS waiver program.

(A) The Ohio department of aging (ODA) is responsible for the daily operation of the PASSPORT home and community based services (HCBS) waiver. ODA will operate this waiver pursuant to an interagency agreement with the Ohio department of job and family services (ODJFS) in accordance with sections 5111.91 and 5111.871 of the Revised Code. ODA will establish processes and procedures to enroll individuals on this waiver.

(B) Individuals who wish to enroll in PASSPORT must have a medicaid eligibility determination made by the county department of job and family services (CDJFS) and an assessment of PASSPORT waiver eligibility made by the PASSPORT administering agency (PAA). The individual may contact either the CDJFS or the PAA to start the enrollment process and the two agencies shall coordinate processing the request for enrollment into the PASSPORT HCBS waiver program:

(1) Individuals initially contacting the CDJFS will complete the JFS 07200 "Request for Cash, Food Stamps, and Medical Assistance" (rev. 3/2010) and the JFS 02399 "Request for Medicaid Home and Community Based Services" (rev. 1/2006) in accordance with rules 5101:1-38-01.2 and 5101:1-38-01.6 of the Administrative Code. The CDJFS will notify the PAA of the individual's application for waiver services. The PAA will initiate contact with the individual to complete the enrollment process.

(2) Individuals initially contacting the PAA will receive an in-person assessment to determine eligibility for the PASSPORT HCBS waiver program. The PAA may assist the individual in applying for medicaid if not already initiated by completing the JFS 07200 and JFS 02399.

(C) If the individual has been determined eligible and a waiver slot is available, the consumer shall be enrolled in accordance with the PASSPORT HCBS waiver program's home first component, if applicable, and rule 173-42-03 of the Administrative Code.

(D) The PAA shall make the determination of PASSPORT eligibility using the criteria set forth in rule 5101:3-31-03 of the Administrative Code. The PAA shall notify the CDJFS of the results of the PASSPORT eligibility determination.

(E) Any applicant for PASSPORT HCBS waiver program services is entitled to notice and hearing rights as set forth in section 5101.35 of the Revised Code and division 5101:6 of the Administrative Code.

Effective: 09/29/2011
R.C. 119.032 review dates: 03/01/2016
Promulgated Under: 119.03
Statutory Authority: 5111.85 , 173.40
Rule Amplifies: 173.40 , 173.401 , 5111.01 , 5111.02
Prior Effective Dates: 7/16/84, 12/22/86 (Emer.), 3/23/87, 7/1/90, 1/14/96, 2/22/01, 10/03/05 (Emer.), 1/1/06, 3/17/11

5160-31-05 PASSPORT HCBS waiver program covered services.

(A) The purpose of this rule is to establish the services covered by the pre-admission screening system providing options and resources today (PASSPORT) home and community based services (HCBS) wavier program.

(B) The PASSPORT HCBS waiver program benefit package is limited to the following services:

(1) Adult day services as set forth in rule 173-39- 02.1 of the Administrative Code;

(2) Alternative meal services as set forth in rule 173-39- 02.2 of the Administrative Code;

(3) Choices home care attendant services as set forth in rule 173-39- 02.4 of the Administrative Code;

(4) Chore services as set forth in rule 173-39- 02.5 of the Administrative Code;

(5) Community transition services as set forth in rule 173-39- 02.17 of the Administrative Code;

(6) Emergency response system services as set forth in rule 173-39- 02.6 of the Administrative Code;

(7) Enhanced community living services as set forth in rule 173-39- 02.20 of the Administrative Code;

(8) Homemaker services as set forth in rule 173-39- 02.8 of the Administrative Code;

(9) Home care attendant services as set forth in rule 173-39- 02.24 of the Administrative Code;

(10) Home delivered meal services as set forth in rule 173-39- 02.14 of the Administrative Code;

(11) Home medical equipment and supplies services as set forth in rule 173-39- 02.7 of the Administrative Code;

(12) Independent living assistance services as set forth in rule 173-39- 02.15 of the Administrative Code;

(13) Minor home modification, maintenance and repair services as set forth in rule 173-39- 02.9 of the Administrative Code;

(14) Non-medical transportation services as set forth in rule 173-39- 02.18 of the Administrative Code;

(15) Nutrition consultation services as set forth in rule 173-39- 02.10 of the Administrative Code;

(16) Out-of-home respite services as set forth in rule 173-39- 02.23 of the Administrative Code;

(17) Personal care services as set forth in rule 173-39- 02.11 of the Administrative Code;

(18) Pest control services as set forth in rule 173-39- 02.3 of the Administrative Code;

(19) Social work counseling services as set forth in rule 173-39- 02.12 of the Administrative Code;

(20) Transportation services as set forth in rule 173-39- 02.13 of the Administrative Code ; and

(21) Waiver nursing services as set forth in rule 173-39- 02.22 of the Administrative Code.

(C) Services shall be delivered by providers in a manner that is consistent with the individual's service plan as documented in the PASSPORT information management system (PIMS).

(D) If an individual enrolled on PASSPORT is also a participant in the helping ohioans move, expanding (HOME) choice demonstration program in accordance with Chapter 5160-51 of the Administrative Code, the individual may, at the individual's discretion, use the HOME choice community transitions service in lieu of, but not in addition to, the community transition service available through the PASSPORT waiver program.

(E) If an individual receives enhanced community living services, per the federally approved waiver, the consumer may not receive either personal care or homemaker services available through the PASSPORT waiver program.

(F) In accordance with the federally approved PASSPORT waiver the services identified in this paragraph are subject to employer and/or budget authority if elected by the individual. Services are to be furnished in accordance with the requirements in paragraph (B) of this rule:

(1) The following services are subject to employer authority, which includes but is not limited to, the ability to hire, fire, and train employees:

(a) Choices home care attendant service; and

(b) Personal care services.

(2) The following services are subject to budget authority, which includes but is not limited to, the ability to negotiate reimbursement rates paid to providers furnishing services:

(a) Alternative meals service;

(b) Choices home care attendant service

(c) Home medical equipment and supplies service;

(d) Minor home modification, maintenance and repair services; and

(e) Pest control service

(G) An individual who elects to self-direct any of the services provided in paragraph (F) of this rule shall be assessed by their case manager to determine the individual's ability to self-direct their services as set forth in rule 173-42-06 of the Administrative Code.

(1) If an individual demonstrates the ability to self-direct their care the case manager may initiate the orientation process to familiarize the individual with the self-direction of services including the role of the financial management service (FMS).

(2) If the individual is unable to demonstrate the ability to self-direct his or her care and to assume the responsibilities associated with the self-direction authorities in paragraph (F) of this rule, the individual may choose an authorized representative to act on his or her behalf.

(3) If no authorized representative is available, the case manager will assist the individual with obtaining services through ODA-certified long-term care agency providers.

(H) If an individual who is seeking to self-direct his or her care chooses an authorized representative to act on his or her behalf in accordance with paragraph (G)(2) of this rule, the authorized representative shall not simultaneously serve as the consumer's authorized representative and the consumer's provider.

Effective: 07/01/2014
R.C. 119.032 review dates: 03/01/2019
Promulgated Under: 119.03
Statutory Authority: 5166.02
Rule Amplifies: 5166.02 , 173.52
Prior Effective Dates: 7/16/84, 12/22/86 (Emer.), 3/23/87, 7/1/90, 1/14/96, 9/1/98, 7/1/06, 7/1/08, 6/28/09, 3/17/11, 3/1/14

5160-31-06 Provider conditions of participation for the PASSPORT HCBS waiver program.

(A) The purpose of this rule is to establish the conditions under which providers are able to participate in the preadmission screening system providing options and resources today (PASSPORT) home and community based services (HCBS) waiver program.

(B) In order to obtain a medicaid provider agreement to be a PASSPORT provider furnishing services in rule 5160-31-05 of the Administrative Code the provider shall be certified by the Ohio department of aging (ODA) or its designee in accordance with the provisions of Chapter 173-39 of the Administrative Code.

(C) Individuals enrolled in the PASSPORT HCBS waiver shall be given a free choice of qualified providers in accordance with rule 173-42-06 of the Administrative Code.

Effective: 07/01/2014
R.C. 119.032 review dates: 03/20/2014 and 07/01/2019
Promulgated Under: 119.03
Statutory Authority: 5166.02
Rule Amplifies: 5166.02 , 173.39 , 173.52
Prior Effective Dates: 7/16/84, 12/22/86 (Emer.), 3/23/87, 7/1/90, 1/14/96, 9/1/98,7/1/06,03/17/2011

5160-31-07 PASSPORT HCBS waiver program rate setting.

The purpose of this rule is to describe the methods used to determine provider rates for the pre-admission screening system providing options and resources today (PASSPORT) home and community based services (HCBS) medicaid waiver program.

(A) Rates determined under this rule shall not exceed the maximum reimbursement rate for PASSPORT services in appendix A to rule 5160-1- 06.1 of the Administrative Code. Payment for PASSPORT HCBS waiver services constitutes payment in full and may not be construed as a partial payment when the payment amount is less than the provider's usual and customary charge. The provider may not bill the individual for any difference between the medicaid payment and the provider's charge or request the individual to share in the cost through a co-payment or other similar charge.

(B) PASSPORT reimbursement rates are established for the services in rule 5160-31-05 of the Administrative Code under the following categories:

(1) Per job bid rate;

(2) Per item rate; and

(3) Unit rate.

(C) Rates set within the categories in paragraph (B) of this rule may be:

(1) Participant-directed, in which the individual or their designated authorized representative, who is acting on the individual's behalf, may negotiate the reimbursement rate for services furnished by providers as specified in paragraphs (D)(3), (E)(3), (G)(4), and (H) of this rule.

(2) Statewide, in which the state establishes a rate that is used on a statewide basis to reimburse for services specified in paragraph (F) of this rule.

(3) Regional, in which the state establishes a regional reimbursement rate for services specified in paragraph (G) of this rule. The regions in which applicable rates are calculated shall be designated by ODA.

(a) The regional rate for each service shall be the weighted average rate paid in the region using cost and unit data either from the most recently completed state fiscal year or the most recent twelve calendar months for which complete data is available, whichever is later.

(b) ODA or its designee shall enter into a contract with providers in each region. The contract shall do all of the following:

(i) Specify the time period for which the rates shall be in effect;

(ii) Specify the timelines for contracting;

(iii) Define the region/subregions for which the rates will be established;

(iv) Base rates on the units of service as set forth in appendix A to rule 5160-1- 06.1 of the Administrative Code;

(v) Reflect the rate the provider is willing to accept ; and

(vi) Adjust the regional rate up to the nearest number that is divisible by four, out to two decimal places.

(c) Regional contract rates shall be established as follows:

(i) No provider shall have a contract rate that exceeds the rate for that service as established in rule 5160-1- 06.1 of the Administrative Code.

(ii) If the state recalculates regional rates for the services in paragraph (G) of this rule, certified providers may either accept the new regional rate or continue to be reimbursed at the rate paid for services prior to the calculation of the regional rate.

(iii) Providers who are certified after the regional rate is established shall have a contract rate less than or equal to the regional rate.

(4) Group rates, in which a provider that is furnishing certain services to more than one individual enrolled on PASSPORT is reimbursed at a rate that is seventy-five per cent of the reimbursement rate the provider would be paid for furnishing PASSPORT services as specified in paragraphs (D)(2), (F)(2), (G)(2), and (G)(3) of this rule.

(D) For the services listed in this paragraph, a per job bid rate shall be negotiated between the provider and the individual's case manager.

(1) A per job bid rate shall be used for the following services:

(a) Chore services;

(b) Community transition services;

(c) Minor home modification services;

(d) Non-medical transportation services;

(e) Pest control services; and

(f) Transportation services.

(2) Transportation and non-medical transportation services rendered simultaneously by the same provider to more than one individual enrolled in PASSPORT residing in the same household and traveling in the same vehicle to the same destination shall be reimbursed using a group rate that is equal to seventy-five per cent of the provider's per job bid rate. This applies to any combination of transportation and/or non-medical transportation services.

(3) Minor home modification and pest control services may be participant directed services in which the individual enrolled on PASSPORT or their authorized representative, acting on the individual's behalf, may negotiate reimbursement rates.

(a) The negotiated rate shall be reviewed by the individual's case manager and reflected on the individual's service plan prior to service delivery.

(b) Should the individual choose not to negotiate a rate of reimbursement the service shall be reimbursed at a rate proposed by the provider and accepted by the consumer and the consumer's case manager. The accepted rate shall be reflected on the consumer's service plan.

(E) A per item rate shall be determined for home medical equipment and supplies service.

(1) The cost of the item shall not exceed the medicaid state plan rate.

(2) The cost of an item that does not have an established medicaid rate shall be reimbursed at a per item bid rate submitted and agreed to in writing by the PASSPORT administrative agency (PAA) prior to delivery of the item.

(3) Home medical equipment and supplies services may be participant directed in which the individual enrolled on PASSPORT or the authorized representative, acting on the individual's behalf, may negotiate reimbursement rates.

(a) The negotiated rate shall be reviewed by the individual's case manager and reflected on the individual's service plan prior to service delivery.

(b) Should the individual choose not to negotiate a rate of reimbursement the service shall be reimbursed at a rate proposed by the provider and accepted by the consumer and the consumer's case manager. The accepted rate shall be reflected on the consumer's service plan.

(F) The Ohio department of aging (ODA) shall establish unit rates for the services listed in this paragraph. No service shall have both a regional and statewide rate set pursuant to this rule.

(1) Statewide rates shall be established and used for the following services:

(a) Adult day services;

(b) Emergency response system services;

(c) Enhanced community living services;

(d) Home care attendant services;

(e) Out-of-home respite services;

(f) Personal care services provided by ODA-certified long-term care consumer-directed personal care provider; and

(g) Waiver nursing services.

(2) The services in paragraphs (F)(1)(d), (F)(1)(f), and(F)(1)(g) of this rule, when rendered during the same visit to more than one but less than four PASSPORT consumers in the same household, as identified in the consumers' service plans, shall be reimbursed using a group rate equal to one hundred per cent of the provider's per unit rate set in accordance with paragraph (C) of this rule for one PASSPORT consumer. The provider shall be reimbursed seventy-five per cent of the provider's per unit rate for each subsequent PASSPORT consumer in the household receiving services during the visit.

(G) ODA shall establish regional unit rates for the services listed in this paragraph pursuant to the methodology in paragraph (C)(3) of this rule. No service, except personal care services provided under paragraph (F)(1)(f) of this rule, shall have both a regional and statewide rate set pursuant to this rule.

(1) Regional unit rates shall be set for the following services:

(a) Adult day services transportation;

(b) Home delivered meals services;

(c) Homemaker services;

(d) Social work counseling services;

(e) Nutritional consultation services

(f) Personal care services; and

(g) Independent living assistance services.

(2) Adult day service transportation services rendered simultaneously by the same provider to more than one consumer residing in the same household and traveling in the same vehicle to the same destination shall be reimbursed using a group rate equal to seventy-five per cent of the provider's regional unit rate.

(3) Personal care services, except personal care services provided under paragraph (F) of this rule, that are rendered during the same visit by the same provider to more than one but less than four PASSPORT consumers in the same household, as identified in the consumers' service plans, shall be reimbursed using a group rate equal to one hundred per cent of the provider's regional per unit rate set in accordance with paragraph (C) of this rule for one PASSPORT consumer. The provider shall be reimbursed seventy-five per cent of their regional per unit rate for each subsequent PASSPORT consumer in the household receiving services during the visit.

(4) Homemaker services may be participant directed services in which the individual enrolled on PASSPORT or their authorized representative, acting on the individual's behalf, may negotiate reimbursement rates.

(a) The negotiated rate shall be reviewed by the individual's case manager and reflected on the individual's service plan prior to service delivery.

(b) Should the individual choose not to negotiate a rate of reimbursement the service shall be reimbursed in accordance with paragraph (G) of this rule. The accepted rate shall be reflected on the consumer's service plan.

(H) The services in this paragraph are participant directed and the individual may negotiate unit rates with providers.

(1) The participant directed services include:

(a) Alternative meals service; and

(b) Choices home care attendant services.

(2) The consumer shall have in effect, before choices home care attendant services are delivered, a signed agreement with each ODA-certified consumer-directed individual provider delivering services to the consumer. The agreement shall:

(a) Include the rate of reimbursement negotiated with the provider;

(b) Specify the time period the rates shall be in effect;

(c) Base rates on the units of service as set forth in Chapter 173-39 of the Administrative Code;

(d) Be signed by the choices HCBS waiver program participant and the HCBS provider.

(3) The rates negotiated by the choices HCBS waiver consumer with providers of services in this paragraph shall not exceed the maximum allowed per unit of service as specified in appendix A to rule 5160-1- 06.1 of the Administrative Code. The negotiated rate shall be reviewed by the consumer's case manager and reflected on the consumer's service plan prior to service delivery.

(4) Should the consumer choose not to negotiate a rate of reimbursement for any of the services in this paragraph, the service shall be reimbursed at a rate proposed by the provider and accepted by the consumer and the consumer's case manager. The accepted rate shall be reflected on the consumer's service plan.

(I) The Ohio department of medicaid, or its designee, shall evaluate unit rates within two years of the effective date of this rule and every two years thereafter.

Replaces: 5160-31-07

Effective: 07/01/2014
R.C. 119.032 review dates: 03/01/2019
Promulgated Under: 119.03
Statutory Authority: 5166.02
Rule Amplifies: 5166.02 , 173.52
Prior Effective Dates: 9/1/98, 3/1/00, 7/1/06, 7/1/08, 7/1/11 (Emer.), 3/17/11, 9/29/11, 3/1/2014