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.
(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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