Ohio Administrative Code
Title 173 - Department of Aging
Chapter 173-42 - Medicaid-Funded PASSPORT Program
Section 173-42-06 - PASSPORT program (medicaid-funded component): individuals' choices and responsibilities
Universal Citation: OH Admin Code 173-42-06
Current through all regulations passed and filed through September 16, 2024
(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
providerif
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 personcentered 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 backup 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
personcentered 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.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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