Choices Home Care Attendant
Prior to apply for certification, please read and understand the conditions of participation and service requirements for which you are seeking certification. You can view this information as well as all current effective rules by clicking on the following link.
Choices Home Care Attendant Service is a service designed to provide supportive services specific to the needs of an individual consumer with impaired physical or cognitive functioning. Allowable home care attendant services include, but are not limited to:
(1) Personal assistance with bathing, dressing, grooming, caring for nail, hair and oral hygiene, shaving, deodorant application, skin care, foot care, ear care, feeding, toileting, ambulation, changing position in bed, assistance with transfers, normal range of motion, and nutrition and fluid intake;
(2) General household assistance with the planning, preparation and clean-up of meals, laundry, bed-making, dusting, vacuuming, shopping and other errands, the replacement of furnace filters, waste disposal, seasonal yard care and snow removal;
(3) Heavy household chores including, but not limited to, washing floors, windows and walls, tacking down loose rugs and tiles, moving heavy items of furniture to provide safe access and egress;
(4) Assistance with money management and correspondence as directed by the consumer; and,
(5) Escort services and transportation to community services, activities and resources. This activity is offered in addition to medical transportation available under the Medicaid state plan, and may not replace it. Whenever possible, other sources, which can provide this service without charge, must be utilized.
To be eligible for certification, you must have an individual currently receiving services through the PASSPORT Medicaid Waiver Program who has identified you to provide their Choices Home Care Attendant Services.
Spouse, parents, step-parents, authorized representatives, legally responsible family members, power of attorney, foster caregiver, authorizing health care professional, and legal guardians are ineligible to become a provider.
Documentation you will be required to submit with your application:
Copy of valid driver’s license: A copy of a current and valid driver’s license.
Current and valid photo ID: A copy of at least one of the following current, valid, government-issued, photographic identification cards: driver’s license, State of Ohio identification card, or U.S. permanent residence care.
Copy of current auto insurance policy: An applicant that intends to provide Choices Home Care Attendant services must provide a copy of a current auto insurance card or policy. If you do not have an automobile, you must submit a letter stating you do not intend to transport the consumer.
Criminal Record Check from BCI: You are required to obtain a criminal record check (BCI) at time of application. The original should be forwarded to your consumer you plan to serve and a copy sent to the Ohio Department of Aging. Please contact the Ohio Attorney General’s office at 877-224-0043 for a location nearest you. You may not submit a criminal record check from a previous employer.
Consumer Request for Provider Form: This for will automatically be completed and available for download during the online application process. This form must be signed by both the consumer receiving PASSPORT services and their PASSPORT case manager.
Completed and Signed W-9: This form will automatically be completed and available to download for signature during the online application process.
Social Security Card: Copy of a valid social security card.
Ohio Health Plans Enrollment Application/Time Limited Agreement for Individuals: This form will be automatically completed and available to download for signature during the online application process.
Proof of Residency: Evidence that applicant has been a resident of Ohio for the last five consecutive years. Acceptable documentation includes: valid driver's license; notification of registration as an elector; a copy of an officially filed federal or state tax form identifying the applicant's permanent residence; any other documentation the responsible entity considers acceptable showing evidence the application has been a resident of Ohio for the past five years. If you currently live or have lived outside of Ohio anytime in the past five years, you are required to submit an FBI background check.
FBI record check (if lived outside of Ohio in past 5 years): If you lived or have lived outside of Ohio anytime in the pat five consecutive years, you are required to submit an FBI background check. The original should be forwarded to the consumer you plan to serve and a copy sent to the Ohio Department of Aging.
Non-Disclosure Statement: This form will be available to download for signature during the online application process.
Required documentation can be submitted by:
Upload directly to application
to submission. prior
Fax to 614-466-9812 or 614-466-5741.
Ohio Department of Aging
50 West Broad Street, 9 th Floor
Columbus, OH 43215
PLEASE NOTE: documentation emailed to our office will not be accepted and can delay the processing of your application.
I acknowledge I have read and understand the above information.