Consumer-Directed Personal Care Individual Provider
Prior to applying for certification, please read and understand the conditions of participation and service requirements for which your are seeking certification. You can view this information, as well as all the current effective rules, by clicking on the following link.
The Consumer-Directed Personal Care Service is a service provided through the PASSPORT Medicaid waiver program that provides home and community-based services and supports to older Ohioans. Providers for the Consumer-Directed Person Care Service can be individual providers that meet the requirements set forth in OAC 173-39-02 Conditions of Participation and OAC 173-39-02.11 Personal Care Service.
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 personal care 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:
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.
Education/Training Requirement: STNA card, certificate from ODA approved training program or certificate of an apprenticeship program in home health, health, or related subject by U.S. Department of Labor.
Criminal Record Check from BCI: You are required to obtain a criminal record check (BCI) at the time of application. The original should be forwarded to the consumer you plan to service 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 form will be automatically completed and available to download during the 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 for will be automatically completed and available to download for signature during the application process.
Ohio Health Plans Provider Enrollment Application/Time Limited Agreement for Individuals: This form will be automatically completed and available to download for signature during the application process.
Proof of Residency: Evidence that application 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 cop of an officially filed federal or state tax form identifying the application's permanent residence; any other documentation the responsible entity considers acceptable for 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 currently live or have lived outside of Ohio in past 5 years): If you currently live or have lived outside of Ohio anytime in the past five consecutive years, you are required to submit an FBI background check. The original should be forwarded to the consumer you plan to service and a copy sent to the Ohio Department of Aging.
Non-Disclosure Statement: This form will be automatically completed and available to download for signature during the 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, 9th 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.