Provider Relations Overview
Provider Relations staff certify and monitor
COAAA service providers to ensure that they remain in compliance with each
program’s conditions of participation, standards and
service specifications.
Provider Relations monitors programs including PASSPORT, Assisted Living and Title III.
Some of our providers are large corporate entities who
provide home health care, and some provider agencies are run by
small business owners who offer very specialized
services such as housecleaning and wheelchair ramp
installation.
PLEASE NOTE: Each agency wishing to become a PASSPORT, Assisted Living or Choices provider must be a formally organized business or
service agency that has been operating and providing
the services to be certified for at least 2 adults for at least 3
months at the point of application. To determine if your
organization can comply with all the necessary
requirements, visit the Rules section. If you are an individual seeking employment as a home care worker, please see the side bar.
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Provider Relations Contacts
Linda Gillespie
Community Assistance & Provider Relations Director
Evelyn McClanahan
Quality Improvement Specialist
Jackie Marchan-Rish
Quality Improvement Specialist
Erika Myers
Quality Improvement Specialist
Kathy Niper
Quality Improvement Specialist
Teresa Shane
Quality Improvement Specialist
Cheryl Wilson
Quality Improvement Specialist
Tracy Moebius
Assisted Living Quality Improvement Specialist
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PASSPORT/Assisted Living/Choices Rules
PASSPORT Provider
Application Process
Thank you for your interest in the PASSPORT program. If
your organization is interested in becoming a PASSPORT
service provider in PSA 6*, the Central Ohio Area Agency
on Aging, please print out and thoroughly read the
following documents:
Assisted Living Provider Applicants: Contact
Linda Gillespie at (614) 645-3860 or email Linda
Gillespie for an application.
PASSPORT Provider Application Instructions:
Each applicant must be a formally organized business or
service agency that is has been operating and providing
services for at least 2 adults for at least 3
months at the point of application. If your
organization can comply with all the necessary
requirements, you must print and complete all the
following application forms:
All the completed forms for the application and all the
required attachments should be returned to the address
listed below. Do not send the forms to any other address
listed on the forms. All signatures on the applications
must be originals; they cannot be copies or facsimiles.
If you have questions about the application or
certification process, please call 614/645-7250.
Mail all completed applications to:
Central Ohio Area Agency on
Aging
Attn: Linda Gillespie
Provider Relations
174 E. Long St.
Columbus, OH 43215
*Organizations that are PASSPORT certified in
another part of the state, have an office in the Central
Ohio area, and are interested in providing PASSPORT
services in PSA 6, should contact the COAAA for a
request to expand to this area.
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Grant
Opportunities
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Frequently Asked Questions
Accreditations : 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.
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.
JCAHO - Joint Commission on Accreditation of
Healthcare Organizations (
http://www.jcaho.org/index.html)
: JCAHO is a not-for-profit organization that
reviews 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 program for certain 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.
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
such as employee dishonesty or theft.
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.
Care Plan : The care plan is a plan for
the services a consumer will receive to help maintain
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.
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.
Pre-Certification : This is the review
process the Provider completes in order to provide
service to 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.
Sanctions : Sanctions are penalties
brought on because of violations of PASSPORT standards.
A provider that is currently under sanctions may be
prevented from providing services to PASSPORT consumers.
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.
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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.
- The COAAA hosts provider meetings throughout the
year, and publishes the Provider Press quarterly. Both are ways for the COAAA to
communicate information about changes in policy &
procedures, and best practice.
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 PASSPORT, Choices
and Assisted Living Consumers?
- Adult Day Services (PASSPORT and Choices)
- Chore Services (PASSPORT)
- Personal Care Services (PASSPORT)
- Homemaker (PASSPORT)
- Home Delivered Meals (PASSPORT and Choices)
- Emergency Response System (PASSPORT and Choices)
- Independent Living Assistance (PASSPORT)
- Home Medical Equipment and Supplies
(PASSPORT and Choices)
- Minor Home Modification, Maintenance and Repair
(PASSPORT and Choices)
- Medical Transportation (PASSPORT)
- Nutrition Consultation (PASSPORT)
- Social Work/Counseling (PASSPORT)
- Alternative meals (Choices)
- Pest Control (Choices)
- Home Care Attendent (Choices)
- Assisted Living Services (Assisted Living)
- Community Transition Services (Assisted Living)
Organizations that provide “Designated Services” -
-Skilled Nursing, Physical Therapy, Occupational Therapy
and Speech Therapy - - must be Medicaid and
Medicare certified. Medicaid and/or Medicare 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 providers.
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 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;
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
- www.hhs.gov/ocr/hipaa/guidelines
- www.mh.state.oh.us/hipaa/policies
- www.cms.hhs.gov.hipaa
The 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/sections/health_care_fraud/index.htm
- 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 1-800-536-5891 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.
Billing -
Direct Data Entry
Disclaimer: This software is to be used for
PASSPORT Billing Purposes ONLY by contracted PASSPORT
Providers. Other use can lead to legal ramifications.
