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SECTION 1. Terms Related to PASSPORT, Choices and Assisted Living »
SECTION 2. Ohio Department of Aging PASSPORT Provider Certification Process »
SECTION 3. Where to Turn if You Need Help »
Terms related to PASSPORT, Choices and Assisted Living
Accreditation: An accreditation is an approval of an organization by an official review board after the organization has met specific requirements. Accreditations are optional for ODA certified providers. Various types of accreditations are listed below.
Annual Structural Compliance Review: This is a yearly visit to the organization’s site, designed to ensure that the organization continues to meet the standards required by the state. Organizations that do not meet 100% compliance have a period of time to make corrections to their policy or practice, and must submit evidence of compliance. Organizations that do not make the corrections risk sanctions or de-certification, i.e. they may lose their approval to provide service to consumers.It is important to understand that the review outcome should only be one part of the picture of in choosing a provider. Please consider other factors, too, such as those listed under “General Tips for Choosing a Home Health Provider.”
Bonding: Bonding offers financial protection to a company in the case of a specific event employee dishonesty or theft.
CARF - Commission on Accreditation Rehabilitation Facilities (http://www.carf.org/): CARF grants accreditation to Adult Day services, Assisted Living Facilities, Behavioral Health and Community Services and Medical rehabilitation programs. CARF is a private not-for-profit organization that has been in operation since 1966. CARF accreditation is optional for providers.
CHAP - Community Health Accreditation Program, Inc. (http://www.chapinc.org/): CHAP specializes is an organization that specializes in accrediting home care and community health organizations. The organization states that its standards meet or succeed those of Medicare. CHAP accreditation is optional for PASSPORT providers.
Care Plan: The care plan is a plan for the services a consumer will receive to independence. The amount of the services included in the care plan are limited to a cost cap, roughly equal to 60% of the cost of nursing home care.
Case Manager: The Case Manager is a licensed nurse or social worker who will help consumers and their families make decisions about services. The Case Manager will contact providers to coordinate services and can help problems or make changes when necessary.
Conditions of Participation and Service Specifications: The Conditions of Participation are the standards required of all PASSPORT providers. The Service Specifications are the standards Service Specifications for each particular service. 100% compliance is the score that a provider can earn. Please remember, that the compliance score is only one part of the picture in choosing a provider. Please consider other factors, such as those found under “How to choose a home care provider".
Consumer: A consumer is a person who is enrolled in and receives services from the PASSPORT program.
Consumer Feedback: It is important that consumers inform the case manager if they experience a problem with a service provider. Communication with the provider and case manager is the first step in making sure that any issue is resolved.
Disciplinary Action: Penalty imposed against a provider for compliance issue that poses a potential health and/or safety risk to consumers.
JCAHO - Joint Commission on Accreditation of Healthcare Organizations (http://www.jointcommission.org): JCAHO is a not-for-profit organization that the quality of a variety of health care organizations, including over 5,600 organizations that provide care in the consumer’s home. In some states, JCAHO accreditation can help an organization to qualify for Medicare or Medicaid certification without undergoing an additional government survey. JCAHO accreditation is optional for PASSPORT providers.
Medicaid (http://cms.hhs.gov): A jointly funded, Federal-State health insurance low-income and needy people. It covers approximately 36 million individuals including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments.
PASSPORT, Choices and Assisted Living are a Medicaid waiver program, which means that Ohio uses some of its Medicaid money for long-term care and makes it available for consumers to receive care in their homes instead of nursing facilities.
Medicare (http://cms.hhs.gov): The nation's largest health insurance program administered by The Centers for Medicare and Medicaid, which covers over 39 million Americans. Medicare provides health insurance to people age 65 and over, those who have permanent kidney failure, and certain people with disabilities.
In order for an organization to provide the designated services (Skilled Nursing, Physical Therapy,Occupational Therapy and Speech Therapy), the organization must be Medicare and Medicaid certified.
Pre-Certification: This is the review process the Provider completes in order to provide PASSPORT consumers. The pre-certification visit is conducted by a COAAA Quality Improvement coordinator and takes place at the organization’s business address. The visit involves a review of the organization’s policies and procedures, physical site and personnel records. Only organizations that demonstrate the ability to reach 100% compliance with the standards set by the state will be recommended for certification.
Provider Relations: Provider Relations is the division of the COAAA dedicated to certifying providers and monitoring the care provided to consumers. The division follows a continuous quality improvement philosophy. The division works in partnership with the agencies that provide PASSPORT care to ensure that consumers receive the best possible service.
Technical Assistance: From time to time, providers may need help in developing or implementing policies and practices required by PASSPORT. A Quality Improvement Coordinator is assigned to each provider. Providers may contact the Coordinator if a provider would like help in ensuring quality services.
Unit of Service Verification: A COAAA Staff member audits the amount of services billed to ensure that they match the services provided by an organization. These audits help to ensure that taxpayer dollars are being used as approved within the care plan.
Ohio Department of Aging PASSPORT Provider Certification Process
What is the Central Ohio Area Agency on Aging?
The Central Ohio Area Agency on Aging (COAAA) is the agency in central Ohio that must determine that any organization wanting to provide PASSPORT, Choices or Assisted Living Waiver services has the capacity to meet all of the Conditions of Participation (Ohio Administrative Code Rule 173-39-02 ) and relevant Service Specifications (Ohio Administrative Code Rule 173-39-02.1 through 173-39-02.17). To determine capacity, COAAA Quality Improvement (QI) coordinators examine the provider applicant’s policies and procedures, documentation system, charting processes, and delivery of direct consumer services.
The Provider Relations Division of the COAAA, the division charged with certifying and monitoring providers, operates with a quality improvement approach. Our goal is to help providers offer the best possible service to PASSPORT consumers.
Who can apply to become an ODA-certified provider?
- Applicants must be legal businesses (not-for-profit or for-profit) within the State of Ohio. All applicants must have provided, at the time of application, services to at least two consumers age 60 years and over in the central Ohio area for a minimum of three months. The applicant must employ qualified staff, and have written policies and procedures that support the Conditions of Participation and Service Specifications.
- Staffing agencies that wish to apply must have a home health care component.
What services are available to consumers?
- Adult Day Services
- Chore Services
- Personal Care Services
- Homemaker
- Home Delivered Meals
- Emergency Response System
- Enhanced Community Living
- Independent Living Assistance
- Home Medical Equipment and Supplies
- Home Care Attendant
- Minor Home Modification, Maintenance and Repair
- Medical Transportation
- Nutrition Consultation
- Social Work/Counseling
- Alternative meals
- Out of Home Respite
- Pest Control
- Home Care Attendent
- Assisted Living Services
- Community Transition Services
- Waiver Nursing Services
Organizations that provide “Designated Services” (Skilled Nursing, Physical Therapy, Occupational Therapy and Speech Therapy) must be Medicaid- and Medicare-certified. Medicaid and/or Medicare also pay for these services.
How will I know whether my agency is able to meet standards?
It is recommended that all applicants thoroughly read the Conditions of Participation and Service Specifications. They indicate what processes and personnel must be in place in order for an organization to become certified as an ODA provider. It is suggested that applicants review each item and analyze how that standard is currently being met. Your organization must meet these standards at the point of application.
What are the Conditions of Participation and Service Specifications?
The Ohio Department of Aging (ODA), in consultation with Ohio Department of Job and Family Services (ODJFS), the regional Area Agencies on Aging, and service providers, established the Conditions of Participation and Service Specifications as the standards by which all services must be delivered. They were designed to ensure the health, safety and welfare of each consumer.
The Conditions of Participation (OAC 173-39-02 ) apply to all service The Service Specifications (OAC 173-39-02.1 through 173-39-2.17 ) define and set the standards for individual PASSPORT services and apply only to providers of those services. There are no exceptions or waivers to the Conditions of Participation or Service Specifications, regardless of the size or the mission of the organization.
Will my organization be required to develop manuals and policies to become an ODA provider? What personnel will the organization need to have?
Since applicants are required to be businesses which are “currently operating and providing services in the community,” most organizations are able to adapt their current policies to meet ODA requirements. However, many organizations will need to develop some additional policies or procedures in order to meet the Conditions of Participation and Service Specifications. Policies and practice should reflect care for older adult individuals who live in their own homes.
The Service Specifications contain the personnel requirements for each service.
How long does the certification process take?
The applicant has considerable control over the length of the certification process.
The certification process, and the timeframe for the process, is written in Ohio Administrative Code. However, to its benefit, the applicant can affect how thoroughly the application is completed, how prepared the applicant is for a pre-certification visit, how quickly the applicant provides evidence of compliance, if necessary, and so on. The better prepared an applicant is, the more likely-- and the more quickly--the applicant will be able to meet the standards and be recommended for certification.After an organization is recommended for certification, Ohio Administrative Code continues to guide the flow of the process and the amount of time allocated to each step. Many organizations are involved with the certification process, including the Ohio Department of Job and Family Services, the Ohio Department of Aging and the City of Columbus.
In short, the certification process involves: an initial review of your application, a pre-certification visit and review at your offices, submission of evidence of compliance (if necessary), review of your application by both the Ohio Department of Aging and the Ohio Department Job and Family Services, and the signing of a contract between your organization and the COAAA/City of Columbus.
See OAC 173-39-03 for details.
When will my organization be able to provide services to consumers?
If ODA grants approval, the fiscal division of the COAAA will mail to you a contract to provide services. As with all contracts, be sure to read the contract carefully. After you return the signed copy to the COAAA Case Managers are notified and your contact information is added to the COAAA provider referral list.
In what counties will my organization provide services?
The Central Ohio Area Agency on Aging has consumers in the following counties: Delaware, Fairfield, Fayette, Franklin, Licking, Madison, Pickaway and Union. On the provider application, there is a space for the applicant to state in exactly which counties the organization will be able to provide services.
We encourage you to apply for only those counties where you currently have staff available to work and where you currently meet local laws (e.g. zoning laws.) If, at some time your organization has the staff available to provide services in additional counties, you may then apply to be a provider in those counties.
How will my organization receive referrals?
Case Managers have a list of providers for each service and county. When it is determined that a consumer is eligible for a service, case managers will telephone or fax a provider based on consumer choice or lowest rate.
How will my organization be paid?
For some services, such as Homemaker and Personal Care, the organization and the COAAA will negotiate rates based upon the regional market rate. List your rate for these services on the application Rate Sheet.
Other services, such as Enhanced and Intensive Adult Day services and Assisted Living, are a flat rate throughout the state. These rates are preprinted on the Rate Sheet.
Still other services, such as Chore, Minor Home Modification, Transportation and Community Transition Services, are per bid services, so reimbursement varies according to the bid/job. If the space for rate is “filled in” on the Rate Sheet, there is no need to provide a rate or charge on the application for that service.
Organizations applying for Home Medical Equipment certification are asked to provide the COAAA with a price list or catalogue of items.
Will my organization need special software to bill for services?
After ODA has approved the organization as a provider, COAAA Billing Staff will send you a packet with a description of the billing process.
All providers are encouraged to use the automated billing system. Providers who bill for more than $5,000 worth of services per month will be required to use the Automated Billing System. As required by contract, when your billing reaches $5,000 per month, you will receive a letter with the software application and instructions.
My organization is a provider for another Ohio Medicaid Waiver. Will we still need to go though the ODA certification process?
Yes. Each provider must be ODA certified as an ODA provider, regardless of the organization’s accreditation, certification or participation in another program.
Does the organization need to have Medicaid or Medicare certification to become an ODA provider?
No.
Does my organization need to be compliant with the Health Insurance Portability and Accountability Act (HIPAA) in order be an ODA-certified Provider?
Yes. Federal law (HIPAA, 1996) requires that all health care providers fitting particular criteria meet Privacy Regulations by April 14th, 2003. HIPAA compliance is investigated by the U.S. Department of Health and Human Services’ Office of Civil Rights. Compliance and is a complaint driven process.The COAAA has internal and external polices and practices designed to meet HIPAA standards. The COAAA is acovered entity. Under HIPAA, a covered entity is defined as “a health plan, a health care clearinghouse or a health care provider who transmits any health information in electronic form in connection with a HIPAA transaction.” As part of the application and certification process, each applicant is required to submit an assurance stating that the applicant is HIPAA compliant. All applicants and certified providers are required to develop plans to meet and maintain compliance with HIPAA; the COAAA does not monitor HIPAA compliance and does not provide applicants with compliance assistance.
As part of its policies and practice, the COAAA educates consumers about HIPAA requirements. While the COAAA does not monitor HIPAA compliance, the COAAA is required to report issues of non-compliance involving providers to the Office of Civil Rights.
Information about HIPAA and HIPAA compliance can be found at the following resources.
Privacy Regulation:
http://www.mgma.com
Compliance Assistance:
http://www.hhs.gov/ocr/hipaa/guidelines
http://www.mh.state.oh.us/hipaa/policies
http://www.cms.hhs.gov.hipaa/
Administrative Simplification law (process, regulation):
http://aspe.os.dhhs.gov/admnsimp
WEDI SNIP (Small provider implementation white paper):
http://wedi.snip.org (check under “work products” and “security & privacy”)
After ODA provider certification, how will my organization be monitored and evaluated?
Each year, your organization will receive an on-site visit called an Annual Structural Compliance Review. QI Coordinators will measure your organization’s compliance with Conditions of Participation and Service Specifications. The organization will receive written feedback from the review and will be required to submit evidence of compliance when necessary. A Unit of Service audit may be conducted to ensure that all service is billed and reimbursed accurately.
QI Coordinators provide on-going monitoring and may contact the agency at any time throughout the year to provide technical assistance and investigate issues of non-compliance.
Where to Turn if You Need Help
There are organizations that are able to help you if you have problems with the care that is being provided to you:
State of Ohio Attorney General’s Office
If you suspect that funds are being used inappropriately in regard to your care, you may contact the State of Ohio Attorney General’s office. The Attorney General’s Office has a unit that investigates Medicaid fraud.
(614) 466-4320
http://www.ag.state.oh.us
Long-Term Care Ombudsman
The Long-Term Care Ombudsman’s Office is an organization that helps to ensure that community based services are upholding consumer’s rights.
Call (614) 221-5891 or (800) 536-5891 for services delivered in Franklin, Delaware, Fairfield, Fayette, Licking, Madison, Pickaway and Union counties. Please contact the COAAA case manager, if applicable, if you experience a problem with your services. This is the first step to resolving any problem with a provider.