Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-80 - Rights and Procedures Applicable to Medical Assistance Recipients › Section 5160-80-02 - Hearing requests

Current through all regulations passed and filed through July 1, 2024
(A)
								Making a request
			 for hearing
(1)
									A request for hearing must be submitted to the depository
			 agent in writing by the medical assistance recipient or by the medical
			 assistance recipient's authorized representative or attorney and shall be
			 subject to the requirements of this rule.
(2)
									The request for
			 hearing shall address only the issue of whether the amount determined for
			 reimbursement of medical assistance paid by the department or county department
			 should be different than set forth in section
			 5160.37 of the Revised Code. The
			 hearing examiner shall freely grant leave to a medical assistance recipient or
			 to a medical assistance recipient's authorized representative or attorney to
			 amend the written hearing request if it fails to comply with this
			 requirement.
(3)
									For a payment owed to the department or county
			 department on or after September 29, 2015, the following shall apply:
(a)
										Before a medical
			 assistance recipient can make a hearing request, the medical assistance
			 recipient must receive from the department or county department a letter with a
			 final lien amount.
(b)
										If the medical assistance recipient is requesting a
			 hearing pursuant to division (L)(1) or (L)(2) of section
			 5160.37 of the Revised Code, the
			 medical assistance recipient must provide the following information with the
			 hearing request, subject to documentation verification upon demand of the
			 department:
(i)
											The total amount to be paid to resolve all claims of the
			 medical assistance recipient, including, but not limited to, medical expenses,
			 loss of income, loss of consortium, and pain and suffering.
(ii)
											The amount that
			 has been collected as a result of the settlement, compromise, judgment, or
			 award giving rise to the department's or county department's claim for
			 reimbursement.
(iii)
											The amount of attorney fees incurred to obtain the
			 settlement, compromise, judgment, or award.
(iv)
											The amount of
			 costs and expenses incurred to obtain the settlement, compromise, judgment, or
			 award.
(c)
										In addition to the information requested pursuant to
			 paragraph (A)(3)(b) of this rule, the medical assistance recipient requesting a
			 hearing pursuant to division (L)(1) or (L)(2) of section
			 5160.37 of the Revised Code
			 shall provide with the hearing request the following documentation:
(i)
											A copy of all
			 written settlement agreements, compromises, judgments, or awards referenced in
			 paragraph (A)(3)(b) of this rule.
(ii)
											If the medical
			 assistance recipient does not pay to the department or county department the
			 final lien amount, documentation from a bank or other financial institution
			 providing the account number and the amount being held in an escrow account or
			 an attestation from an attorney identifying the amount being held in an
			 interest on lawyers' trust account pursuant to division (L)(1) of section
			 5160.37 of the Revised
			 Code.
(d)
										If the medical assistance recipient does not include
			 all of the information and documentation required in Paragraphs (A)3(b) and
			 (A)(3)(c) of this rule, the department shall send written notice to the medical
			 assistance recipient and the medical assistance recipient's attorney or
			 authorized representative listing the information and documentation not
			 provided. If the medical assistance recipient or the medical assistance
			 recipient's attorney or authorized representative fails to provide all the
			 requested information and documentation within thirty calendar days of the date
			 of mailing of the written notification, the department shall dismiss the
			 hearing request without prejudice.
(4)
									Written
			 documentation of the appointment of an authorization representative by a
			 medical assistance recipient must accompany the hearing request made on the
			 medical assistance recipient's behalf by an authorized representative.
			 Attorneys may make a written hearing request on a medical assistance
			 recipient's behalf without providing written authorization. To obtain medical
			 assistance information or protected health information, an attorney
			 representing the medical assistance recipient must provide a written release
			 meeting the requirements of section
			 5160.45 of the Revised Code or
			 written documentation that the attorney is acting in the capacity as an
			 authorized representative.