Ohio Admin. Code 173-42-06 - PASSPORT program (medicaid-funded component): individuals' choices and responsibilities
(A) Person-centered planning:
(1) The individual and ODA's designee shall
meet by telephone, video conference, or in person to develop the individual's
person-centered services plan (plan) according to rule
5160-44-02
of the Administrative Code.
(2)
Responsibilities for ODA's designee:
(a) ODA's
designee shall draft the plan in plain language that an individual with
disabilities or limited English proficiency, and the individual's team, may
understand.
(b) To assure the
individual's health and safety, ODA's designee shall help the individual make
choices that ODA's designee shall record into the plan. In doing so, ODA's
designee shall acknowledge that the individual may make choices that negatively
impact his or her life.
(c) In the
plan, ODA's designee shall record the following:
(i) Where the individual chooses to live
while receiving services.
(ii) The
providers from which the individual chooses to receive services.
(iii) The individual's personal preferences
on how services are to be provided to the individual.
(iv) Any additional information required by
rule
5160-44-02
of the Administrative Code.
(d) After the plan is developed, ODA's
designee shall give electronic or paper copies of the plan to the individual,
the individual's team, and the providers authorized in the plan.
(3) Choices and responsibilities
for the individual:
(a) In addition to any
person from ODA's designee, the individual may choose a team of people to join
the individual and ODA's designee in the meeting required 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 individual moves to
another address.
(b) The
individual's physical, mental, or emotional status changes.
(c) The individual's environmental status
significantly changes.
(d) Other
significant health or safety issues.
(4) The medicaid-funded component of the
PASSPORT program only pays for services authorized in the plan.
(B) Responsibilities regarding
providers in general:
(1) The individual shall
treat providers with respect.
(2)
The individual shall allow ODA's designee to exchange information with any of
the individual's service providers on a need-to-know basis.
(3) The individual shall neither request, nor
offer assistance to, a provider to engage in unethical, unprofessional,
disrespectful, or illegal behavior when providing a service.
(4) The individual shall report any incident
involving the provider to ODA's designee. In turn, ODA's designee shall
investigate any reported incident and report any incident that may impact the
health or safety of the individual to ODA.
(5) The individual shall notify ODA's
designee if the provider (or if an agency provider, the provider's staff)
misses a scheduled service episode.
(6) The individual shall notify 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) Immediately following the conclusion of
each episode of service by a participant-directed provider, the individual
shall provide the provider (or, if an agency provider, the provider's staff)
with his or her signature
the individual's unique identifier to verify that
the provider (or the provider's staff) provided the service. The individual
shall never sign
verify blank time sheets or time sheets that the
provider (or the provider's staff) completes before providing
services.
(8) The individual shall
verify when each episode of service begins and ends, and if rule
5160-1-40
of the Administrative Code requires using electronic visit verification (EVV),
verify when each episode of service begins and ends by using the provider's
chosen EVV method.
(9) The
individual shall work with ODA's designee to resolve problems and
concerns.
(10) If requested by the
individual, ODA's designee shall act as a facilitator to resolve conflicts
between the individual and the provider.
(C) Responsibilities for individuals to
direct participant-directed providers:
(1) An
individual may choose to direct a participant-directed provider. ODA's designee
shall authorize a participant-directed provider for the individual if all of
the following are met:
(a) The individual
completes form ODA1041 and submits
provides it to ODA's designee. As used in this
paragraph, "form ODA1041" means form ODA1041 'Individual's Request for a
Participant-Directed Provider' (Rev. 10/2020).
(b) The
provider is qualified and willing to provide the services the individual
needs.
(c) The individual
successfully completes any training that ODA or its designee
requires.
(d) ODA's designee
determines the individual is able to manage the provider (i.e., perform the
responsibilities of an employer). ODA's designee shall base this determination
on an assessment of the individual's strengths and weaknesses related to his or
her ability to direct a provider. The assessment shall evaluate whether the
individual demonstrates an 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 entering
into written or electronic agreements with
providers for specific activities.
(vi) The methods for training providers to
meet the individual's specific needs.
(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 develop a
back-up plan for providing a service if a provider is unable to provide the
agreed-upon service.
(ix) The
methods for lodging complaints, including use of the regional and state long
term care ombudsman, and familiarity with how to contact the state long-term
care ombudsman.
(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 using EVV.
(xii) Records-retention
requirements.
(2) ODA's designee shall retain records of
its assessment and determination under paragraph (D)(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) In a manner that is most-effective for
the individual, ODA's designee shall provide the individual with the following
information:
(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 medicaid-funded
component of the PASSPORT program.
(b) ODA's designee shall review the
information listed under paragraph (D)(3) (a) of this rule with the individual
and offer assistance to help him or her understand the information.
(c) ODA's designee shall help the individual
recruit, hire, retain, and fire his or her participant-directed
provider.
(d) ODA's designee shall
communicate with the individual in a manner that protects the individual's
confidentiality.
(e) ODA's designee
shall help the individual identify the method by which the individual shall
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) ODA's designee may
revise the person-centered services plan to require the individual to receive
services from only agency or non-agency providers if the individual fails to
comply with the requirements under paragraph (D) of this rule or if the
individual's health and safety cannot be assured by a participant-directed
provider. If ODA's designee requires the individual to receive services from
only agency providers, ODA's designee shall give the individual a notice to
this effect that also explains the individual's hearing rights in 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 his or her
participant-directed provider, the individual with the assistance of ODA's
designee shall review databases and check criminal records according to 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 his or her obligation to provide a service to the
individual.
(c) The individual
shall work with ODA's designee and the provider to decide what, if any,
additional orientation or training with the provider's scope of practice is
necessary for the provider to successfully complete in order to meet the
individual's needs. The individual and ODA's designee shall work with the
provider to secure the educational opportunity.
(d) The individual shall work with ODA's
designee and the provider to decide what, if any, continuing education
requirement within the provider's scope of practice is necessary to meet the
individual's expectations. The individual and ODA's designee shall work with
the provider to secure the educational opportunity. (The individual may
participate in the continuing education.)
(e) The individual shall work with the
financial management service ODA's designee provides for individuals who direct
participant-directed providers under the medicaid-funded component of the
PASSPORT program.
(f) The
individual shall work with ODA's designee to ensure 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 requires using EVV.
(3) Responsibility for the individual: The
individual shall designate a location in his or her 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.)
(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.
"Financial management service" has the same meaning as in rule 5160-31-02 of the Administrative Code.
"Incident" has the same meaning as in rule 173-39-01 of the Administrative Code.
"Signature"
"individual's signature" in rule
173-39-01
of the Administrative Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 121.07, 173.01, 173.02, 173.52
Rule Amplifies: 173.52; 42 C.F.R. 441.352
Prior Effective Dates: 03/17/2011, 01/01/2013, 03/01/2014, 01/01/2020, 06/11/2020 (Emer.), 12/31/2020
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