Chapter 173-40 | State-Funded PASSPORT Program

Rule 173-40-01 | PASSPORT program (state-funded component): introduction and definitions.

• Effective: November 1, 2018
• Promulgated Under: 111.15

(A) Introduction: Chapter 173-40 of the Administrative Code regulates the state-funded component of the PASSPORT program created under section 173.522 of the Revised Code. (See Chapter 173-42 of the Administrative Code for rules on the medicaid-funded component of the PASSPORT program.)

(B) Definitions for this chapter:

"Authorized representative" has the same meaning as in rule 5160-1-33 of the Administrative Code.

"Form ODA1115" means "form ODA1115 'Financial Assessment Worksheet' (rev. November 1, 2018)." ODA publishes the form on www.aging.ohio.gov. It is available to the general public at no cost.

"Form ODA1116" means "form ODA1116 'Enrollment Agreement' (September, 2011)." ODA publishes the form on www.aging.ohio.gov. It is available to the general public at no cost.

"Form ODA1117" means "form ODA1117 'Notice of Proposed Action and Opportunity for Hearing' (rev. April, 2012)." ODA publishes the form on www.aging.ohio.gov. It is available to the general public at no cost.

"ODA" means "the Ohio department of aging.

"ODA's designee" has the same meaning as in rule 173-39-01 of the Administrative Code.

"ODM" means "the Ohio department of medicaid."

"ODM's administrative agency" has the same meaning as "administrative agency" in rule 5160:1-1-01 of the Administrative Code.

"Person-centered services plan" means the written outline of the services that a case manager authorizes a provider to provide to an individual, regardless of the funding source for those services. It includes the person-centered planning in rule 5160-44-02 of the Administrative Code.

Supplemental Information

Authorized By: 173.01, 173.02, 173.522
Amplifies: 173.522
Five Year Review Date: 11/1/2023
Prior Effective Dates: 6/11/1991 (Emer.), 7/1/2016, 2/1/2017

Rule 173-40-02 | PASSPORT program (state-funded component): individual eligibility requirements.

• Effective: December 31, 2020
• Promulgated Under: 111.15

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

(1) Consultation: The individual participated in a long-term care consultation under Chapter 173-43 of the Administrative Code.

(2) Financial requirements:

(a) The individual contacted either ODA's designee or ODM's administrative agency to apply for the medicaid-funded component of the PASSPORT program, but the application is still pending because ODM's administrative agency has not yet made a final determination on the individual's financial eligibility. (If ODM's administrative agency already determined the individual was eligible to participate in the medicaid-funded component of the PASSPORT program, he or she would be enrolled in the medicaid-funded component of the PASSPORT program and no longer be eligible for the state-funded component of the PASSPORT program. If ODM's administrative agency already determined the individual was not financially eligible to participate in the medicaid-funded component of the PASSPORT program, he or she would also not be eligible to participate in the state-funded component of the PASSPORT program.)

(b) The individual agreed that, if he or she is enrolled into the state-funded component of the PASSPORT program, then ODM's administrative agency determines the individual is financially eligible for the medicaid-funded component of the PASSPORT program, that he or she would immediately be transferred to the medicaid-funded component of the PASSPORT program.

(c) The individual is actively assisting ODM's administrative agency in determining if he or she is financially eligible to participate in the medicaid-funded component of the PASSPORT program by timely providing ODM's administrative agency with information and copies of any records ODM's administrative agency needs to make its financial eligibility determination.

(d) ODA or its designee completed form ODA1115 and determined that ODM's administrative agency would most likely determine the individual meets all financial eligibility requirements for the medicaid-funded component of the PASSPORT program listed in rules 5160:1-2-03 and 5160:1-2-10 of the Administrative Code, and ODA or its designee has no reason to doubt that determination.

(3) Non-financial requirements:

(a) ODA or its designee and the individual completed form ODA1116, and the form indicated the individual chose to enroll in the state-funded component of the PASSPORT program, named the individual's representative (if any), and indicated the individual authorized ODA or its designee to release information.

(b) ODA or its designee determined the individual meets all non-financial eligibility requirements for the medicaid-funded component of the PASSPORT program in rule 5160-31-03 of the Administrative Code.

(4) Post-eligibility treatment of income (i.e., patient liability or share of cost): ODA or its designee assessed the individual's income and resources using the methodology described in rule 5160:1-6-07.1 of the Administrative Code to determine if the individual should pay any share of cost and the individual agreed to pay, and pays, any share of cost as it becomes due.

(B) Grandparented: Only an individual who meets all the following requirements 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 since 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, has fully complied with the application and enrollment procedures for the medicaid-funded component of the PASSPORT program, and was determined ineligible for the medicaid-funded component of the PASSPORT program. ODA or its designee shall disenroll any such individual from the state-funded component of the PASSPORT program who is found eligible for enrollment in the medicaid-funded component of the PASSPORT program. An individual's failure or refusal to cooperate in providing either ODA or its designee or an ODM administrative agency with the information and records necessary to establish the individual's eligibility for the medicaid-funded component of the PASSPORT program constitutes a failure to meet this eligibility requirement.

(3) ODA or its designee and a physician have determined the individual needs an intermediate level of care or a skilled level of care, as both are defined in rule 5160-3-05 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 or its 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 5160:1-2-03 and 5160:1-2-10 of the Administrative Code and the medicaid eligibility manual. ODA or its 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 present ODA or its designee with records to verify he or she 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.

(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 present ODA or its designee with records to verify he or she 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 or its designee has approved a person-centered services plan for the individual that is signed by the individual's physician.

(6) The individual's approved person-centered services plan indicates 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 from only ODA-certified providers and agrees to cooperate with ODA or its designee in establishing and re-establishing eligibility for the medicaid-funded component of the PASSPORT program or the state-funded component of the PASSPORT program, when requested by ODA's designee.

(8) The individual's participation 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 or its designee, a threat to the individual's health and safety.

(C) An individual who is eligible for the state-funded component of the PASSPORT program because the individual meets all the requirements under paragraph (A) of this rule shall not participate in the state-funded component of the PASSPORT program for more than ninety days, unless ODA's director approves an extended number of days.

(D) ODA's designee may collect the individual's handwritten or electronic signature for the agreements required in paragraphs (A)(2)(b), (A)(3)(a), (A)(4), and (B)(7) of this rule on a date later than the date the individual makes each agreement, but no later than the next reassessment of the individual.

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.522
Amplifies: 173.522
Five Year Review Date: 11/28/2025
Prior Effective Dates: 9/29/2011 (Emer.), 9/10/2012, 2/1/2017

Rule 173-40-03 | PASSPORT program (state-funded component): individual disenrollment and other actions.

• Effective: December 31, 2020
• Promulgated Under: 111.15

(A) Presumptive: For each individual 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 its designee shall disenroll any individual who no longer meets all requirements under paragraph (A) of rule 173-40-02 of the Administrative Code unless the only requirement the individual no longer meets is the PETI (i.e., patient-liability or share of cost) requirement listed in paragraph (A)(5) of that rule or during a state of emergency declared by the governor.

(2) No appeals: ODA or its designee shall not provide the individual with an opportunity for a hearing in accordance with Chapter 119. of the Revised Code if ODA or its designee disenrolls the individual for either or both of the following reasons:

(a) The individual has been enrolled in the state-funded component of the PASSPORT program under the requirements of paragraph (A) of rule 173-40-02 of the Administrative Code for the maximum enrollment period of ninety days, unless ODA's director approves an extended number of days.

(b) The individual voluntarily disenrolled from the state-funded component of the PASSPORT program under the requirements of paragraph (A) of rule 173-40-02 of the Administrative Code before reaching the maximum enrollment period of ninety days, unless ODA's director approves an extended number of days.

(3) Post-disenrollment prohibitions:

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

(b) After ODA or its designee disenrolls an individual from the state-funded component of the PASSPORT program, ODA or its designee shall not subsequently enroll the individual into the medicaid-funded component of the PASSPORT program until ODM's administrative agency determines the individual meets all medicaid financial eligibility requirements and ODA or its designee determines the individual meets all non-financial eligibility requirements under rule 5160-31-03 of the Administrative Code.

(c) After ODA or its designee disenrolls an individual from the state-funded component of the PASSPORT program, ODA or its designee shall not subsequently enroll the individual into the state-funded component of the assisted living program.

(4) Appeals:

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

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

(ii) To require the individual to pay a specified PETI (i.e., patient-liability amount or share of cost) each month.

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

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

(b) On form ODA1117, ODA or its 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 its designee shall also print a mailing date on the form.

(c) If an individual wishes to appeal ODA's or its 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

246 N. High St., 1st Floor

Columbus, OH 43215"

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

(B) Grandparented: For an individual 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) Reassessment:

(a) Whenever ODA or its designee reassesses the condition and service needs of the individual, ODA or its designee shall verify if the individual continues to meet all eligibility requirements under paragraph (B) of rule 173-40-02 of the Administrative Code.

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

(c) At least once every six months ODA or its designee shall develop and implement a revised person-centered services plan for the individual so long as the individual continues to meet all the eligibility requirements under paragraph (B) of rule 173-40-02 of the Administrative Code.

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

(2) Disenrollment:

(a) ODA or its designee may propose to disenroll an individual from the state-funded component of the PASSPORT program for any one or more of the following:

(i) The individual does not continue to meet all the eligibility requirements under paragraph (B) of rule 173-40-02 of the Administrative Code.

(ii) The individual's permanent relocation.

(iii) The individual's death.

(b) When the individual's services are suspended for any reason for sixty calendar days, ODA or its designee shall provide the individual (or the individual'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 its designee shall not provide the individual with an opportunity for a hearing in accordance with Chapter 119. of the Revised Code if ODA or its designee disenrolls an individual if the individual voluntarily disenrolled from the state-funded component of the PASSPORT program under the requirements of paragraph (B) of rule 173-40-02 of the Administrative Code.

(4) Post-disenrollment prohibitions:

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

(b) After ODA or its designee disenrolls the individual from the state-funded component of the PASSPORT program, ODA or its designee shall not subsequently enroll the individual into the state-funded component of the assisted living program.

(5) Appeals:

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

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

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

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

(b) On form ODA1117, ODA or its 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 its designee shall also print a mailing date on the form.

(c) If an individual wishes to appeal ODA's or its 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

246 N. High St., 1st Floor

Columbus, OH 43215"

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

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.522
Amplifies: 173.522
Five Year Review Date: 11/28/2025
Prior Effective Dates: 6/11/1991 (Emer.)

Rule 173-40-04 | PASSPORT program (state-funded component): provider certification.

• Effective: March 1, 2017
• Promulgated Under: 119.03

A person or entity that seeks to become an ODA-certified provider for the state-funded component of the PASSPORT program shall apply to become so under rule 173-39-03 of the Administrative Code.

Supplemental Information

Authorized By: 173.01, 173.02, 173.391, 173.522
Amplifies: 173.39, 173.522
Five Year Review Date: 3/1/2022
Prior Effective Dates: 2/13/2012

Rule 173-40-05 | PASSPORT program (state-funded component): covered services.

• Effective: February 1, 2017
• Promulgated Under: 119.03

(A) The service plan for an individual enrolled in the state-funded component of the PASSPORT program shall only authorize services allowed under rule 5160-31-05 of the Administrative Code for the medicaid-funded component of the PASSPORT program.

(B) While a provider may provide an individual enrolled in the state-funded component of the PASSPORT program with a service not authorized in the individual's service plan, ODA or its designee shall not pay a provider for any service not explicitly authorized in the individual's service plan.

Supplemental Information

Authorized By: 173.01, 173.02, 173.522
Amplifies: 173.522
Five Year Review Date: 2/1/2022

Rule 173-40-06 | PASSPORT program (state-funded component): individual's choices and responsibilities.

• Effective: January 1, 2020
• Promulgated Under: 119.03

An individual enrolled in the state-funded component of the PASSPORT program has the same choices and responsibilities as rule 173-42-06 of the Administrative Code gives to an individual enrolled in the medicaid-funded component of the PASSPORT program.

ODA's designee has the same responsibilities regarding an individual enrolled in the state-funded component of the PASSPORT program as rule 173-42-06 of the Administrative Code gives to ODA's designee regarding an individual enrolled in the medicaid-funded component of the PASSPORT program.

Supplemental Information

Authorized By: 173.01, 173.02, 173.522
Amplifies: 173.522
Five Year Review Date: 1/1/2025
Prior Effective Dates: 2/13/2012