reglab/statecodes huggingface dataset:
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-05 - State hearings: exceptions to prior notice

Current through all regulations passed and filed through July 1, 2024
(A) Public assistance and social services
(1) Under the following circumstances, prior
			 notice of adverse action is not required, but the assistance group shall be
			 provided written notice on or before the effective date of the action.
									The agency is not required to
			 continue fair hearing benefits.
(a) The agency
			 has factual information confirming the death of an individual, or of the payee
			 when there is no relative available to serve as a new payee.
(b) The agency receives a clear, written
			 statement, signed by the individual, that he or she no longer wishes to receive
			 benefits, or that the appellant understands that based on the information they
			 provided, their benefits will be reduced or terminated.
In no way does this exception permit the preparation of any
				type of blanket statement to be signed at the time of application or at any
				other time that would allow the agency to take action at some future date
				without providing prior notice.
(c) The agency determines, based on reliable
			 information, that the individual has been admitted or committed to an
			 institution where he or she is ineligible for further benefits.
(d) The agency determines, based on reliable
			 information, that the individual has been placed in skilled nursing care,
			 intermediate care, or long-term hospitalization where he or she is ineligible
			 for further benefits.
(e) The
			 assistance group's whereabouts are unknown and agency mail directed to the
			 assistance group has been returned by the post office indicating no known
			 forwarding address.
However, the assistance group's benefit
				shall be
				made available if the assistance group's whereabouts become known during the
				period covered by the returned benefit.
(f) The agency determines, based on reliable
			 information, that the assistance group has moved to another state.
(g) A child is removed from the home as a
			 result of a judicial determination or is voluntarily placed in foster care by
			 the child's legal guardian.
(h) A
			 special allowance, or supportive service, granted for a specific period is
			 terminated at the end of the specified period. The assistance group
			 shall be
			 informed, in writing, when the allowance is initiated, of the exact date upon
			 which the allowance will automatically terminate.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-06 - State hearings: notice of mass change in benefits

Current through all regulations passed and filed through July 1, 2024
(A) When a change
			 in state law, federal law, or local agency policy adopted pursuant to options
			 authorized in state law requires automatic adjustment of benefits, the
			 assistance group shall be provided prior written notice of the action. The
			 exception to this rule is some classes of supplemental nutrition assistance
			 program (SNAP) recipients for which federal law does not require
			 notification.
(1) The notice shall be mailed
			 or personally delivered no less than fifteen  days prior to the processing of the
			 action.
(2) The notice shall
			 contain:
(a)
										A clear and understandable statement of the proposed
			 action and the reasons for it.
(b)
										Citations of the
			 applicable regulations.
(c)
										An explanation of the assistance group's right to and
			 the method of obtaining a county conference and a state
			 hearing.
(d)
										An explanation of the circumstances under which a
			 timely hearing request shall result in continued benefits.
(e)
										A telephone
			 number to call about free legal services.
(3) When a change in state or federal law
			 requires such an adjustment statewide, the JFS 04025 "Important Notice about
			 your Welfare Benefits" (rev. 5/2001), its computer-generated equivalent, or
			 other notice specifically developed and designated by the Ohio department of
			 job and family services (ODJFS), shall be used. Local agencies shall receive
			 instructions concerning notice prior to implementation of the change.
(4) When a change in local agency policy
			 requires such an adjustment, the local agency is responsible for developing the
			 content of the notice, in accordance with paragraph (A)(2) of this rule. The
			 language under "Your Right to a State Hearing" contained on the JFS 04025
			 shall be
			 duplicated exactly on any such local agency notice regarding a policy change
			 that could be misapplied to individual circumstances, in accordance with
			 paragraph (A) of rule
			 5101:6-3-01
			 of the Administrative Code.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-07 - State hearings: notice of the right to a state hearing - child support services

Current through all regulations passed and filed through July 1, 2024
(A) Notice at the time of application
(1) Public assistance recipients shall be
			 informed, in writing, of the right to a state hearing. Notification shall be
			 mailed or personally delivered within five business days
			 of the date of receipt of a referral made by the public assistance agency to
			 the child support enforcement agency (CSEA).
(2) Individuals who are not public assistance
			 recipients who request child support services shall be informed, in writing, of
			 the right to a state hearing. Notification shall be mailed or personally
			 delivered at the time an application is provided to the individual.
(3)
									The JFS
			 04059 "Explanation of State Hearing Procedures" (rev.
			 1/2015), shall be used.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-08 - State hearings: notice whenever disagreement with an action or inaction is expressed

Current through all regulations passed and filed through July 1, 2024
(A) Whenever an assistance group
			 disagrees with an agency action or lack of action, the
			 agency shall remind the assistance group of the right to request a state
			 hearing via the JFS 04059 "Explanation of
			 State Hearing Procedures" (rev.
			 1/2015). The published hearing rules shall also be
			 made available upon request.
(B)
			 When an assistance group disagrees with a denial or termination
			 of benefits, a reapplication for benefits as well as a hearing request
			 may be appropriate.
(C) The
			 provisions of this rule do not apply to county public children services
			 agencies (PCSAs) except insofar as the action or inaction complained of
			 involves programs to which state hearing rights apply, in accordance with rules
			 5101:6-1-01
			 and
			 5101:6-3-01
			 of the Administrative Code.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-20 - State hearings: notice of overpayment/overissuance

Current through all regulations passed and filed through July 1, 2024
(A) When the local
			 agency has determined that a cash benefit overpayment has occurred, responsible
			 parties from whom repayment is being sought shall be provided written notice of
			 the overpayment determination.
Notice is also required whenever a previous overpayment
				determination is revised to change the amount or period of the
				overpayment.
(1) The notice shall
			 contain:
(a)
										A clear and
			 understandable statement of the determination and the reasons for it, including
			 the amount and period of the overpayment and any offsetting done to reduce
			 it.
(b)
										Citations of the applicable
			 regulations.
(c)
										An explanation of the available methods of repayment
			 and the individual's right to and the method of obtaining a county conference
			 and a state hearing, unless there has already been a state hearing on the
			 issue.
(d)
										A telephone number to call about free legal
			 services.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-25 - State hearings: notice of eligibility for lost supplemental nutrition assistance program (SNAP) benefits

Current through all regulations passed and filed through July 1, 2024
(A)
								If the agency
			 determines that a loss of SNAP benefits has occurred and that the assistance
			 group is or may be entitled to restoration of those benefits, the assistance
			 group shall be provided prompt written notice of the agency's
			 determination.
The notice shall contain:
(1)
									A clear and
			 understandable statement of the amount and period of the underissuance, any
			 offsetting that was done and the method of restoration.
(2)
									An explanation of
			 the assistance group's right to and the method of obtaining a county conference
			 and a state hearing.
(3)
									The name and telephone number of the person to contact
			 for more information.
(4)
									A telephone number to call about free legal
			 services.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-26 - State hearings: notice of approval, denial or delay of replacement supplemental nutrition assistance program (SNAP) benefits

Current through all regulations passed and filed through July 1, 2024
When the agency approves, denies, or delays an assistance
				group's request for replacement SNAP benefits, the assistance
				group shall be provided written notice of the action.
(A) The notice shall be mailed or personally
			 delivered no less than ten  days
			 from the date the loss was reported, fifteen days if the issuance was made by
			 certified or registered mail, or within two business days
			 after the agency receives the signed JFS 07222, "Statement Requesting
			 Replacement of Supplemental Nutrition Assistance Program (SNAP)
			 Benefits (rev. 10/2016)," whichever is later.
If a notice of delay was issued, the agency shall issue an
				approval or denial notice within two business days
				from the date it receives the information which caused the delay.
(B) The notice shall contain:
(1)
									A clear and
			 understandable statement of the decision and the reasons for
			 it.
(2)
									Citations of the applicable
			 regulations.
(3)
									An explanation of the assistance group's right to and
			 the method of obtaining a county conference and a state
			 hearing.
(4)
									A telephone number to call about free legal
			 services.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-30 - State hearings: notice of medical determination

Current through all regulations passed and filed through July 1, 2024
(A)
								The JFS 04022 "Notice of Medical Determination
			 and a Right to a State Hearing" (rev. 3/2002),
			 or its computer-generated equivalent shall be mailed or personally delivered to
			 the individual and authorized representative in the following situations:
(1) When, as the result of a preadmission
			 review for long-term care, the local agency receives an authorization of a
			 level of care that assigns a noninstitutional level of care, or a level of care
			 that is different from the specific level of care certified by the individual's
			 physician, the local agency shall send notice to the individual and authorized
			 representative, with a copy of the notice filed in the individual's case
			 record.
Notice is not required when the assigned level of care is
				different from the level of care certified by the individual's physician, but
				the individual is or will be placed in a facility with dual certification to
				provide the assigned level of care.
(2) When a request for prior authorization
			 for additional hospital stays, visits, or therapeutic leave days beyond thirty
			 days for a medicaid individual with a developmental disability level of care is
			 denied, the local agency shall send the notice to the individual and authorized
			 representative, with a copy of the notice filed in the individual's case
			 record.
(3) When a review agency
			 denies or modifies a request for precertification of a hospital admission or
			 medical procedure, the review agency shall send the notice to the individual
			 and authorized representative, with a copy of the notice sent to the local
			 agency.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-31 - State hearings: notice of denial of prior authorization for medical or dental services

Current through all regulations passed and filed through July 1, 2024
When a request for prior authorization for a medical or dental
				service is denied, the individual and authorized representative shall be
				provided prompt written notice of the decision. Copies shall also be sent to
				the provider and to the local agency.
(A) The notice shall contain:
(1)
									A clear and understandable statement of the action
			 taken and the reasons for it.
(2)
									Citations of the
			 applicable regulations.
(3)
									An explanation of the assistance group's right to and
			 the method of obtaining a state hearing.
(4)
									A telephone
			 number to call about free legal services.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-32 - State hearings: notice of adverse preadmission screening and resident review (PASRR) determinations

Current through all regulations passed and filed through July 1, 2024
(A)
								Notice of adverse
			 preadmission screening (PAS) determination
When an applicant for admission to a
				nursing facility, receives an adverse determination as the result of a
				preadmission screening (PAS) performed by the Ohio department of mental health
				and addiction services (MHAS) or the Ohio department of developmental
				disabilities (DODD), MHAS or DODD shall provide the affected individual with
				written notice of the determination in accordance with rules
				5122-21-03
				and
				5123:2-14-01
				of the Administrative Code.
(1)
									The notice shall be mailed or personally delivered to
			 the individual and his or her legal guardian and/or authorized representative,
			 at the time the adverse determination is made.
(2)
									The notice shall
			 contain:
(a)
										A
			 clear and understandable statement of the determination and the reasons for
			 it.
(b)
										Citations of the applicable
			 regulations.
(c)
										An outline of the implications of the decision for
			 admission to the facility.
(d)
										An explanation of
			 the individual's right to and the method of obtaining a state
			 hearing.
(e)
										A telephone number to call about free legal
			 services.
(3)
									Copies of the notice shall be sent to:
(a)
										The nursing
			 facility.
(b)
										The individual's attending physician.
(c)
										The discharging
			 hospital.
(d)
										The Ohio department of medicaid (ODM) (or
			 designee).
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-36 - State hearings: notice of denial of just cause request for termination of managed care plan membership

Current through all regulations passed and filed through July 1, 2024
(A) Following the bureau of managed health
			 care's determination that the request does not meet one of the criteria for
			 just cause termination of managed care plan membership, the Ohio department of
			 medicaid, bureau of managed care,
								shall send a notice to an individual.
(B) The notice shall contain:
(1)
									A clear and understandable statement that the request
			 was denied.
(2)
									An explanation about why the request for just cause
			 termination of managed care plan membership did not meet the criteria for just
			 cause termination of managed care plan membership.
(3)
									Citations of the
			 applicable regulations.
(4)
									An explanation of the individual's right to and the
			 method of obtaining a state hearing.
(5)
									A telephone
			 number to call about free legal services.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-40 - State hearings: coordinated services program state hearing and notice requirements

Current through all regulations passed and filed through July 1, 2024
(A) The purpose of this rule is to describe
			 the process by which the Ohio department of medicaid (ODM) or a medicaid
			 managed care plan (MCP), as described in rule
			 5160-26-01
			 of the Administrative Code, informs an individual of notice and hearing rights
			 for the medicaid coordinated services program (CSP).
(B) Definitions.
(1) "Authorized representative" means a
			 person, eighteen years or older, who stands in place of the individual. The
			 authorized representative may include a legal entity. ODM may request proper
			 identification from the authorized representative.
(2) "Coordinated services program (CSP)," has
			 the same meaning as described in rule
			 5160-20-01
			 of the Administrative Code.
(3)
									"Designated pharmacy" has the same meaning as described
			 in rule
			 5160-20-01
			 of the Administrative Code.
(4)
									"Designated
			 provider" has the same meaning as described in rule
			 5160-20-01
			 of the Administrative Code.
(5) "Individual," for
			 the purpose of this rule, means a recipient who is currently receiving medicaid
			 services, either through fee-for-service or through an MCP.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-2 - Notice › Section 5101:6-2-51 - Notice of interim assistance reimbursement

Current through all regulations passed and filed through July 1, 2024
When, as the result of an interim assistance agreement, the
				local agency receives an individual's retroactive supplemental security income
				(SSI) payment for initial or initial post-eligibility SSI benefits, the
				individual and authorized representative shall be provided written
				notice.
(A) The notice shall be mailed
			 or personally delivered no later than ten working days following the local
			 agency's receipt of the SSI payment.
(B) The notice shall contain a clear and
			 understandable statement of the apportionment of the SSI payment and the
			 reasons for it, cite the applicable regulations, explain the individual's right
			 to and the method of obtaining a county conference and a state hearing, and
			 contain a telephone number to call about free legal services.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-3 - Request for a State Hearing › Section 5101:6-3-02 - State hearings: state hearing requests

Current through all regulations passed and filed through July 1, 2024
(A) Definition
(1) A "request for a state hearing" is
			 defined as a clear expression, by the individual or authorized representative,
			 to the effect that he or she wishes to appeal a decision or wants the
			 opportunity to present his or her case to a higher authority. The request may
			 be either made orally, in writing, or electronically.
A state hearing may only be requested by or on behalf of an
				individual applying for or receiving benefits. A state hearing may not be
				requested by the local agency, the state agency, or another entity, such as a
				managed care plan, acting for or in place of the local or state agency.
(2) Oral requests for a hearing
			 shall immediately be converted to a written record by the person to whom the
			 request is made. It is not appropriate to require the individual to submit a
			 written request once the desire for a hearing has been expressed orally.
			 Requests made by telephone must be made by the individual.
(3) Written authorization including, but not
			 limited to letters of guardianship or power of attorney, must accompany all
			 requests made on an individual's behalf by an authorized representative except:
(a) Upon a showing that such authorization
			 cannot be obtained because of the individual's death or incapacity, and that
			 the representative is, in fact, acting in the individual's best
			 interest.
(b) That an individual's
			 spouse or minor individual's parent or legal guardian may request a hearing on
			 behalf of the individual without written authorization.
(c) That a provider of long-term care may
			 request a hearing, without obtaining written authorization, to contest the
			 level of care assigned to the individual.
(4) Written authorization is nontransferable.
			 Unless paragraph (A)(3)(a) or (A)(3)(b) of this rule apply, documentary
			 evidence must be in the appellant's hearing record that the appellant, the
			 appellant's legal guardian, or the power of attorney has granted authorization
			 to another individual to represent the appellant in the hearings process.
			 Otherwise, the appellant is the only individual who can grant another
			 individual authorization to represent the individual.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-4 - Continuation of Benefits After Hearing Request › Section 5101:6-4-01 - State hearings: continuation of benefits when a state hearing is requested

Current through all regulations passed and filed through July 1, 2024
(A) When a request for a state hearing is
			 received by the state, a managed care plan (MCP), a "MyCare Ohio" plan (MCOP),
			 or local agency within the 
								fifteen-calendar day prior notice period,
			 benefits shall not be reduced, suspended, or terminated until a state hearing
			 decision is rendered unless one of the following occurs:
(1) A determination is made at the hearing
			 that the sole issue is one of state or federal law, and not one of fact or
			 judgment.
(2) The appeal is
			 withdrawn or abandoned pursuant to rule
			 5101:6-5-03 of the
			 Administrative Code.
(3) A change
			 affecting the assistance group's eligibility or level of benefits occurs while
			 the decision is pending and the assistance group fails to timely request a
			 hearing upon receipt of the subsequent notice of adverse action.
(4) A mass change that adversely affects an
			 assistance group's eligibility for 
									the supplemental nutrition
			 assistance program (SNAP) or basis of issuance occurs while the hearing
			 decision is pending.
(5) The
			 assistance group specifically waives continuation of 
									SNAP 
			 benefits.
The section for requesting a state hearing on the prior notice
				contains a space for the assistance group to indicate whether it desires to
				waive continued food assistance benefits. If the assistance group does not
				positively indicate that it waives continued benefits, the local agency shall
				assume that continued benefits are desired.
(6) The assistance group's
			 
									SNAP certification period expires. Further entitlement
			 to 
									SNAP benefits cannot be established without
			 recertification based upon a new application as provided in rule
			 5101:4-7-07 of the
			 Administrative Code.
(7) The
			 assistance group's learning earning and parenting (LEAP) supportive services,
			 and support services provided to participants in a work activity under the Ohio
			 works first (OWF) program, or the 
									SNAP employment and training
			 program are being reduced or terminated.
(8) The MCP or MCOP member specifically
			 waives continuation of medicaid benefits.
(9) The MCP or MCOP continues the provision
			 of medical 
									services, and the member receives the services
			 previously requested by the provider and authorized by the MCP or MCOP before
			 the hearing decision is rendered. Further entitlement to medical services
			 cannot be established without a provider requesting additional services and the
			 MCP or MCOP making a medical necessity determination.
(10) If, upon the expiration of a period of
			 authorized service, the enrollee requests further services, denial of that
			 request shall be considered a denial, rather than a reduction, suspension, or
			 termination, of service and continuation of benefits will not apply.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-5 - Pre-Hearing Procedures; Postponement, Denial, or Dismissal of Hearing › Section 5101:6-5-02 - State hearings: postponement of the state hearing

Current through all regulations passed and filed through July 1, 2024
(A) Postponement is a request prior to the
			 hearing date to schedule the hearing for a later date.
(1) Public assistance, social
			 
									services, and child support services
(a) The hearing may be postponed at the
			 request of the individual or authorized representative when good cause, as
			 defined in rule
			 5101:6-5-03 of the
			 Administrative Code, exists.
(b)
			 The hearing authority shall have final authority to determine whether good
			 cause exists. Verification of good cause may be required.
(c) The hearing authority shall have final
			 authority to deny repeated requests for postponement.
(d) Postponement shall not extend the time
			 limit for issuing a state hearing decision.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-6 - Hearing Procedure › Section 5101:6-6-01 - State hearings: scheduling and attendance

Current through all regulations passed and filed through July 1, 2024
(A) Time and place of the hearing
(1) The hearing shall be conducted at a
			 reasonable time, date, and place. The hearing will usually be conducted
			 
									virtually, since it is usually most convenient to the
			 individual. However, there may be circumstances which warrant conducting the
			 hearing at another time, date, or place. In these cases, efforts shall be made
			 to schedule the hearing at a time, date, and place convenient to all parties
			 involved.
(a) State hearings
			 conducted 
										virtually, and on camera  shall be considered
			 face to face hearings.
(b)
										If an individual is unable to particpate in a virtual
			 hearing due to phone or internet limitations, they can attend the hearing at
			 the local agency. The local agency will assure an adequate location for the
			 individual to particpate in the hearing that is private, with proper decorum,
			 and a minimum of distractions.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-6 - Hearing Procedure › Section 5101:6-6-02 - State hearings: rights and responsibilities of the participants

Current through all regulations passed and filed through July 1, 2024
(A) The agency representative
The agency representative presents and is the advocate for the
				agency's case at the hearing. This person shall explain the reasons for the
				agency's action, cite the regulations upon which the action was based, provide
				relevant case information and documents, and answer relevant questions from the
				individual and the hearing officer. The agency representative has the same
				rights as the individual to confront and cross-examine during the hearing. If
				the issue being addressed at the hearing is an action taken by the agency,
				based on the agency's prevention, retention and contingency (PRC) plan, and the
				agency wants to have the application of that plan considered in the
				
									decision-making process, a copy of the plan must be
				provided to the hearing officer for inclusion in the record.
(B) The individual making the hearing request
(1) The individual and representative shall
			 have the opportunity to present their case in their own way. The hearing shall
			 be conducted informally, and formal rules of evidence shall not
			 apply.
(2) The individual and
			 authorized representative shall have adequate opportunity to:
(a) Examine, at a reasonable time before the
			 hearing as well as during the hearing, the contents of the case file, except
			 for confidential information protected from release, as well as all records and
			 documents to be used by the local agency at the hearing.
(b) Bring witnesses.
(c) Submit evidence to establish all
			 pertinent facts and circumstances.
(d) Advance arguments without undue
			 interference.
(e) Question or
			 refute any testimony or evidence, including the opportunity to confront and
			 cross-examine adverse witnesses.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-6 - Hearing Procedure › Section 5101:6-6-03 - State hearings: recording the hearing

Current through all regulations passed and filed through July 1, 2024
(A) All state hearings shall be recorded by
			 the hearing officer. The recording shall be started at the beginning of the
			 hearing and shall continue until the hearing is concluded. There shall be no
			 testimony or other proceedings off the record. The recording shall not be
			 altered or edited in any manner or for any reason.
(B) The recording of the hearing shall not be
			 a part of the official hearing record. The recording shall be maintained for
			 thirty  days after the issuance of
			 the hearing decision unless an administrative appeal has been requested. If an
			 administrative appeal is requested, the recording shall be maintained for seven
			 months after all administrative appeal proceedings have been completed. The
			 recording may be erased after expiration of the  period identified in
			 this paragraph.
(C) The
			 individual, authorized representative, or agency may request a copy of the
			 recording. The bureau of state hearings shall respond to such requests within
			 two business days whenever possible, and shall mail the
			 copy free of any charge. Nonreceipt of a copy of a recording within the
			 administrative appeal period shall not result in an extension of the
			 administrative appeal period.
(D)
			 The individual, authorized representative, and/or the agency may record the
			 hearing, at their own expense, so long as it does not seriously interfere with
			 the orderly conduct of the hearing.
(E) If, during the administrative appeal
			 process, it is found that the hearing officer's recording is lost or unusable
			 (for example, because it has been damaged or because material portions of the
			 recording are inaudible), the administrative appeal hearing examiner shall
			 remand the case to the state hearing officer for a new hearing if the
			 individual takes material issue with the recitation of the testimony set forth
			 in the hearing decision.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-7 - Hearing Decisions › Section 5101:6-7-01 - State hearings: state hearing decisions

Current through all regulations passed and filed through July 1, 2024
(A) Hearing authority
(1) The bureau of state hearings is
			 responsible for preparing and issuing state hearing decisions under the
			 authority of the director of the Ohio department of job and family services
			 (ODJFS). For this purpose, the chief of the bureau of state hearings shall
			 designate hearing authorities in addition to the chief to review the findings,
			 conclusions, and recommendations of the hearing officers and to issue decisions
			 under the authority of the ODJFS director.
(2) No person designated as hearing authority
			 shall have previously participated in the agency decision being appealed, nor
			 shall the hearing authority and the hearing officer who conducted the hearing
			 be the same person.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-7 - Hearing Decisions › Section 5101:6-7-02 - State hearings: standards for revising community spouse income and resource allowances at a state hearing

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule sets forth the standards to be applied in a state
				hearing requested for the purpose of revising a community spouse's minimum
				monthly maintenance needs allowance in accordance with rule
				
									5160:1-6-07 of the Administrative Code, or the
				community spouse resource allowance in accordance with rule
				
									5160:1-6-04 of the Administrative Code. In so doing,
				this rule incorporates by reference the definitions set forth in those rules
				and the standards for evaluating income and resources. An appellant may request
				a single hearing for revising both the minimum monthly maintenance needs
				allowance and the community spouse resource allowance, which the hearing
				officer may continue to successive dates as necessary to determine both
				issues.
(B) Minimum monthly
			 maintenance needs allowance
(1) If either the
			 community spouse or the institutionalized spouse establishes at a state hearing
			 that the community spouse needs additional income above the level otherwise
			 provided by the existing minimum monthly maintenance needs allowance, the
			 hearing decision shall substitute the allowance with an amount adequate to
			 provide such additional income to the community spouse as is necessary,
			 notwithstanding the minimum monthly maintenance needs allowance cap set forth
			 in rule 
									5160:1-6-07 of the Administrative Code.
(2) The standard for granting such a revision
			 in the minimum monthly maintenance needs allowance is that the community
			 spouse's need for additional income is due to exceptional circumstances that
			 have resulted in significant financial duress. Exceptional circumstances are
			 those that are more rare than occur in everyday life, such as acts of God or
			 accidents and illnesses that result in personal harm or property damage.
			 Significant financial duress is the result of an exceptional circumstance only
			 when the community spouse is faced with a financial obligation that exceeds the
			 spouse's ability to also pay reasonable living expenses from income or
			 resources that exceed the community spouse resource allowance.
(3) A substituted minimum monthly maintenance
			 needs allowance may not exceed the institutionalized spouse's income minus
			 personal needs allowance. It shall be tailored to the circumstance of significant
			 financial duress and may be time-limited as appropriate to the
			 circumstance.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-7 - Hearing Decisions › Section 5101:6-7-03 - State hearings: implementation of the hearing decision

Current through all regulations passed and filed through July 1, 2024
(A) Responsibility
(1) When the hearing decision orders action
			 to be taken by the agency, the agency that is ordered to take the action is
			 responsible for promptly and fully implementing the decision.
(2) State hearings is responsible for
			 monitoring timely compliance with decisions.
(3) When the hearing decision orders action
			 to be taken by a managed care plan or "MyCare Ohio" plan, the managed care plan
			 or "MyCare Ohio" plan is responsible for promptly and fully implementing the
			 decision.
The Ohio department of medicaid (ODM) is responsible for timely
				compliance with decisions involving compliance by a managed care plan or
				"MyCare Ohio" plan.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-8 - Administrative Appeal › Section 5101:6-8-01 - State hearings: administrative appeal of the state hearing decision

Current through all regulations passed and filed through July 1, 2024
(A) An individual who disagrees with a state
			 hearing decision, or with a decision by the hearing authority to deny or
			 dismiss a hearing request, has the right to request an administrative appeal.
The administrative appeal process does not apply to
				administrative disqualification hearing decisions.
An administrative appeal may only be requested by or on behalf
				of an individual applying for or receiving benefits. An administrative appeal
				may not be requested by the local agency, the state agency, or another entity,
				such as a managed care plan or "MyCare Ohio" plan, acting for or in place of
				the local or state agency.
The administrative appeal process is the responsibility of the
				bureau of state hearings.
(B) Notice of the right to and the method of
			 obtaining an administrative appeal shall be included on the state hearing
			 dismissal notice, on the JFS 04005 "State Hearing Decision," 
			 and on the notice of failure to establish good cause for abandonment required
			 by rule
			 5101:6-5-03 of the
			 Administrative Code.
(C)
			 Administrative appeal requests
(1) A state
			 hearing decision, or a decision by the hearing authority to deny or dismiss a
			 hearing request, will be reviewed for one or more of the following reasons:
(a) The decision is contrary to the weight of
			 the evidence presented.
(b) A
			 prejudicial error was committed in the course of the proceedings.
(c) The decision relies on an incorrect
			 application of law or rule.
(d)
			 When a decision is regarding the prevention, retention and contingency (PRC)
			 program, the decision relies on an incorrect application of the following:
(i) The Ohio department of job and family
			 services (ODJFS) model design, developed under section
			 5108.03 of the Revised Code, if
			 the county department of job and family services (CDJFS) involved adopted it;
			 or
(ii) CDJFS's written statement
			 of policies adopted under section
			 5108.04 of the Revised Code and
			 any amendments the CDJFS has adopted to the statement.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-8 - Administrative Appeal › Section 5101:6-8-02 - State hearings: county reviews

Current through all regulations passed and filed through July 1, 2024
(A) Any local agency
			 that disagrees with a state hearing decision, to which it was a party, may
			 request that the decision be reviewed by the bureau of state hearings, through
			 a process similar to the administrative appeal process described in rule
			 5101:6-8-01
			 of the Administrative Code.
(1) The request
			 shall be
			 signed by the agency director and received by the bureau of state
			 hearings
									no later than thirty days after the decision was
			 mailed. In lieu of a hard copy request, requests for county review can be
			 made via E-mail from the agency director.
(2) The request shall include the
			 reason why the director would like the decision reviewed. A decision will be
			 reviewed if the director asserts the decision relies on an incorrect
			 application of the law or rule.
(3)
			 The request for review shall not stay
			 the implementation of the state hearing decision nor shall it change
			 the outcome of the state hearing decision.
(4) If the written request does not meet the
			 requirements of paragraphs (A)(1) and (A)(2) of this rule,
			 the bureau of state hearings
			 shall
			 dismiss the request for review by sending written notice of dismissal to the
			 local
			 agency.
(5) Once a request is
			 accepted for review, the bureau of state hearings shall issue a
			 county review decision, within thirty days from the date the request for review
			 is received. Copies of the review decision shall be sent to
			 all hearing supervisors and hearing officers in state hearings, the relevant
			 policy areas and the local agency.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-9 - Further Appeal › Section 5101:6-9-01 - State hearings: further appeal rights

Current through all regulations passed and filed through July 1, 2024
(A) Judicial review
(1) Individuals who disagree with an
			 administrative appeal decision have the right to appeal that decision to the
			 court of common pleas, with the following exceptions:
(a) Judicial review does not apply to
			 administrative appeals subject to the appeal process described in paragraph (B)
			 of this rule.
(b) Judicial review
			 does not apply to appeals involving the child support program, except for
			 appeals that involve the child support disregard payment.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-20 - Administrative Violations › Section 5101:6-20-01 - State hearings - disqualification for an intentional program violation

Current through all regulations passed and filed through July 1, 2024
(A) Chapter 5101:6-20 of the Administrative
			 Code governs disqualification for intentional program violation in the Ohio
			 works first (OWF), prevention, retention and contingency (PRC) and
			 supplemental nutrition assistance program (SNAP)
			 programs.
(B) An individual may be
			 disqualified from the OWF, PRC and/or SNAP programs for
			 an intentional program violation based on one of
			 the following.
(1) A finding by a court that
			 the individual has committed a criminal offense connected to violation of the
			 OWF and/or PRC program, and/or SNAP requirements.
(2) A disqualification consent agreement,
			 signed by the individual, in accordance with rule
			 5101:6-20-40
			 of the Administrative Code.
(3) An
			 administrative disqualification hearing decision that finds that the individual
			 has committed an intentional program violation.
(4) A waiver of the right to an
			 administrative disqualification hearing, signed by the individual, in
			 accordance with rule
			 5101:6-20-30
			 of the Administrative Code.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-20 - Administrative Violations › Section 5101:6-20-02 - State hearings - definition of an intentional program violation

Current through all regulations passed and filed through July 1, 2024
(A) In the Ohio
			 works first (OWF) program, an intentional program
			 violation shall consist of any action by an individual, for the purpose of
			 establishing or maintaining the family's eligibility for OWF or for increasing
			 or preventing a reduction in the amount of the monthly OWF grant that is
			 intentionally:
(1) A false or misleading
			 statement or misrepresentation, concealment, or withholding of facts;
			 or
(2) Any act intended to mislead,
			 misrepresent, conceal, or withhold facts or propound a falsity.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-20 - Administrative Violations › Section 5101:6-20-04 - State hearings: notification at application

Current through all regulations passed and filed through July 1, 2024
(A) The local agency shall inform the
			 assistance group in writing of the disqualification penalties for
			 an intentional program violation each time the
			 assistance group files an application for program benefits.
(B) Disqualification penalties shall be in
			 clear, prominent, and bold-face lettering on the JFS 07200s "Request for Cash,
			 Food, and Medical Assistance" (rev. 10/2016
			 ) and the JFS 07501s "Program Enrollment & Benefit
			 Information" (rev. 4/2018), or their computer-generated equivalents.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-20 - Administrative Violations › Section 5101:6-20-10 - State hearings: initiating an administrative disqualification hearing

Current through all regulations passed and filed through July 1, 2024
(A) To initiate an
			 administrative disqualification hearing, the local agency shall complete and
			 submit a JFS 04060 "Referral for Administrative Disqualification Hearing" (rev.
			 1/2015
								) or its
			 computer-generated equivalent, to the bureau
			 of state hearings.
(B) The
			 JFS 04060 shall be accompanied by all information and documentation relied upon
			 by the local agency in reaching its conclusion that an intentional program violation has been
			 committed.
(C) If more than one
			 assistance group member is suspected of committing an intentional program
			 violation, a separate JFS 04060 shall be completed for each.
(D) If an individual is suspected of
			 an intentional program violation in more than one
			 program, a separate JFS 04060 shall be completed for each.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-20 - Administrative Violations › Section 5101:6-20-11 - State hearings: consolidation of an administrative disqualification hearing with a state hearing

Current through all regulations passed and filed through July 1, 2024
(A) An individual's state hearing, in
			 accordance with Chapters 5101:6-1 to 5101:6-9 of the Administrative Code, and
			 an administrative disqualification hearing may be combined into a single
			 hearing if the factual issues arise out of the same or related
			 circumstances.
(B) If the hearings
			 are to be combined, the accused individual shall be given notice of that fact
			 at the time the hearing is scheduled.
(C) The assistance group may waive the
			 thirty-day advance notice period required by rule
			 5101:6-20-12
			 of the Administrative Code when a state hearing and a disqualification hearing
			 are combined.
(D) If the hearings
			 are combined to decide the amount of the overpayment/overissuance and whether
			 an intentional program violation was committed, the assistance group shall lose
			 its right to a subsequent state hearing on the amount of the overpayment/
			 overissuance.
(E) If the state
			 hearing and the administrative disqualification hearing are combined, the time
			 frames for conducting disqualification hearings shall apply.
(F) When an administrative disqualification
			 hearing is combined with a state hearing, separate decisions shall be issued
			 for the administrative disqualification and state hearing issues, using the JFS
			 04007 "Administrative Disqualification Hearing Decision" (rev.
			 1/2015), and the JFS 04005 "State Hearing Decision"
			 (rev. 1/2015
								) or their
			 computer-generated equivalents, respectively. The
			 JFS 04005 and JFS 04007 forms are both generated in the hearings and appeals
			 tracking system (HATS X).
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-20 - Administrative Violations › Section 5101:6-20-12 - State hearings: advance notice of the administrative disqualification hearing

Current through all regulations passed and filed through July 1, 2024
(A) The bureau of state hearings shall
			 provide written notice to the accused individual at least thirty days prior to
			 the hearing date, unless the thirty-day advance notice period has been waived
			 under the provisions of rule
			 5101:6-20-11
			 of the Administrative Code.
(B) The
			 notice shall be provided by one of the following methods:
(1) Certified mail - return receipt
			 requested.
Notice provided by this method shall be mailed certified mail -
				return receipt requested.
(2) Personal service.
Notice provided by this method shall be hand-delivered, to the
				accused individual, by a person designated to do so by the Ohio department of
				job and family services (ODJFS) or by the local agency.
The person so designated shall record the date and location of
				delivery and the person to whom notice was delivered and maintain the
				information in the case file. The personal service record shall be made a part
				of the hearing record. Failure to make delivery shall be similarly
				recorded.
(3) Residence
			 service.
Notice provided by this method shall be hand-delivered, to some
				person of suitable age and discretion residing at the accused individual's
				current place of residence, by a person designated to do so by (ODJFS) or by
				the local agency.
The person so designated shall record the date and location of
				delivery and the person to whom notice was delivered and maintain the
				information in the case file. The residence service record shall be made a part
				of the hearing record. Failure to make delivery shall be similarly
				recorded.
Ohio Administrative Code › Title 5101:6 - Hearings › Chapter 5101:6-20 - Administrative Violations › Section 5101:6-20-13 - Effect of a pending administrative disqualification hearing

Current through all regulations passed and filed through July 1, 2024
(A) A pending administrative disqualification
			 hearing shall not affect the right of either the accused individual, or the assistance group, to apply for program benefits and to receive them if
			 otherwise eligible.
(B) A pending
			 administrative disqualification hearing shall not prevent the local agency from
			 taking appropriate action to deny, reduce, or
			 terminate assistance for other reasons.
(C) The local agency is responsible for
			 processing the application and issuing proper notice pursuant to rules
			 5101:6-2-02 and
			 5101:6-2-03 of the
			 Administrative Code.