Frequently Asked Questions
The page provides answers to common questions for providers associated with the Central Ohio Area Agency on Aging.
Common Terms & Definitions
An accreditation is an approval of an organization by an official review board after the organization has met specific requirements. Accreditations are optional for AGE-certified providers. Various types of accreditations are listed below.
Bonding offers financial protection to an organization in the case of employee dishonesty or theft.
(carf.org): CARF grants accreditation to organizations providing adult day, assisted living, behavioral health, community, and medical rehabilitation services. CARF is a private not-for-profit organization that has been in operation since 1966. CARF accreditation is optional for AGE-certified providers.
(chapinc.org): CHAP specializes in accrediting home care and community health organizations. CHAP states that its standards meet or exceed those of Medicare. CHAP accreditation is optional for AGE-certified providers.
The Case Manager is a licensed nurse or social worker who helps consumers and their families make decisions about services. The Case Manager will contact providers to coordinate services and can help resolve problems or make changes when necessary.
A consumer is a person who is enrolled in and receives services through a waiver program.
It is important that consumers inform their Case Manager if they experience a problem with a service provider. Communication between the provider and the Case Manager is the first step in resolving an identified issue.
Disciplinary actions can be imposed against a provider for good cause, misfeasance, malfeasance, nonfeasance, confirmed abuse or neglect, financial irresponsibility, or other conduct AGE determines is injurious, or poses a threat, to the health or safety of consumers being served. Disciplinary actions can also be imposed against a provider if they’ve failed to submit required evidence of compliance after compliance deficiencies are identified and communicated.
(jointcommission.org): JCAHO is a not-for-profit organization that assesses the quality of a variety of health care providers, including over 5,600 that provide care in a 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 AGE-certified providers.
(cms.gov): Medicaid is a jointly funded, Federal-State health insurance program for 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, Consumer Direction, and Assisted Living are Medicaid waiver programs, which means that Ohio uses some of its Medicaid money for long-term care to ensure consumers can receive care in their homes instead of moving to an institutional setting.
(cms.gov): Medicare is 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 aged 65 and over, those who have permanent kidney failure, and those with certain other disabilities. In order to provide skilled nursing, state plan, physical therapy, occupational therapy, and speech therapy, an organization must be Medicare and Medicaid certified.
This is the review process an applicant must complete in order to provide PASSPORT, Consumer Direction, or Assisted Living services. The pre-certification visit is conducted by a COAAA Provider Relations Coordinator and takes place at the applicant’s business site. The visit involves a review of the applicant’s policies and procedures, documentation system, charting processes, personnel charts, and service delivery documentation as applicable. Only applicants that demonstrate the ability to reach 100% compliance with the standards set by the state will be recommended for certification.
Provider Relations is the division of COAAA dedicated to certifying providers and monitoring providers’ ongoing compliance with state rules. The division follows a continuous quality improvement philosophy. The division works in partnership with AGE-certified providers to ensure that consumers receive the best possible service.
These are the two primary sets of state rules that providers must follow when providing PASSPORT, Consumer Direction, and/or Assisted Living services. (codes.ohio.gov/ohio-administrative-code/chapter-173-39)
The service plan identifies the services a provider is authorized to provide and bill for during a consumer’s active enrollment on a waiver program. The amount of the services included in the plan are limited to a cost cap – roughly equal to 60% of the cost of nursing home care.
This is a routine, scheduled visit to the provider’s business site designed to ensure that the provider continues to meet the standards required by the state. Providers that do not meet 100% compliance have a period of time to make corrections to their policies and/or procedures and must submit evidence of compliance. Providers that do not make the corrections risk disciplinary action or revocation (i.e. they may lose their certification to provide service to consumers.) It is important to understand that the review outcome should only be one part of the picture in choosing a provider. Please also consider other factors, such as those listed under “General Tips for Choosing a Home Health Provider.”
From time to time, providers may need help interpreting rules and implementing them into policy and/or practice. A Provider Relations Coordinator is assigned to each provider. Providers may contact their Provider Relations Coordinator if they have questions or would like help ensuring compliance and delivery of quality services.
A COAAA staff member audits the amount of services billed to ensure that they match the services reportedly provided. These audits help to ensure that taxpayer dollars are being used as approved within the service plan.
A waiver program is funded by Medicaid with the intent to allow individuals with disabilities, chronic conditions, age-related care needs, and/or medical fragility to remain in their homes while receiving services instead of moving to an institutional setting. Examples of waiver programs/services include PASSPORT, Consumer Direction, Assisted Living, Ohio Home Care, Department of Developmental Disabilities, and MyCare.
Ohio Department of Aging PASSPORT Provider Certification Process
The Central Ohio Area Agency on Aging (COAAA) is the agency in central Ohio that must determine whether an applicant seeking to provide PASSPORT, Consumer Direction, or Assisted Living services has the capacity to meet all of the Requirements for providers to become, and to remain, certified (Ohio Administrative Code Rule 173-39-02) and relevant Service Specifications (Ohio Administrative Code Rules 173-39-02.1 through 173-39-02.25). To determine eligibility, COAAA Provider Relations Coordinators conduct a pre-certification review of the applicant’s policies and procedures, documentation system, charting processes, personnel charts, and service delivery documentation as applicable.
The Provider Relations Division of COAAA, the division charged with certifying and monitoring providers, operates with a quality improvement approach. Our goal is to help providers understand requirements, maintain compliance, and offer the best possible service to consumers.
Applicants must be legal businesses (not-for-profit or for-profit) authorized to operate within the state of Ohio. The applicant must employ qualified staff and maintain written policies and procedures demonstrating compliance with the rules.
- Adult Day Service
- Alternative Meals
- Choices Home Care Attendant Services
- Home Maintenance and Chores
- Personal Emergency Response System
- Home Medical Equipment and Supplies
- Homemaker
- Home Modification
- Nutritional Consultations
- Personal Care
- Social Work or Counseling
- Home-Delivered Meals
- Community Integration
- Assisted Living Service
- Community Transition
- Non-Medical Transportation
- Enhanced Community Living
- Waiver Nursing Service
- Out-of-Home Respite
- Home Care Attendant Service
- Structured Family Caregiving
We recommend that all applicants thoroughly read the rules. They indicate what policies, procedures, processes, and personnel must be in place in order for an applicant to become certified as an AGE provider. Applicants should review each item and analyze how that standard is currently being met within their organization. You are expected to meet these standards at the time of application.
The Ohio Department of Aging (AGE), in consultation with the Ohio Department of Job and Family Services (ODJFS), the regional Area Agencies on Aging (AAA), and service providers, established these rules as the standards by which all services must be delivered. They were designed to ensure the health, safety, and welfare of each consumer.
The Requirements for providers to become, and to remain, certified (Ohio Administrative Code Rule 173-39-02) apply to all providers, regardless of service. The Service Specifications (Ohio Administrative Code Rules 173-39-02.1 through 173-39-02.25) define standards for individual services and apply only to providers of those services. There are no exceptions to or waiver for rule compliance, regardless of the size or the mission of the organization.
Yes, organizations must develop and implement their own policies and procedures that are compliant with the rules outlined in the Ohio Administrative Code (OAC.) 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.
The timeline is defined in OAC 173-39-03; however, each applicant has some control over the process. Applicants who complete each step timely, are prepared for their pre-certification review, and submit any required evidence of compliance by the communicated due date are more likely to be recommended for certification promptly.
If AGE grants approval, the fiscal division of COAAA will email you a contract to provide services. As with all contracts, be sure to read the contract carefully. After you return your signed contract and its start date is established, COAAA Case Managers are notified and your contact information is added to the COAAA provider referral list. Case Managers consult this list when looking for providers options for specific service needs.
COAAA serves consumers in the following counties: Delaware, Fairfield, Fayette, Franklin, Licking, Madison, Pickaway, and Union. Provider applicants will confirm with the Provider Relations Coordinator during their pre-certification review which counties they are prepared to serve.
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 contact your Provider Relations Coordinator to request to add those counties to your certification.
We currently use SharePoint for Adult Day, Homemaker, Personal Care, and Structured Family Caregiving referrals. Once your COAAA contract is effective, you will receive a registration link for SharePoint. You can then view available referrals and respond to those you can staff. Referrals for all other services will come directly from the Case Manager via phone, fax, or email.
Service rates are established and consistent throughout the state for most services. Some services, like Home Modification, are payed at “per job/bid” rates. These depend on the scope of the work/service and are agreed upon between the provider and Case Manager prior to job completion. Once certified, contracted, and awarded your first referral, you will receive a registration link for the billing system DDE.
You will receive a PDF with your finalized contract that describes the billing process. Billing is submitted through the DDE system. All providers are also required to use direct deposit, which will be established with you by our fiscal department during the contracting process.
Yes. Each provider must be AGE certified to provide PASSPORT services, regardless of the organization’s other accreditations, certifications, or participation in other programs.
No.
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. COAAA has internal and external policies and practices designed to meet HIPAA standards. COAAA is a covered 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; COAAA does not monitor HIPAA compliance and does not provide applicants with compliance assistance or training.
As part of its policies and practice, COAAA educates consumers about HIPAA requirements. While COAAA does not monitor HIPAA compliance, 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:
Compliance Assistance:
On an annual or tri-annual basis, your organization will receive an on-site visit called a Structural Compliance Review. Provider Relations Coordinators will measure your organization’s compliance with all applicable rules. You 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 documented, billed, and paid accurately.
Provider Relations 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. Though the majority of on-site visits are scheduled, the Provider Relations Coordinators are authorized to conduct unannounced visits as necessary.
Where to Turn if You Need Help
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.
The Long-Term Care Ombudsman’s Office is an organization that helps to ensure that community-based services are upholding consumers’ 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.