NOTICE: The Ohio Department of Medicaid (ODM) is introducing a new provider application system called Provider Network Module (PNM), the new single front door platform for Medicaid Providers. ODM will roll-out the new PNM system for all new and existing Ohio Medicaid Providers later this year. Learn more.
Prior to applying 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.
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.
Spouses, 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 includes:
- 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 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. BCI&I CODE: 173.27; 173.38; 173.381; 3701.881; 5123.081; or 5123.169 ONLY
- Consumer Request for Provider Form: This form will automatically be completed and available for download during the online application process. This form must be signed by both the consumer receiving PASSPORT/MyCare Ohio services and their PASSPORT/MyCare Ohio case manager.
- Completed and Signed W-9: This for 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.
- 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. BCI&I CODE 173.41 ONLY.
- Non-Disclosure Statement: This form will be automatically completed and available to download for signature during the application process.
How to submit documentation:
- 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.
By continuing, you signify that you have read and understand the above information.