(A) Person-centered
planning:
(1) The individual is
subject to rule 5160-44-02 of the Administrative Code. To comply with that
rule, the individual and ODA's designee have flexibility to meet by
telephone, video conference, or in person to develop the individual's
person-centered services plan (plan).
(2) ODA's designee shall draft the
plan according to the requirements in rule 5160-44-02 of the Administrative
Code.
(3) Choices and
responsibilities for the individual:
(a) The individual may choose a team of people to join the
individual and ODA's designee in the meeting 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 provider does not
provide an authorized service at the time, or for the period of time,
authorized by ODA's designee.
(b) The individual moves to another address.
(c) The individual
repeatedly refuses to receive services.
(4) The medicaid-funded
component of the PASSPORT program only pays for services authorized in the
plan.
(B) General responsibilities for the
individual regarding providers:
(1) Treating providers
with respect.
(2) Allowing ODA's
designee to exchange information with any of the individual's service
providers on a need-to-know basis.
(3) Neither requesting,
nor offering assistance to, a provider to engage in unethical, unprofessional,
disrespectful, or illegal behavior when providing a service.
(4) Reporting any
incident involving the provider to ODA's designee. In turn, ODA's
designee is subject to the incident-reporting requirements in rule 5160-44-05
of the Administrative Code.
(5) Notifying ODA's
designee if the provider (or if an agency provider, the provider's staff)
misses a scheduled service episode.
(6) Notifying 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) Providing 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 a service immediately following the conclusion
of each episode.
(8) Verifying when each
episode of service begins and ends, and if rule 5160-1-40 of the Administrative
Code requires using electronic visit verification (EVV), verifying when each
episode of service begins and ends by using the provider's chosen EVV
method.
(9) Working with ODA's designee to
resolve problems and concerns. If requested by the individual, ODA's
designee shall act as a facilitator to resolve conflicts between the individual
and the provider.
(C) Qualifications for individuals to
direct participant-directed providers:
(1) An individual
qualifies to direct a participant-directed provider if ODA's designee
determines that all of the following are met:
(a) The provider is qualified and willing to provide the
services the individual needs.
(b) The individual successfully completes any training that
ODA or its designee determines is necessary for the individual to direct a
participant-directed provider.
(c) ODA's designee determines that the individual is
able to direct a provider (i.e., perform the responsibilities of an employer)
based upon an assessment by ODA's designee of the individual's
strengths and weaknesses related to the individual's ability to direct a
provider and 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
developing written or electronic activity plans with providers.
(vi) How to determine the
necessary skills for a provider to meet the individual's specific needs
and the options for providers to acquire those skills.
(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 work with
ODA's designee to develop a back-up plan for providing a service if a
provider is unable to provide the agreed-upon service.
(ix) How to seek
assistance from the state or regional long-term care ombudsman program to
resolve a problem or concern with a provider.
(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 participant-directed providers to
use EVV.
(xii) Records-retention requirements.
(2) ODA's designee
shall retain records of its assessment and determination under paragraph
(C)(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) Providing the individual with the following information in a
manner that is most effective for the individual:
(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
PASSPORT program.
(b) Reviewing the information listed under paragraphs (D)(2) and
(D)(3) of this rule with the individual and offer assistance to help the
individual understand the information.
(c) Helping the individual recruit, hire, retain, and fire the
individual's participant-directed provider.
(d) Communicating with the individual in a manner that protects
the individual's confidentiality.
(e) Helping the individual identify the an appropriate method for
the individual to 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) Revising the person-centered services plan to remove
authorization for a participant-directed provider if both of the following
occur:
(i) Either the individual
fails to comply with the responsibilities for individuals under paragraphs
(D)(2) and (D)(3) of this rule or the individual's health and safety
cannot be assured by a participant-directed provider.
(ii) ODA's designee
notifies the individual that it no longer authorizes the individual to receive
a service from a participant-directed provider and the individual's right
to a hearing on this matter under 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 the individual's participant-directed provider, the individual
may seek the assistance of ODA's designee to comply with 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 the provider's obligation to provide a service to the
individual.
(c) The individual shall consult with ODA's designee to
determine what, if any, skills the provider needs to meet the individual's
specific needs, training the provider needs to obtain those skills, deadline to
impose on the provider to complete the training, and means for the provider to
access the training. The individual may participate in the
training.
(d) The individual shall work with the financial management
service that ODA's designee provides for individuals who direct
participant-directed providers under the medicaid-funded component of the
PASSPORT program.
(e) The individual shall work with ODA's designee to
ensure that 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 obligates participant-directed providers
to use EVV.
(3) Responsibilities for
the individual:
(a) The individual shall develop an activity plan with the
provider, date the plan, and provide the individual's unique identifier to
authenticate the plan, in a manner that does not conflict with the
person-centered services plan.
(b) The individual shall designate a location in the
individual's 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.)
(c) No individual may verify blank time sheets or time
sheets that the provider (or the provider's staff) completes before
providing services.
(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.
"Electronic visit verification" (EVV)
has the same meaning as 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.
"Unique identifier" has the same
meaning as in rule 173-39-01 of the Administrative Code.
