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

Ohio Admin. Code 5160-31-02

Effective: 1/1/2019
Five Year Review (FYR) Dates: 01/01/2024
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