Ohio Admin. Code 5160-31-02 - Pre-admission screening system providing options and resources today (PASSPORT) HCBS waiver program definitions
(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
Notes
Promulgated Under: 119.03
Statutory Authority: 5166.02
Rule Amplifies: 173.52
Prior Effective Dates: 07/16/1984, 12/22/1986 (Emer.), 03/23/1987, 07/01/1990, 01/14/1996, 09/01/1998, 03/01/2000, 03/03/2001, 07/01/2006, 03/17/2011, 09/29/2011, 03/06/2014
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