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

 

 

 

TO BE RESCINDED

 

173-42-01                    Enrollment       process         for       PASSPORT         home                          and community-based services medicaid waiver program.

 

 

 

(A)   The purpose of this rule is to establish the enrollment process for the PASSPORT home and community-based services medicaid waiver program.

 

(B)  Definitions for this rule:

 

(1)  "CDJFS" means "county department of job and family services."

 

(2)   "Nursing facility" has the same meaning as in section 5111.20 of the Revised Code.

 

(3)   "ODJFS" means "the Ohio department of job and family services."

 

(4)    """PASSPORT administrative agency" ("PAA") has the same meaning as in section 173.42 of the Revised Code.

 

(5)     "PASSPORT program" ("PASSPORT") means the program created under section 173.40 of the Revised Code.

 

(6)    "Authorized representative" means a person, eighteen years of age or older, acting on behalf of an individual who is applying for or receiving medical assistance. An authorized representative may be a family member, attorney, hospital social worker, or any other person chosen to act on the individual's behalf. In accordance with rule 5101:1-38-01.2 of the Administrative Code, the individual must provide a written statement naming the authorized representative and the duties which the named authorized representative may perform on the individual's behalf.

 

(C)    An individual may contact either the CDJFS or the PAA to start the enrollment process. The two agencies shall coordinate processing the request for enrollment into PASSPORT.

 

(1)    An individual who makes initial contact with the CDJFS must complete the application for home and community-based services using the medicaid application JFS07200 "Request for Cash, Food Stamp, and Medical Assistance" form and the JFS 02399 "Request for Medicaid Home and Community-Based Services (HCBS)" form. The CDJFS must notify the PAA of the individuals' application for waiver services. The PAA must initiate contact with the individual to complete the enrollment process.

 

 

 

(2)   An individual who makes initial contact with the PAA will receive an in person assessment to determine eligibility for PASSPORT. The PAA may assist the individual in applying for medicaid financial eligibility, if not already initiated, by completing the medicaid application JFS 07200 "Request for Cash, Food Stamp, and Medical Assistance" form and securing the individual's or authorized representative's signature on the JFS 02399 "Request for Medicaid Home and Community-Based Services (HCBS)" form. The PAA may submit these forms to the CDJFS on behalf of the individual.

(D)   The PAA must ensure that the following conditions are met before an individual may be enrolled in PASSPORT:

(1)    The CDJFS must determine that the individual meets the financial eligibility requirements for medicaid coverage of home and community-based services specified in Chapters 5101:1-37 to 5101:1-39 of the Administrative Code; and,

(2)   The PAA must determine that the individual meets the eligibility requirements for enrollment into PASSPORT specified in rule 5101:3-31-03 of the Administrative Code.

(3)   Because the United States centers for medicare and medicaid services limits the number of slots available for enrollment in PASSPORT, and the Ohio department of aging is responsible for managing enrollment into the program, the PAA must determine that there is a slot available before an individual may be enrolled in the program.

(E)   Any applicant for PASSPORT services is entitled to notice and hearing rights as set forth in section 5101.35 of the Revised Code and division-level designation 5101:6 of the Administrative Code.

(1)   The PAA must notify the individual and authorized representative, if any, of the approval for enrollment for an individual determined to meet all PASSPORT eligibility criteria.

(2)     If the PAA determines that the individual does not meet the criteria for enrollment into PASSPORT, the PAA must notify the CDJFS of the results, and the CDJFS must send notice of denial of the application to the individual and authorized representative, if any.

(3)    If the CDJFS determines the individual does not meet the financial eligibility

criteria,  the  CDJFS  must  send  notice  of  denial  of  the  application  to  the individual and authorized representative, if any, and notify the PAA.

(F)     If an individual meets all the non-financial eligibility criteria, but a slot is not available for enrollment in PASSPORT, the individual must be placed on a waiting list according to the later of the individual's signature date on the JFS 02399 "Request for Medicaid Home and Community-Based Services (HCBS)" form or the date all non-financial eligibility criteria have been met.

(1)    With the exception of the circumstance specified in paragraph (F)(2) of this rule, the PAA must remove each individual from the waiting list to be enrolled in PASSPORT according to the chronological order of the date the individual was placed on the waiting list.

(2)   The PAA must offer enrollment to an individual on the waiting list residing in a nursing facility according to the chronological order of the date the individual was placed on the waiting list, and prior to all other individuals on the waiting list who are not residents of a nursing facility.

Effective:	03/12/2011
R.C. 119.032 review dates:	11/18/2010
CERTIFIED ELECTRONICALLY
Certification
03/02/2011
Date
Promulgated Under:	119.03
Statutory Authority:	173.02, 173.40, 173.404
Rule Amplifies:	173.40, 173.401, 173.404
Prior Effective Dates:	02/22/2001, 01/13/2006, 01/14/2010