Prior to apply for certification, please read and understand the conditions of participation and service requirements for which you are seeking certification. View this information as well as all current effective rules.
Waiver nursing services are defined as services provided to PASSPORT consumers that require the skills of a registered nurse (RN) or license practical nurse (LPN) at the direction of an RN. All nurses providing waiver nursing services to a consumer on the PASSPORT Medicaid waiver program shall provide services within the nurse's scope of practice and shall possess a current, valid and unrestricted license from the Ohio Board of Nursing.
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.
- 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.
- 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.
- 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.
- 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 prior to submission
- Fax to 614-466-9812 or 614-466-5741
- Mail to:
Ohio Department of Aging
246 N. High St./1st Fl.
Columbus, Ohio 43215-2406
PLEASE NOTE: Documentation emailed to our office will not be accepted and can delay the processing of your application.