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Provider Information
PASSPORT - Learn how to become a provider in
Ohio's premiere in-home waiver program for older
adults, stay up on the latest developments and get
help with billing formats.
ADDITIONAL LINKS:
Online Defensive Driving
HIPAA Compliance Information
PASSPORT Provider
Certification
You
must be a certified PASSPORT service provider in
order to provide services to PASSPORT consumers. The
initial enrollment process is somewhat lengthy and
will take several months to complete. The process is
somewhat shorter for
currently certified providers
who wish to either add a county or service. All
providers must meet the
Conditions of Participation and
Service
Specifications for the service or services they wish
to provide.
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Quality Assurance Department is available
8:00 a.m. through 4:30 p.m., Monday through
Friday. If you need technical assistance,
feel free to call us at 1-800-582-7277.
Also, the Area Agency on Aging, District 7
Quarterly Newsletter is mailed directly to
all certified PASSPORT providers. The
newsletter provides another great resource
tool for technical assistance regarding the
PASSPORT program. |
Interested providers must complete all enrollment
forms and include all required attachments. Forms
must be submitted with attachments and include
original signatures. Faxed or photocopied
signatures will not be accepted and will be returned
as incomplete.
Mail Completed Forms to:
Area Agency on Aging, District 7,
Inc.
Quality Assurance Department
F32-URG, P.O. Box 500
Rio Grande, Ohio 45674-0500
ATTENTION: In accordance with Conditions of
Participation, you must be “a formally organized
business or service agency registered with the Ohio
secretary of state that has been operating,
providing, and being paid for the same services for
which certification is being applied, for at least
two adults in the community for a minimum of three
months at the point of application.”
PASSPORT Initial
Enrollment
Application forms: (Must
complete ALL links)
PP Application for Organizations
OR
PP Application
for Individuals
Homeland
Security
ODA
1105
IRS W-9
Currently Certified
PASSPORT Provider
Expansion & Renewal of Services
Application form: (Must complete
BOTH links)
Providers expanding from another PAA
Providers currently serving PAA7
Links to OHIO ADMINISTRATIVE CODE:
173-39-02 Conditions of Participation
Service Specifications:
173-39-02.1 Adult Day Service
173-39-02.3 Pest Control
173-39-02.5 Chore Service
173-39-02.6 Emergency Response Systems
173-39-02.7 Home Medical Equipt & Supplies
173-39-02.8 Homemaker Service
173-39-02.9 Minor Home Modification, Maintenance &
Repair
173-39-02.10 Nutritional Consultation Service
173-39-02.11 Personal Care Service
173-39-02.12 Social Work Counseling Service
173-39-02.13 Transportation Service
Transportation Service Appendix A
Transportation Service Appendix B
Transportation Service Appendix C
173-39-02.14 Home Delivered Meals Service
173-39-02.15 Independent Living Service
Additional Links:
Ohio Administrative Code: Complete List of Rules for
PASSPORT Program
Online Defensive Driving
HIPAA Compliance Information
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