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

Current through all regulations passed and filed through July 1, 2024
(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.
As used in this chapter:
(B)
								"Activities of Daily Living (ADL)" means activities of daily
			 living as defined in rule
			 5160-3-05
			 of the Adminstrative Code.
(C)
								"Assessment"
			 means a face-to-face evaluation used to obtain information about an individual
			 including his or her condition, personal goals and preferences, functional
			 limitations, health status and other factors that are relevant to the
			 authorization and provision of services. Assessment information supports the
			 determination that an individual requires waiver services as well as the
			 development of the person-centered services plan.
(D)
								"Authorized
			 representative" has the same meaning as defined in rule
			 5160-1-33
			 of the Administrative Code.
(E)
								"C.F.R." means
			 the code of federal regulations.
(F)
								"Caregiver" means
			 relatives, friend, and/or significant others who voluntarily provide assistance
			 to the individual enrolled in PASSPORT and are responsible for the individual's
			 care on a continuing basis.
(G)
								"Case manager"
			 means the registered nurse, licensed social worker or licensed independent
			 social worker that ODA's designee employs to plan, coordinate, monitor,
			 evaluate, and authorize services received by individuals enrolled in
			 PASSPORT.
(H)
								"Case management" means the administrative activities
			 to assess, plan, coordinate, monitor, evaluate, and authorize services,
			 supports and resources provided to an individual enrolled in
			 PASSPORT.
(I)
								"Centers for medicare and medicaid services (CMS)"
			 means the federal agency that is part of the U.S. department of health and
			 human services, and that administers the medicaid program and approves home and
			 community-based services waivers.
(J)
								"Certification"
			 means providers are approved by the Ohio department of aging (ODA) to provide
			 services for PASSPORT as established in Chapter 173-39 of the Administrative
			 Code.
(K)
								"Financial management service (FMS)" is 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.
(L)
								"HCBS" or " Home and community-based services (HCBS)"
			 means services provided under the provisions set forth in 42 C.F.R. 441 Subpart
			 G ( October 1, 2018) that permit individuals to live in a home setting rather
			 than a nursing facility (NF) or hospital. HCBS waiver services are approved by
			 CMS for specific populations and are not otherwise available under the medicaid
			 state plan.
(M)
								"Home First" means the component of the PASSPORT HCBS
			 waiver program that offers priority enrollment for certain individuals in
			 accordance with section
			 173.521 of the Revised
			 Code.
(N)
								"Individual" means a medicaid recipient, a medicaid
			 recipient enrolled in a HCBS program, or person with pending medicaid
			 eligibility who is applying for HCBS waiver enrollment, or other long-term care
			 services
(O)
								"Individual provider" means a person with a signed
			 medicaid provider agreement with ODM to provide PASSPORT services in rule
			 5160-31-05
			 of the Administrative Code, and who meets the PASSPORT waiver program's
			 conditions of participation set forth in rule
			 5160-31-06
			 of the Administrative Code and who is not the spouse, parent, stepparent,
			 and/or legal guardian of the individual.
(P)
								"Instrumental
			 activities of daily living (IADL)" has the same meaning as defined in rule
			 5160-3-05
			 of the Administrative Code.
(Q)
								"Level of care"
			 or "LOC" means the designation describing a person's functional levels and
			 nursing needs pursuant to the criteria defined in rule
			 5160-3-05
			 of the Administrative Code.
(R)
								"Nursing Facility
			 (NF)" has the same meaning as defined in section
			 5165.01 of the Revised
			 Code.
(S)
								"ODA's designee" means an entity to which ODA delegates
			 one or more of daily waiver operations. ODA's current designees include the
			 area agencies on aging that ODA lists in rule
			 173-2-04
			 of the Administrative Code and catholic social services of the Miami
			 Valley.
(T)
								"ODM's administrative agency" has the same meaning as
			 "administrative agency" in rule
			 5160:1-1-01
			 of the Administrative Code.
(U)
								"Participant-directed individual provider" means a person
			 with a signed medicaid provider agreement with ODM to provide PASSPORT services
			 in rule
			 5160-31-05
			 of the Administrative Code, and who meets the PASSPORT waiver program's
			 conditions of participation set forth in rule
			 5160-31-06
			 of the Administrative Code and who is not the spouse, parent, stepparent,
			 and/or legal guardian of the consumer individual.
(V)
								"PASSPORT" or
			 "PASSPORT HCBS waiver program" means the medicaid-funded component of the
			 PASSPORT program created under section
			 173.52 of the Revised
			 Code.
(W)
								"Person-centered services plan" has the same meaning as
			 in rule
			 5160-44-02
			 of the Administrative Code.
(X)
								"Region" means
			 the geographic area in which ODA's designee operates the PASSPORT
			 program.
(Y)
								"Subregion" means a geographic area located within
			 ODA's designee's region for the purpose of establishing PASSPORT unit rates in
			 rule
			 5160-31-07
			 of the Administrative Code.
(Z)
								"Waiver service
			 provider" means an agency or person with a signed medicaid provider agreement
			 with ODM to provide HCBS waiver services, and who meets the conditions of
			 participation set forth in rule
			 5160-31-06
			 of the Administrative Code.
Replaces: 5160-31-02