Providers

Becoming a provider for the PASSPORT Program

Applications are accepted at any time from organizations interested in becoming a provider for the PASSPORT Program. Prospective providers must review the rules and regulations to first verify their compliance or modify their processes to come into compliance before applying to be a provider. Once a prospective provider comes into compliance, they may submit an application to the Area Agency on Aging for review. The rules and regulations for the program in general as well as service specific regulations are listed and available for download below. Applicants should be careful to review and understand all regulations pertaining to the service being provided. Questions about the provider process may be directed to the Contracting and Evaluation Manager at 330-746-2938.

To be eligible to become a PASSPORT provider, an organization must already be an established business (for at least three months), serving at least two clients in the local community and must be in compliance with the rules and regulations of the PASSPORT program.

Organizations interested in becoming providers are required to have a pre-certification visit. During the pre-certification visit, an Agency representative will verify compliance with all applicable rules and regulations. That review will include:

• The organization's policy and procedure manual, including policies that address:
  • Procedure by consumer for filing a claim of theft, property damage, etc.
  • Supervision and training of volunteers, if used;
  • Prevention of employees providing service to someone other than consumer;
  • Incident reporting;
  • Confidentiality;
• Reporting of suspected abuse or neglect.
• The organization by-laws or articles of incorporation;
• The organization's personnel policies;
• A sample employee file;
• A sample consumer file;
• Sample documentation forms to be used for documenting service to PASSPORT consumers;
• Documentation of liability coverage;
• Vehicle maintenance log (if applicable).

After a successful pre-certification visit, the application, with appropriate documentation, will be submitted to the Ohio Departments of Aging and Job and Family Services for acceptance or denial.

Once the provider is accepted, the provider will sign a contract with the Area Agency on Aging specifying the services which will be provided and the rate of payment for those services.

Acceptance as a provider to the PASSPORT program does NOT guarantee any given number of referrals.

PASSPORT Application Materials

Applications must include:

1. Ohio Department of Aging Application for Certification as a Long Term Care Agency, Non-Agency and Assisted Living Service Provider
2. Ohio Health Plans Provider Enrollment Application- JFS Form Number 06750 -this form is available in paper format by calling the Area Agency on Aging 11 at 330-746-2938 or by visiting the Ohio Department of Job and Family Services web site to download the .pdf file
   
   or
   
   Ohio Health Plans Provider Enrollment Application for Individuals - this form is available in paper format by calling the Area Agency on Aging 11 at 330-746-2938 or by visiting the Ohio Department of Job and Family Services web site to download the .pdf file
3. Ohio Health Plans Provider Enrollment Application Instructions
4. Form W-9
5. Declaration Regarding Material Assistance/ Non-Assistance to a Terrorist Organization NOTE: This form is REQUIRED for any organization receiving state funding

Rules and Regulations

Potential providers should also read and understand the following rules and regulations governing the PASSPORT program:

1. Provider Certification
2. Provider Structural Compliance Review
3. Sanctions for Non-compliance
4. Notice of denial of certification and proposed sanctions
5. Appeal of denial of certification and proposed sanctions
6. Appeal hearings and adjudication orders
7. Introductions and definitions
8. Conditions of participation

Service Specifications

Finally, potential providers should read and understand the guidelines for the specific service or services for which they are applying to be a provider:

Adult Day Service
Alternative Meals Service
Chore Service
Emergency Response Systems
Home Care Attendant Service
Home Delivered Meal Service
Homemaker Service
Home Medical Equipment and Supplies
Independent Living Assistance Service
Minor Home Modification, Maintenance, and Repair Services
Nutritional Consultation Service
Personal Care Service
Pest Control Service
Social Work Counseling Service
Transportation Service

Additional questions should be directed to the Contracting and Evaluation Manager at 330-746-2938.

PASSPORT Provider Training Modules

• DDE Provider Training - Module 1 (WMV - 4.4MG)
• DDE Provider Training - Module 2 (WMV - 17.9MG)
• DDE Provider Training - Module 3 (WMV - 4.3MG)
• DDE Provider Training - Module 4 (WMV - 7.6MG)
• DDE Provider Training - Manual (PDF)