Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-31 - Medicaid Home and Community Based Services Waiver Portion of the PASSPORT Program › Section 5160-31-03 - Eligibility for enrollment in the PASSPORT HCBS waiver program

Current through all regulations passed and filed through July 1, 2024
(A) To be eligible
			 for the medicaid-funded component of the pre-admission screening system
			 providing options and resources today (PASSPORT) program, an individual must
			 meet all of the following requirements:
(1)
			 The individual must have been determined eligible for medicaid in accordance
			 with Chapters 5160:1-1 to 5160:1-6 of the Administrative Code.
(2) The cost of waiver services in the
			 person-centered services plan does not exceed the individual cost limit at the
			 time of initial enrollment. The individual cost limit is equal to fourteen
			 thousand and seven hundred dollars per month for waiver services.
(a) If ODA's designee determines that the
			 applicant's waiver service needs cannot be met within the individual cost
			 limit, the individual shall not be enrolled.
(b) Once enrolled in PASSPORT, additional
			 waiver services may be authorized in excess of the individual cost limit with
			 prior approval from ODA.
(c) When
			 additional waiver services that exceed the individual cost limit are not
			 approved, the individual shall be disenrolled from the waiver.
(3) The needed services are not
			 readily available through another source at the level required to allow the
			 individual to live in the community.
(4) The individual agrees to participate in
			 PASSPORT and while enrolled in PASSPORT, shall 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).
(5) The individual's health related needs can
			 be safely met in a home and community-based setting as determined by ODA's
			 designee.
(6) The individual will
			 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.
(7)
									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/or the
			 medicaid state plan) in an amount sufficient to meet the individual's assessed
			 needs; or
(b)
										Has a need for and agrees to receive all of the
			 following:
(i)
											Medicaid state plan private duty nursing
			 services,
(ii)
											At least monthly monitoring of the individual's health
			 and welfare through a combination of telephonic and in-person contacts with the
			 case manager, and
(iii)
											At least one waiver service
			 annually.
(8) Services in the person-centered services
			 plan are to be approved by one of the medical practitioners in paragraphs
			 (A)(8)(a) to (A)(8)(c) of this rule, within the scope of his/her or their
			 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.
(9)
			 While enrolled in PASSPORT, the individual must reside in a setting that
			 possesses the home and community-based setting characteristics set forth in
			 rule 5160-44-01 of the Administrative
			 Code and not reside in a hospital, nursing facility (NF), intermediate care
			 facility for individuals with an intellectual disability (ICF-IID) or another
			 licensed/certified facility, any facility covered by section 1616(e) of the
			 Social Security Act (42
			 U.S.C. 1382e(e) (January 1,
			 2024)
			 residential care facility, adult foster home or another group living
			 arrangement subject to state licensure or certification.
(10) The individual is age sixty or older at
			 the time of enrollment.
(11) The
			 individual must be 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, would require NF services as defined in
			 42 C.F.R.
			 440.40 (as in effect on October 1,
			 2023).
(12) PASSPORT has not reached the
			 CMS-authorized limit on the number of individuals who may enroll on the waiver
			 during the current year.