(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, the individual would also not be eligible to participate in the
state-funded component of the PASSPORT program.)
(b) The individual agreed that, if the individual 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 the individual 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 the individual 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 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.
(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 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.
(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.
