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This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and universities.

Chapter 173-42 | Medicaid-Funded PASSPORT Program

 
 
 
Rule
Rule 173-42-01 | PASSPORT program (medicaid-funded component): introduction and definitions.
 

(A) Introduction: Chapter 173-42 of the Administrative Code regulates the medicaid-funded component of the PASSPORT program created under section 173.52 of the Revised Code. (See Chapter 173-40 of the Administrative Code for rules on the state-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.

"Nursing facility" has the same meaning as in section 5165.01 of the Revised Code.

"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.

"PASSPORT program" means the medicaid-funded component of the PASSPORT program created under section 173.52 of the Revised 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: 173.52, 173.02, 173.01
Amplifies: 173.52; 42 C.FR. 441.352
Five Year Review Date: 11/1/2023
Prior Effective Dates: 2/22/2001, 3/12/2011
Rule 173-42-02 | PASSPORT program (medicaid-funded component): eligibility requirements for individuals.
 

A person is only eligible for the medicaid-funded component of the PASSPORT program if he or she meets the eligibility requirements under rule 5160-31-03 of the Administrative Code.

Supplemental Information

Authorized By: 173.01, 173.02, 173.52
Amplifies: 173.52' 42 C.F.R. 441.352
Five Year Review Date: 11/1/2023
Rule 173-42-03 | PASSPORT program (medicaid-funded component): enrollment and reassessment of individuals.
 

(A) Initial contact: To determine if an individual who applies for the medicaid-funded component of the PASSPORT program meets all eligibility requirements for the program under rule 5160-31-03 of the Administrative Code, ODM's administrative agency shall determine if the individual meets all medicaid financial eligibility requirements required by that rule and ODA's designee shall determine if the individual meets all non-financial eligibility requirements required by that rule. An individual may contact either ODM's administrative agency or ODA's designee to start the enrollment process. The two agencies shall coordinate processing the request for enrollment into the medicaid-funded component of the PASSPORT program.

(1) ODM's administrative agency: An individual who makes initial contact with ODM's administrative agency shall apply for medicaid (unless already enrolled in medicaid) and for the medicaid-funded component of the PASSPORT program. ODM's administrative agency shall determine if the individual meets all financial eligibility requirements and shall notify ODA's designee of the application. In response, ODA's designee shall initiate contact with the individual to conduct an assessment by telephone, video conference, or in person to determine if the individual meets all non-financial eligibility requirements.

(2) ODA's designee:

(a) An individual who makes initial contact with ODA's designee shall apply for medicaid (unless already enrolled in medicaid) and for the medicaid-funded component of the PASSPORT program with the assistance of ODA's designee. ODA's designee shall conduct an assessment by telephone, video conference, or in person to determine if the individual meets all non-financial eligibility requirements.

(b) After the individual applies for the medicaid-funded component of the PASSPORT program, ODA or its designee shall notify the individual of the existence of the state-funded component of the PASSPORT program in Chapter 173-40 of the Administrative Code and offer the individual an opportunity to apply for enrollment in the state-funded component of the program.

(B) If determined ineligible: If ODM's administrative agency or ODA's designee determines the individual does not meet all eligibility requirements for the program under rule 5160-31-03 of the Administrative Code, ODA's designee shall not enroll the individual in the program.

(1) ODM's administrative agency: If ODM's administrative agency determines the individual does not meet all financial eligibility requirements, it shall notify ODA's designee and send the individual a notice of denial and hearing rights under section 5101.35 of the Revised Code and division 5101:6 of the Administrative Code.

(2) ODA's designee: If ODA's designee determines the individual does not meet all non-financial eligibility requirements, it shall send the individual a notice of denial and hearing rights under section 5101.35 of the Revised Code and division 5101:6 of the Administrative Code.

(C) If determined eligible: If ODM's administrative agency or ODA's designee determine the individual meets all eligibility requirements for the program under rule 5160-31-03 of the Administrative Code, ODA's designee shall notify the individual that he or she meets all eligibility requirements and enroll the individual into the program according to paragraph (C)(1) or (C)(2) of this rule.

(1) Available slot: If a waiver slot in the medicaid-funded component of the PASSPORT program is available, ODA's designee shall enroll the individual into the program, if the individual continues to meet the eligibility requirements for the program and continues to want to enroll into the program. ODA's designee shall not place the individual on the unified waiting list.

(2) No available slot: If a waiver slot is not available in the medicaid-funded component of the PASSPORT program, ODA's designee may enroll the individual when a waiver slot does become available by one of two means: the unified waiting list or the home-first component of the medicaid-funded component of the PASSPORT program.

(a) Unified waiting list: If an individual meets all the non-financial eligibility requirements, but a slot is not available in the PASSPORT program, ODA's designee shall place the individual on the unified waiting list according to rule 173-44-04 of the Administrative Code, unless the individual qualifies for the home first component of the PASSPORT program, as addressed in paragraph (C)(2)(b) of this rule.

(b) Home first: If an individual meets all requirements for the home first component of the PASSPORT program in section 173.521 of the Revised Code, ODA's designee shall enroll the individual before enrolling any individual from the unified waiting list.

(D) Reassessment: ODA's designee shall reassess each individual enrolled into the medicaid-funded component of the assisted living program no less often than one time each year after the date the individual enrolled into the program. After ODA's designee conducts each reassessment, if the individual continues to qualify for the medicaid-funded component of the program, the individual shall decide if he or she wishes to remain in the program. If the individual wishes to remain, the individual shall sign form ODA1044 as a condition of continued enrollment. ODA's designee may collect the individual's handwritten or electronic signature on the form on a date later than the date the individual agrees to continue in the program, but no later than the next reassessment of the individual. As used in this paragraph, "ODA1044" means "ODA1044 'Annual Enrollment Agreement' (March, 2014)."

(E) An authorized representative may represent an individual in the enrollment and reassessment processes.

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.52
Amplifies: 173.52; 42 C.F.R. 441.352
Five Year Review Date: 11/28/2025
Prior Effective Dates: 10/3/2005 (Emer.), 1/13/2006, 1/14/2010, 9/29/2011
Rule 173-42-06 | PASSPORT program (medicaid-funded component): individuals' choices and responsibilities.
 

(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 his or her signature to verify that the provider (or the provider's staff) provided the service. The individual shall never sign 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 submits 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 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 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.

"Signature" has the same meaning as "individual's signature" in rule 173-39-01 of the Administrative Code.

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.52
Amplifies: 173.52; 42 C.F.R. 441.352
Five Year Review Date: 11/28/2025
Prior Effective Dates: 3/1/2014, 1/1/2020