(A) Person-centered
planning:
(1) The individual and
ODA's designee shall meet by telephone, video conference, or in person to
develop the individual's person-centered services plan (plan) according to
rule 5160-44-02 of the Administrative Code.
(2) Responsibilities for
ODA's designee:
(a) ODA's designee shall draft the plan in plain language
that an individual with disabilities or limited English proficiency, and the
individual's team, may understand.
(b) To assure the individual's health and safety, ODA's
designee shall help the individual make choices that ODA's designee shall
record into the plan. In doing so, ODA's designee shall acknowledge that
the individual may make choices that negatively impact his or her
life.
(c) In the plan, ODA's designee shall record the
following:
(i) Where the individual
chooses to live while receiving services.
(ii) The providers from
which the individual chooses to receive services.
(iii) The
individual's personal preferences on how services are to be provided to
the individual.
(iv) Any additional
information required by rule 5160-44-02 of the Administrative
Code.
(d) After the plan is developed, ODA's designee shall give
electronic or paper copies of the plan to the individual, the individual's
team, and the providers authorized in the plan.
(3) Choices and
responsibilities for the individual:
(a) In addition to any person from ODA's designee, the
individual may choose a team of people to join the individual and ODA's
designee in the meeting required in paragraph (A)(1) of this rule.
(b) The individual shall cooperate with, and show respect to,
ODA's designee to facilitate the following:
(i) Assessing the
individual and visiting the individual's home to determine the
individual's eligibility for the PASSPORT program, enroll the individual
into the PASSPORT program, and determine the individual's service
needs.
(ii) Recruiting,
selecting, and dismissing the individual's providers. 42 C.F.R. 431.51
allows an individual to choose the providers from whom the individual wants to
receive services, so long as each provider the individual chooses is qualified
and willing to provide the services the individual needs.
(iii) Developing and
maintaining back-up plans that meet the individual's needs.
(c) After the plan is developed, the individual shall do the
following:
(i) Understand the
services authorized in the individual's person-centered services
plan.
(ii) Use the services
ODA's designee authorizes in the approved plan.
(iii) Notify ODA's
designee if the individual desires to change the provider from whom the
individual receives services.
(iv) Notify ODA's
designee of any significant change that may affect the individual's
service needs so that ODA's designee may update the plan. Significant
changes include the following:
(a) The individual moves
to another address.
(b) The individual's
physical, mental, or emotional status changes.
(c) The individual's
environmental status significantly changes.
(d) Other significant
health or safety issues.
(4) The medicaid-funded
component of the PASSPORT program only pays for services authorized in the
plan.
(B) Responsibilities regarding providers
in general:
(1) The individual shall
treat providers with respect.
(2) The individual shall
allow ODA's designee to exchange information with any of the
individual's service providers on a need-to-know basis.
(3) The individual shall
neither request, nor offer assistance to, a provider to engage in unethical,
unprofessional, disrespectful, or illegal behavior when providing a
service.
(4) The individual shall
report any incident involving the provider to ODA's designee. In turn,
ODA's designee shall investigate any reported incident and report any
incident that may impact the health or safety of the individual to
ODA.
(5) The individual shall
notify ODA's designee if the provider (or if an agency provider, the
provider's staff) misses a scheduled service episode.
(6) The individual shall
notify the provider if the individual is going to miss a scheduled service
episode, unless the provider is already informed of the individual's
absence.
(7) Immediately following
the conclusion of each episode of service by a participant-directed provider,
the individual shall provide the provider (or, if an agency provider, the
provider's staff) with the individual's unique identifier to verify
that the provider (or the provider's staff) provided the service. The
individual shall never verify blank time sheets or time sheets that the
provider (or the provider's staff) completes before providing
services.
(8) The individual shall
verify when each episode of service begins and ends, and if rule 5160-1-40 of
the Administrative Code requires using electronic visit verification (EVV),
verify when each episode of service begins and ends by using the
provider's chosen EVV method.
(9) The individual shall work with
ODA's designee to resolve problems and concerns.
(10) If requested by the individual,
ODA's designee shall act as a facilitator to resolve conflicts between the
individual and the provider.
(C) Responsibilities for individuals to
direct participant-directed providers:
(1) An individual may
choose to direct a participant-directed provider. ODA's designee shall
authorize a participant-directed provider for the individual if all of the
following are met:
(a) The individual completes form ODA1041 and provides it to
ODA's designee. As used in this paragraph, "form ODA1041" means
form ODA1041 'Individual's Request for a Participant-Directed
Provider' (Rev. 10/2020).
(b) The provider is qualified and willing to provide the services
the individual needs.
(c) The individual successfully completes any training that ODA
or its designee requires.
(d) ODA's designee determines the individual is able to
manage the provider (i.e., perform the responsibilities of an employer).
ODA's designee shall base this determination on an assessment of the
individual's strengths and weaknesses related to his or her ability to
direct a provider. The assessment shall evaluate whether the individual
demonstrates an understanding of all of the following:
(i) The services
authorized in the individual's person-centered services plan.
(ii) The service
activities the medicaid-funded component of the PASSPORT program covers for
each service the individual would receive.
(iii) The methods for
hiring and firing a participant-directed provider and selecting and dismissing
agency and non-agency providers.
(iv) How to review
databases and check criminal records according to Chapter 173-9 of the
Administrative Code.
(v) The methods for
entering into written or electronic agreements with providers for specific
activities.
(vi) The methods for
training providers to meet the individual's specific needs.
(vii) The methods for
supervising and monitoring the provider's performance of specific
activities, including written or electronic approval of the provider's
time sheets.
(viii) How to develop a
back-up plan for providing a service if a provider is unable to provide the
agreed-upon service.
(ix) The methods for
lodging complaints, including use of the regional and state long term care
ombudsman, and familiarity with how to contact the state long-term care
ombudsman.
(x) The state appeal and
fair hearing request procedures.
(xi) How to verify when
each episode of service begins and ends, and to do so by using EVV, if rule
5160-1-40 of the Administrative Code requires using EVV.
(xii) Records-retention requirements.
(2) ODA's designee
shall retain records of its assessment and determination under paragraph
(D)(1)(c) of this rule.
(D) Choices and responsibilities
regarding participant-directed providers: If ODA's designee authorizes a
participant-directed provider for the individual in the person-centered
services plan, the following additional responsibilities apply:
(1) Responsibilities for
ODA's designee:
(a) In a manner that is most-effective for the individual,
ODA's designee shall provide the individual with the following
information:
(i) A list of the
individual's choices and responsibilities listed in this
rule.
(ii) The provider's
requirements under Chapter 173-39 of the Administrative Code.
(iii) Information on the
medicaid-funded component of the PASSPORT program.
(b) ODA's designee shall review the information listed under
paragraph (D)(3)(a) of this rule with the individual and offer assistance to
help him or her understand the information.
(c) ODA's designee shall help the individual recruit, hire,
retain, and fire his or her participant-directed provider.
(d) ODA's designee shall communicate with the individual in
a manner that protects the individual's confidentiality.
(e) ODA's designee shall help the individual identify the
method by which the individual shall verify that the provider provides each
episode of service according to the person-centered services plan, retain
records on verified services, and provide (or give access to) those records to
the participant-directed provider.
(f) ODA's designee may revise the person-centered services
plan to require the individual to receive services from only agency or
non-agency providers if the individual fails to comply with the requirements
under paragraph (D) of this rule or if the individual's health and safety
cannot be assured by a participant-directed provider. If ODA's designee
requires the individual to receive services from only agency providers,
ODA's designee shall give the individual a notice to this effect that also
explains the individual's hearing rights in division 5101:6 of the
Administrative Code.
(2) Responsibilities for
the individual and ODA's designee to perform together:
(a) For any person the individual has under final consideration
to hire as his or her participant-directed provider, the individual with the
assistance of ODA's designee shall review databases and check criminal
records according to section 173.38 of the Revised Code and Chapter 173-9 of
the Administrative Code.
(b) The individual and ODA's designee shall work together to
develop a back-up plan for providing a service if the provider cannot, or does
not, meet his or her obligation to provide a service to the
individual.
(c) The individual shall work with ODA's designee and the
provider to decide what, if any, additional orientation or training with the
provider's scope of practice is necessary for the provider to successfully
complete in order to meet the individual's needs. The individual and
ODA's designee shall work with the provider to secure the educational
opportunity.
(d) The individual shall work with ODA's designee and the
provider to decide what, if any, continuing education requirement within the
provider's scope of practice is necessary to meet the individual's
expectations. The individual and ODA's designee shall work with the
provider to secure the educational opportunity. (The individual may participate
in the continuing education.)
(e) The individual shall work with the financial management
service ODA's designee provides for individuals who direct
participant-directed providers under the medicaid-funded component of the
PASSPORT program.
(f) The individual shall work with ODA's designee to ensure
the person-centered services plan reflects the primary method to verify when
each episode of service begins and ends, including EVV, if rule 5160-1-40 of
the Administrative Code requires using EVV.
(3) Responsibility for
the individual: The individual shall designate a location in his or her home in
which the provider may safely store a copy of the individual's activity
plan in a manner that protects the individual's confidentiality. (Having a
copy of the activity plan in the individual's home contributes to the
provider's ability to adhere to the activity plan.)
(E) Authorized representative: If an
individual has an authorized representative, the individual's authorized
representative may represent the individual for any purpose under this
rule.
(F) Definitions for this
rule:
"Agency provider," 'non-agency
provider," and "participant-directed provider" have the same
meanings as in the definition of "provider" in rule 173-39-01 of the
Administrative Code.
"Financial management service" has the
same meaning as in rule 5160-31-02 of the Administrative Code.
"Incident" has the same meaning as in
rule 173-39-01 of the Administrative Code.
"Unique identifier" has the same
meaning as in rule 173-39-01 of the Administrative Code.
