(A) Presumptive: Only an individual
meeting all the following qualifications 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, the individual would enroll
into 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 enrolls 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
transfer immediately to the medicaid-funded component of the PASSPORT
program.
(c) The individual is cooperating and 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 determined that ODM's administrative
agency would determine that the individual most likely 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.
(3) Non-financial
requirements:
(a) ODA or its designee and the individual entered into an
enrollment agreement, and the agreement indicated that the individual chose to
enroll in the state-funded component of the PASSPORT program, named the
individual's representative (if any), and 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 qualifications 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 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
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 on a documented inability of the individual to pay for nursing facility
care without assistance from the medicaid program. ODA or its designee only
considers 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 calculates 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 is not eligible to
participate in the state-funded component of the PASSPORT program for more than
ninety days, unless ODA's director approved an extended number of
days.
(D) ODA's designee may allow an
individual to provide verbal agreement for intent to enroll on the state-funded
component of the PASSPORT program at the time of assessment if the individual
is unable to provide a unique identifier of the individual. ODA's designee
may collect a unique identifier of the individual for the agreements required
in paragraphs (A)(2)(b), (A)(3)(a), (A)(4), and (B)(7) of this rule no later
than thirty days after the individual's original enrollment
date.
