Rule 173-40-03 | PASSPORT program (state-funded component): individual disenrollment and other actions.
(A) Presumptive: For each individual enrolled in the state-funded component of the PASSPORT program on the basis of paragraph (A) of rule 173-40-02 of the Administrative Code:
(1) Disenrollment: ODA or its designee shall disenroll any individual who no longer meets all requirements under paragraph (A) of rule 173-40-02 of the Administrative Code unless the only requirement the individual no longer meets is the PETI (i.e., patient-liability or share of cost) requirement listed in paragraph (A)(5) of that rule, during a state of emergency declared by the governor, or during a federal public health emergency if federal financial participation pays for all of the individual's services.
(2) Post-disenrollment limitations: After ODA or its designee disenrolls an individual from the state-funded component of the PASSPORT program, the following limits apply:
(a) The individual is not eligible to re-enroll into the state-funded component of the PASSPORT program on the basis of presumptive eligibility.
(b) The individual is not eligible to enroll into the medicaid-funded component of the PASSPORT program until ODM's administrative agency determines the individual meets all medicaid financial eligibility requirements and ODA or its designee determines the individual meets all non-financial eligibility requirements under rule 5160-31-03 of the Administrative Code.
(c) The individual is not eligible to enroll into the state-funded component of the assisted living program.
(B) Grandparented: For an individual who is enrolled in the state-funded component of the PASSPORT program on the basis of paragraph (B) of rule 173-40-02 of the Administrative Code:
(1) Reassessment: ODA or its designee shall do all of the following:
(a) Verify if the individual continues to meet all eligibility requirements under paragraph (B) of rule 173-40-02 of the Administrative Code whenever ODA or its designee reassesses the condition and service needs of the individual.
(b) Reassess the individual to assess the individual's condition and service needs at least once every twelve months or at any time the individual's condition or service needs change substantially.
(c) Develop and implement a revised person-centered services plan for the individual at least once every six months so long as the individual continues to meet all the eligibility requirements under paragraph (B) of rule 173-40-02 of the Administrative Code.
(2) Disenrollment:
(a) ODA or its designee may propose to disenroll an individual from the state-funded component of the PASSPORT program for any of the following:
(i) The individual does not continue to meet all the eligibility requirements under paragraph (B) of rule 173-40-02 of the Administrative Code.
(ii) The individual's permanent relocation.
(b) When the individual's services are suspended for any reason for sixty calendar days, ODA or its designee shall provide the individual (or the individual's authorized representative, if any) with notice of disenrollment from the state-funded component of the PASSPORT program.
(c) Suspensions which ultimately result in disenrollment have a disenrollment date which is retroactive to the first day of the suspension of services.
(3) Post-disenrollment limitations: After ODA or its designee disenrolls an individual from the state-funded component of the PASSPORT program, the following limits apply:
(a) The individual is not eligible to re-enroll into the state-funded component of the PASSPORT program on the basis of presumptive eligibility.
(b) The individual is not eligible to enroll into the state-funded component of the assisted living program.
(C) Appeals: An eligible individual may appeal a decision made under this rule pursuant to section 173.523 of the Revised Code. The individual's appeal is timely only if the request for a hearing is received by ODA within thirty days of the date in which ODA mailed the notice of opportunity for hearing.
Last updated February 1, 2023 at 8:46 AM
Supplemental Information