Chapter 5160-31 | Medicaid Home and Community Based Services Waiver Portion of the PASSPORT Program

Rule 5160-31-02 | Pre-admission screening system providing options and resources today (PASSPORT) HCBS waiver program definitions.

• Effective: September 22, 2025
• Promulgated Under: 119.03

(A) The purpose of this rule is to define the terms used in Chapter 5160-31 of the Administrative Code governing the preadmission screening system providing options and resources today (PASSPORT) home and community-based services (HCBS) waiver program.

(B) "Assessment" means an evaluation used to obtain information about an individual including their condition, personal goals and preferences, functional limitations, health status, and other factors that are relevant to the authorization and provision of services. Information obtained from the assessment supports the determination of program eligibility and the development of the person-centered services plan.

(C) "Authorized representative" means as defined in rule 5160-1-33 of the Administrative Code.

(D) "Case manager" means as defined in rule 173-39-01 of the Administrative Code.

(E) "Centers for medicare and medicaid services (CMS)" means the federal agency that is part of the United States department of health and human services, and that administers the medicaid program and approves HCBS waivers.

(F) "Financial management service (FMS)" means a support provided to waiver participants who direct some or all of their waiver services. In the PASSPORT waiver, this support is conducted as an administrative activity through an entity under contract with the state of Ohio. When used in conjunction with the participant-directed authorities available to individuals enrolled in PASSPORT, this support includes operating a payroll service for participant-employed workers and making required payroll withholdings.

(G) "Home and community-based services (HCBS)" means services furnished under the provisions set forth in 42 C.F.R. 441 Subpart G (October 1, 2024) that permit individuals to live in a home setting rather than in a facility. HCBS waiver services are approved by CMS for specific populations and are not otherwise available under the medicaid state plan.

(H) "Home first" means the component of the PASSPORT HCBS waiver program that offers priority enrollment in the waiver for certain individuals in accordance with section 173.521 of the Revised Code.

(I) "Individual" means a person applying for or receiving medical assistance or home and community-based services.

(J) "Level of care (LOC)" means the designation describing an individual's person's functional levels and nursing needs pursuant to the criteria defined in rule 5160-3-05 of the Administrative Code.

(K) "Nursing Facility (NF)" means as defined in section 5165.01 of the Revised Code.

(L) "ODA's designee" means as defined in rule 173-39-01 of the Administrative Code.

(M) "ODM's administrative agency" has the same meaning as "administrative agency" as defined in rule 5160:1-1-01 of the Administrative Code.

(N) "PASSPORT" or "PASSPORT HCBS waiver program" means the medicaid-funded component of the PASSPORT program created under section 173.52 of the Revised Code and approved by the centers for medicare and medicaid services.

(O) "Person-centered services plan" means as defined in rule 5160-44-02 of the Administrative Code.

(P) "Provider" means an agency or a person with a signed medicaid provider agreement with ODM and certified by ODA.

Last updated September 22, 2025 at 7:44 AM

Supplemental Information

Authorized By: 5166.02
Amplifies: 173.52
Five Year Review Date: 9/22/2030
Prior Effective Dates: 3/23/1987, 1/14/1996, 7/1/2006, 9/29/2011

Rule 5160-31-03 | PASSPORT HCBS waiver program: eligibility and enrollment.

• Effective: September 22, 2025
• Promulgated Under: 119.03

(A) The "Ohio department of aging (ODA)" is the agency responsible for daily operations for the pre-admission screening system providing options and resources today (PASSPORT) home and community-based services (HCBS) waiver. ODA will operate this waiver pursuant to an interagency agreement with the Ohio department of medicaid (ODM) in accordance with sections 5162.35 and 173.52 of the Revised Code. ODA will establish processes and procedures to enroll individuals on the waiver that is in accordance with rule 173-42-03 of the Administrative Code.

(B) An individual is eligible for the medicaid-funded component of the PASSPORT program only if the individual meets all of the following criteria:

(1) The individual is determined eligible for medicaid in accordance with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code.

(2) The needed services are not readily available through another source at the level required to allow the individual to live in the community.

(3) The individual agrees to participate in PASSPORT and not be simultaneously enrolled in the state-funded component of the PASSPORT program, the state-funded component of the assisted living program, another medicaid home and community-based program, the residential state supplement (RSS) program, or the program of all inclusive care for the elderly (PACE) while enrolled in PASSPORT.

(4) The individual's health related needs can be safely met in a home and community-based setting as determined by ODA or its designee.

(5) The individual agrees to participate in the development of a person-centered services plan in accordance with the process and requirements set forth in rule 5160-44-02 of the Administrative Code.

(6) The individual:

(a) Has a need for and agrees to receive at least one waiver service monthly that is otherwise unavailable through another source (including, but not limited to, private pay, community resources and the medicaid state plan) in an amount sufficient to meet the individual's assessed needs; or

(b) Has a need for:

(i) Continuous nursing services for more than four hours in length,

(ii) At least one waiver service annually, and

(iii) Monthly monitoring of the individual's health and welfare through a combination of telephonic and in-person contacts with the case manager and agrees to cooperate with the monthly monitoring.

(7) The individual resides in a setting that possesses the home and community-based setting characteristics set forth in rule 5160-44-01 of the Administrative Code and that is not a hospital, nursing facility (NF), intermediate care facility for individuals with an intellectual disability (ICF-IID), or another licensed or certified facility, any facility covered by section 1616(e) of the Social Security Act (42 U.S.C. 1382(e) (January 1, 2025) residential care facility or another group living arrangement subject to state licensure or certification.

(8) The individual is age sixty years or older at the time of enrollment.

(9) The individual is determined to meet the criteria for an intermediate or skilled level of care in accordance with rule 5160-3-08 of the Administrative Code and, in the absence of PASSPORT, requires NF services as defined in 42 C.F.R. 440.40 (as in effect on October 1, 2024).

(C) To be enrolled and maintain enrollment in PASSPORT, the individual will meet all of the following criteria:

(1) The individual is determined eligible for PASSPORT in accordance with paragraph (B) of this rule.

(2) The services in the person-centered services plan are approved by one of the medical practitioners in paragraphs (C)(2)(a) to (C)(2)(c) of this rule, acting within their scope of practice. Approval may be verbal or written and is to be obtained prior to initial enrollment. Written approval may be satisfied via electronic signature.

(a) A licensed physician;

(b) A licensed certified nurse practitioner;

(c) A licensed physician assistant.

(3) The individual cost limit does not exceed fourteen thousand and seven hundred dollars per month for waiver services.

(a) At the time of enrollment, the initial cost of waiver services in the person-centered services plan does not exceed the cost limit.

(b) The ongoing cost of waiver services in the person-centered services plan may not exceed the cost limit unless otherwise approved by ODA.

(4) There is an available PASSPORT slot that does not exceed the CMS-authorized limit for individuals enrolled for the waiver program year.

(D) If, at any time, the individual does not meet the criteria in paragraph (B) or paragraph (C) of this rule, the individual will be denied enrollment or disenrolled from PASSPORT. In such instances, the individual is notified of their hearing rights in accordance with division 5101:6 of the Administrative Code.

Last updated September 22, 2025 at 7:44 AM

Supplemental Information

Authorized By: 5166.02
Amplifies: 173.52
Five Year Review Date: 9/22/2030
Prior Effective Dates: 7/1/2008, 11/25/2016, 1/1/2019

Rule 5160-31-05 | PASSPORT HCBS waiver program covered services.

• Effective: October 1, 2024
• Promulgated Under: 119.03

(A) The purpose of this rule is to establish the services covered by the pre-admission screening system providing options and resources today (PASSPORT) home and community based services (HCBS) program.

(B) The PASSPORT program benefit package is limited to the following services:

(1) Adult day as set forth in rule 173-39-02.1 of the Administrative Code;

(2) Alternative meals as set forth in rule 173-39-02.2 of the Administrative Code;

(3) Choices home care attendant as set forth in rule 173-39-02.4 of the Administrative Code;

(4) Community integration as set forth in rule 173-39-02.15 of the Administrative Code;

(5) Community transition as set forth in rule 173-39-02.17 of the Administrative Code;

(6) Enhanced community living as set forth in rule 173-39-02.20 of the Administrative Code;

(7) Homemaker as set forth in rule 173-39-02.8 of the Administrative Code;

(8) Home care attendant as set forth in rule 173-39-02.24 of the Administrative Code;

(9) Home delivered meals as set forth in rule 173-39-02.14 of the Administrative Code;

(10) Home maintenance and chore as set forth in rule 173-39-02.5 of the Administrative Code;

(11) Home medical equipment and supplies as set forth in rule 173-39-02.7 of the Administrative Code;

(12) Home modification as set forth in rule 173-39-02.9 of the Administrative Code;

(13) Non-medical transportation as set forth in rule 173-39-02.18 of the Administrative Code;

(14) Nutrition consultation as set forth in rule 173-39-02.10 of the Administrative Code;

(15) Out-of-home respite as set forth in rule 173-39-02.23 of the Administrative Code;

(16) Personal care as set forth in rule 173-39-02.11 of the Administrative Code;

(17) Personal emergency response system as set forth in rule 173-39-02.6 of the Administrative Code;

(18) Social work or counseling as set forth in rule 173-39-02.12 of the Administrative Code;

(19) Structured family caregiving as set forth in rule 173-39-02.25 of the Administrative Code; and

(20) Waiver nursing as set forth in rule 173-39-02.22 of the Administrative Code.

(C) Services will be delivered by providers who meet the requirements in Chapter 173-39 of the Administrative Code in a manner that is consistent with the individual's person-centered services plan as documented in the PASSPORT information management system (PIMS).

(D) In accordance with the federally approved PASSPORT waiver, the services identified in this paragraph are subject to employer and/or budget authority if elected by the individual. Services will be provided in accordance with the requirements in paragraph (B) of this rule:

(1) The following services are subject to employer authority, including the ability to hire, fire, and train employees:

(a) Choices home care attendant; and

(b) Personal care.

(2) The following services are subject to budget authority, including the ability to negotiate reimbursement rates paid to providers furnishing services:

(a) Alternative meals;

(b) Choices home care attendant;

(c) Home medical equipment and supplies;

(d) Home maintenance and chore; and

(e) Home modification.

(E) An individual who elects to direct any of the services provided in paragraph (D) of this rule will be assessed by their case manager to determine the individual's ability to direct their services as set forth in rule 173-42-06 of the Administrative Code.

(1) If an individual demonstrates the ability to direct their services, the case manager may initiate the orientation process to familiarize the individual with the participant direction of services including the role of the financial management service (FMS).

(2) If an individual is unable to demonstrate the ability to direct his or her care and to assume the responsibilities associated with the participant direction authorities in paragraph (D) of this rule, the individual may choose an authorized representative to act on his or her behalf.

(3) If no authorized representative is available, the case manager will assist the individual with obtaining services through ODA-certified long-term care agency providers.

(F) If an individual who is seeking to direct his or her services chooses an authorized representative to act on his or her behalf in accordance with paragraph (E)(2) of this rule, the authorized representative will not serve as the individual's provider.

Last updated October 1, 2024 at 9:07 AM

Supplemental Information

Authorized By: 5166.02
Amplifies: 173.52
Five Year Review Date: 10/1/2029
Prior Effective Dates: 3/1/2014, 1/1/2019, 7/1/2019

Rule 5160-31-07 | PASSPORT HCBS waiver program rate setting.

• Effective: October 1, 2024
• Promulgated Under: 119.03

The purpose of this rule is to describe the methods used to determine provider rates for the pre-admission screening system providing options and resources today (PASSPORT) program.

(A) Rates determined under this rule will not exceed the maximum allowable rates for PASSPORT services in appendix A to rule 5160-1-06.1 of the Administrative Code. Payment for PASSPORT waiver services constitutes payment in full and will not be construed as a partial payment when the payment amount is less than the provider's usual and customary rate. In accordance with rule 5160-1-13.1 of the Administrative Code, the provider will not bill the individual for any difference between the medicaid payment and the provider's rate or request the individual to share in the cost through a co-payment or other similar charge.

(B) PASSPORT rates are established for the services in rule 5160-31-05 of the Administrative Code under the following categories:

(1) Per-job bid rate;

(2) Per-item rate; and

(3) Unit rate.

(C) Rates set within the categories in paragraph (B) of this rule may be:

(1) Participant-directed, in which the individual or a designated authorized representative, who is acting on the individual's behalf, may negotiate the rate for services furnished by providers as specified in paragraphs (D)(3), (E)(3), and (G)(1) of this rule.

(2) Statewide, in which the state establishes a rate used on a statewide basis to pay for services specified in paragraph (F)(1) of this rule.

(3) Group rates which are seventy-five per cent of the rate the provider would be paid for providing PASSPORT services as specified in paragraphs (D)(2), (F)(2), and (F)(3) of this rule.

(D) For the services listed in this paragraph, the provider and the Ohio department of aging or its designee negotiate a per-job rate.

(1) A per-job bid rate applies to the following services:

(a) Community transition;

(b) Home maintenance and chores;

(c) Home modification;

(d) Non-medical transportation.

(2) Non-medical transportation rendered simultaneously by the same provider to more than one individual enrolled in the PASSPORT program, who reside in the same home and who travel in the same vehicle to the same destination is paid at a group rate of seventy-five per cent of the provider's per-job bid rate.

(3) Home modification and home maintenance and chores may be participant-directed services in which the individual enrolled in the PASSPORT program, or their authorized representative, acting on the individual's behalf, may negotiate rates.

(a) The negotiated rate is reviewed by Ohio department of aging's (ODA) designee and reflected on the individual's person-centered service plan prior to service delivery.

(b) Should the individual choose not to negotiate a rate the service may be paid at a rate proposed by the provider and accepted by the individual and ODA's designee. The accepted rate is reflected on the individual's person-centered service plan.

(E) A per-item rate applies to home medical equipment and supplies.

(1) No per-item rate may exceed the medicaid state plan rate.

(2) A home medical equipment and supplies item that does not have an established medicaid rate may be paid at a per-item bid rate from the provider which has been agreed to in writing by ODA's designee prior to delivery of the item.

(3) Home medical equipment and supplies may be participant-directed in which the individual enrolled on PASSPORT or the authorized representative acting on the individual's behalf, may negotiate rates.

(a) The negotiated rate is reviewed by ODA's designee and reflected on the individual's person-centered services plan prior to service delivery.

(b) Should the individual choose not to negotiate a rate, the service may be paid at a rate agreed upon between the provider, the individual, and ODA's designee. The agreed upon rate is reflected on the individual's person-centered services plan.

(F) ODA will establish unit rates for the services listed in this paragraph.

(1) Statewide unit rates are established and used for the following services:

(a) Adult day;

(b) Adult day transportation;

(c) Community integration;

(d) Enhanced community living;

(e) Home care attendant;

(f) Home delivered meals;

(g) Homemaker;

(h) Nutritional consultation;

(i) Out-of-home respite;

(j) Personal care;

(k) Personal emergency response system;

(l) Social work or counseling;

(m) Structured family caregiving; and

(n) Waiver nursing.

(2) The services in paragraphs (F)(1)(e), (F)(1)(j), and (F)(1)(m) of this rule, when rendered consecutively during the same visit to more than one but fewer than four PASSPORT individuals in the same household, and identified in the individuals' person-centered service plans, are paid to one hundred per cent of the provider's per unit rate set in accordance with paragraph (C) of this rule for one PASSPORT individual and paid a group rate for each subsequent PASSPORT individual in the household receiving services during the visit.

(3) Adult day transportation rendered simultaneously by the same provider to more than one individual residing in the same household and traveling in the same vehicle to the same destination is paid using a group rate equal to seventy-five per cent of the provider's rate.

(G) The services in this paragraph are participant directed and the individual may negotiate unit rates with providers.

(1) The participant directed services include:

(a) Alternative meals; and

(b) Choices home care attendant.

(2) The individual will have in effect, before choices home care attendant services are delivered, a signed provider agreement with each ODA-certified participant-directed individual provider delivering services to the individual. The provider agreement will:

(a) Include the rate negotiated with the provider;

(b) Specify the time period the rates are in effect;

(c) Base rates on the units of service as set forth in Chapter 173-39 of the Administrative Code; and

(d) Be signed by the individual receiving the choices home care attendant service and the home and community based services (HCBS) provider.

(3) The rates negotiated by the individual with providers of services in paragraph (G)(1) of this rule will not exceed the maximum allowed per unit of service as specified in appendix A to rule 5160-1-06.1 of the Administrative Code. The negotiated rate is reviewed by ODA's designee, and reflected on the individual's person-centered service plan prior to service delivery.

(4) Should the individual choose not to negotiate a rate for any of the services in paragraph (G)(1) of this rule, the service may be paid at a rate agreed upon by the provider, the individual and the individual's case manager. The agreed upon rate is reflected on the individual's person-centered services plan.

(H) The Ohio department of medicaid, or its designee,will evaluate unit rates within two years of the effective date of this rule and every two years thereafter.

Last updated October 1, 2024 at 9:07 AM

Supplemental Information

Authorized By: 5166.02
Amplifies: 173.52
Five Year Review Date: 10/1/2029
Prior Effective Dates: 9/1/1998, 7/1/2006, 7/1/2008, 7/1/2014