OAC 5101:3-31-12 Passport HCBS waiver enrollee referrals to certified passport HCBS waiver providers. 

 

      (A) Enrollees in the passport HCBS waiver shall receive services from certified providers of their choice.

 

      (B) If the enrollee has no stated provider preference, the PAA shall make enrollee service referrals based on the criteria listed in paragraph (C) of this rule. Enrollee choice is facilitated by the provision of information about provider cost and performance that shall be be made available to the enrollee by the PAA in order for the enrollee to make an informed decision. The provider information shall include, but not be limited to:

 

      (1) Services provided;

 

      (2) Provider contract rate;

 

      (3) Provider performance data as set forth in rule 5101:3-31-14 of the Administrative Code;

 

      (4) Structural compliance review data as set forth in rule 5101:3-31-13 of the Administrative Code;

 

      (5) Any certification/accreditation status that the provider may have;

 

      (6) Whether provider is bonded and insured;

 

      (7) Provider's capacity to provide services; and

 

      (8) Whether provider has seven days per week and twenty-four-hour per day availability.

 

      (C) On the effective date of this rule, providers subject to the unit rate setting process described in paragraph (D) of rule 5101:3-31-11 of the Administrative Code are placed on a referral list by lowest cost.

 

      (1) If the provider chosen by the enrollee is unavailable to commence services, or if the enrollee does not choose a provider, the PAA will refer the enrollee to the provider with the lowest cost. If the provider with the lowest cost is unavailable, the PAA shall continue to consider the next lowest cost provider and continue to refer to providers until locating a provider that is available to commence services.

 

      (2) The ranking of providers by lowest cost on the referral list is based on a provider's contract rate as established in rule 5101:3-31-11 of the Administrative Code.

 

      (D) The PAA shall track provider referral patterns and shall make tracking information available upon request to the provider or ODA.

 

      (E) When the referral list is implemented as described in paragraph (C) of this rule, the providers' existing enrollees will remain with the providers who are serving the enrollees.

 

      (F) Providers subject to per bid and per item rate-setting as set forth in paragraphs (B) and (C) of rule 5101:3-31-11 of the Administrative Code shall receive referrals based on the lowest and best quoted price obtained from up to three certified passport providers from the PAA rotating list of providers of that requested service.

 

 HISTORY: Eff 9-1-98 

 

 Rule promulgated under: RC Chapter 119.

 

 Rule authorized by: RC 173.40, 5111.02

 

 Rule amplifies: RC 173.40, 5111.01, 5111.02

 

REVIEW DATE: 01 SEP 2003