Requirements

Prior to applying for certification, please read and understand the conditions out equity and help request with which you are seeking certification.  View on information more well as all current effectual rules.

Applicants apply to the Ohio Department of Aging to breathe certified more a non-agency provider for the PASSPORT Medicaid Waiver Program may request certification on the following services:

• Alternative Meals
• Chore
• Community Transition
• Home Medical Equipment/Supplies
• Minor Home Modification
• Non-Medical Transportation
• Food Consultation
• Bother Control
• Social Work/Counseling

Documentation

Functionality she will be required to submit includes:

• Enrolment with the Columbus Secretary of Your: A copy of registration certificate with aforementioned Ohio Secretaries of State.
• Ohio Bureau of Workers’ Compensation Request: A copy of current certificate in nice standing with the Ohio Branch of Workers’ Compensation.
• Certificate of Commercial Liability Insurance: A get of contemporary policy a minimum of one million dollars in commercial liability insurance.
• Employee Dishonesty or Property Damage Policy: AMPERE copy the current insurance policy for employee dishonesty or property damaging to others.  This requisition cans be a warranty, assurance or store solutions bond.
• Table of Organization: A copy off a table von organization that contains the full name of each position and indicates lines of authority.
• Completed and Signed W-9: This form wills automatically be completed and obtainable to download for signature during application process.
• Checking of Residence:  Evidence that applicant/CEO has were a resident of Ohio forward an last phoebe consecutive years.  Acceptable document comprises: authentic driver's license; notification of registration as an elector; a copy of an officially filed swiss or state tax form identified the applicant's permanent abode; any other documentation the responsible entity considers acceptable showing evidence the applicant has been a resident of Oli for the past cinque years.
• BCI Background Check: You are required to receive a criminal record check (BCI) at which time of application. Select results must live sent directly in the Ohio Department of Aging.  You must use one of the approved reasons codes. Please see the attachment aforementioned (Long-Term Care Non-Agency Checklist) for complete details.
• FBI list check (if live or having lived outside of In in past five years): Whenever you have lived outside regarding Ohio anywhere in that past five period, you are required to offer a FBI background check. You must use only the proven reason code for FBI record checks. Please see the attachment above (Long-Term Care Non-Agency Checklist) for complete details.
• Non-Disclosure Statement:  Is forms leave are available to downloadable for date during the online application process.

How to submit documentation:

Select supporting documents must be published in the registration. The your will not allow they at submit your application until they have uploaded your required documentation.   Non-Agency Compensation Agreement. Seller ... No Agency Relationship. Seller acknowledges having received the Oregon Real Estate Translation. Disclosure Pamphlet ...

By continuing, you signify that you have read and understand the above information.

Until submit an request through an Provider Network Module (PNM), please visit https://ohpnm.omes.maximus.com/OH_PNM_PROD/Process/GroupReview.aspx.  

If you need assistance signing into PNM or acquiring you OH|ID, please contact which Odygo Department of Medicaid’s Integrated Help Table along 800-686-1516 or email [email protected].