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The Ohio Department of Aging

Ohio Department of Aging Provider FAQ

What kind of service provider will qualify for certification?

Any individual or agency currently operating and providing the service, or one similar, in their community may apply for certification. An agency provider must have already procured qualified staff and be providing the service to consumers and have a record for being paid for at least two older adults for at least three months. In addition, it must have documentation supporting compliance with policy, procedural and documentation requirements of the ODA-certified Medicaid Waiver Programs Conditions of Participation and Service Specifications.

A consumer-directed individual provider must demonstrate a person receiving ODA-administered Medicaid waiver program services wants to hire him or her as their service provider before applying for certification.
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What are the Conditions of Participation and Service Specifications and how do they apply to the individual applicant?

ODA has established the PASSPORT Conditions of Participation and Service Specifications as the standards by which all PASSPORT services must be delivered. The Conditions of Participation apply to all service providers. The Service Specifications define and set the standards for each individual service and apply only to providers of those individual services.
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Must an applicant be a Medicare Certified Home Health Agency or a "traditional" Medicaid agency provider to quality for certification by ODA?

Medicare certification as a home health agency is not a requirement for all ODA-certified Medicaid Waiver Program service providers. However, a certified provider of personal care service that is also a Medicare Certified Home Health Agency and a "Traditional" Medicaid State Plan Home Health provider offers consumers who need both skilled home health services and unskilled personal care services with the most continuity of care options. Though all Medicaid Waiver services must be medically necessary, most ODA-certified Medicaid Waiver services are not medical in nature. Providers who are certified to provide State Plan Medicaid services, Medicare services and ODA-certified Medicaid Waiver Program services only bill each payer source for reimbursement that authorizes a particular service or a particular number of units of service. One exception is that a provider of Enhanced Community Living Service must be certified to provide all three types of services: ODA-certified Medicaid waiver program services, Medicare certified services, and "traditional" state plan Medicaid services.
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Is a provider limited to serving in only one of the Ohio Department of Aging thirteen regions or PASSPORT Administrative Agencies (PAAs)?

No. Each applicant is reviewed for certification by the PAA in which their place of business or service origination is geographically located. Once certified, an agency may expand service delivery to other geographic areas. Agencies can be certified to furnish services in any size area for which they can demonstrate they meet the qualifications of the Conditions of Participation and Service Specifications. For instance, a provider of home medical equipment may be able to serve consumers in all of Ohio's eighty-eight counties if the provider only ships a particular item to consumers through a delivery service, while a personal care provider would need to have several regional offices to serve consumers throughout the state in order to meet the requirements to provide supervision of aides, ensure back-up staff and furnish services seven days per week.
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Does the agency have to complete another full application to provide services in another PASSPORT Administrative Agency?

No. Once certified to provide services in one region, the provider only needs to request approval to expand into another region by requesting a contract to provide services in another region. The request is made to the regional PAA in the area it wishes to offer services.
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Must an agency be or become a traditional Ohio Medicaid service provider to participate in the PASSPORT program?

No. While ODA-certified Medicaid Waiver Programs, including PASSPORT, are Medicaid waiver programs, ODA certification does not make an agency eligible to deliver traditional State Plan Medicaid services in Ohio. ODA-certified Medicaid Waiver Provider enrollment permits the provider to be reimbursed for ODA Medicaid waiver program services only.

Medicare certification as a home health agency is not a requirement for all ODA-certified Medicaid waiver program service providers. However, a certified provider of personal care service that is also a Medicare certified home health agency and a "traditional" Medicaid State Plan home health provider offers consumers who need both skilled home health services and unskilled personal care services with the most continuity of care options. Though all Medicaid Waiver services must be medically necessary, most ODA-certified Medicaid Waiver services are not medical in nature. Providers who are certified to provide State Plan Medicaid services, Medicare services and ODA-certified Medicaid waiver program services only bill each payer source for reimbursement that authorizes a particular service or a particular number of units of service. One exception is that a provider of Enhanced Community Living Service must be certified to provide all three types of services: ODA-certified Medicaid waiver program services, Medicare certified services and "traditional" State Plan Medicaid services.
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How does an ODA-certified Medicaid Waiver provider receive reimbursement for services?

Reimbursement for ODA Medicaid Waiver Program services requires the provider to have a Medicaid provider number that indicates it is certified by ODA to provide specific services.
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If the applicant is already a provider of traditional State Plan Ohio Medicaid services, does it need to apply for another Medicaid number?

Yes. Reimbursement for ODA Medicaid Waiver Program services requires the provider to have a Medicaid number that has a waiver designation code. The application process begins when the applicant applies for certification through the MITS portal. ODJFS will assign the appropriate waiver designation code to an existing provider Medicaid number or will assign a new number to the provider to be used exclusively for reimbursement of waiver services.
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What happens if the applicant does not successfully demonstrate compliance with the Conditions of Participation and Service Specifications?

There are key elements of the Conditions of Participation and Service Specifications that are viewed as basic "structural elements." These identify the agency's basic organizational structure, policies, procedures, documentation formats and current service to the community. Development of a quality community provider base is an ODA value. To ensure consumer choice, we have developed technical assistance mechanisms to assist applicants in understanding and complying with the Conditions of Participation and Service Specifications. The PASSPORT Administrative Agency representative will identify areas of non-compliance and provide a timeframe for corrective action.
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What are typical non-compliance findings?

Typical findings are: documentation formats that do not provide for consumer or worker signature, record retention policies that do not meet the six-year requirement, documentation of personnel orientation, qualifications and training and documentation demonstrating compliance with criminal record check requirements. An applicant has only thirty days to clearly demonstrate it is in full compliance with all Conditions of Participation and Service Specifications. If an applicant cannot demonstrate it is in full compliance within the allotted time, the application for certification will be denied and the applicant must wait for a period of one year to reapply.
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What will the PAA reviewer expect to see or look at during the on-site pre-certification visit?

The reviewer(s) will be assessing key elements of the Conditions of Participation and Service Specifications. For instance, the reviewer(s) will review consumer files to ensure documentation of service provided is clear and complete and includes required elements such as a record of the tasks completed, date and time of aide's arrival and departure, signatures of both the consumer and aide, evidence that the tasks completed were authorized in the consumer's service plan, evidence the agency nurse conducted an initial assessment of the consumer, etc. The reviewer(s) will also review employee files to ensure documentation clearly indicates the employee was qualified to be hired; the employee underwent a criminal record check, etc. In addition, reviewer(s) will review the provider's table of organization, billing records, and written policies and procedures.

Each specific service that the applicant wishes to furnish adds elements to the initial on-site pre-certification visit. Specific service areas require review or assessment of the elements listed in the Service Specifications of each service, such as documentation of training and skill testing, as well as documentation specific to the service delivered.
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