Ohio Adm.Code 5101:6 | Ohio Administrative Code 5101:6 — Department of Job and Family Services | Hearings

Chapter 5101:6-1 General Provisions

Ohio Adm.Code 5101:6-1-01 State hearings: general.

(A) Chapters 5101:6-1 to 5101:6-9 of the Administrative Code describe the hearing and appeal rights and procedures applicable to family services program benefits, pursuant to section 5101.35 of the Revised Code, child support services, pursuant to section 3125.25 of the Revised Code, and the medicaid program, pursuant to section 5160.31 of the Revised Code.

(B) All rules relating to the right to a hearing and limitations on that right will be liberally construed in favor of the right to a hearing.

(C) When it appears that an individual may not be able to understand or exercise the right to a state hearing due to factors such as limited mental capability or language barriers, the local agency will assist the individual in naming a responsible party (guardian, relative, legal aid attorney, etc.) to act as authorized representative and receive a copy of notice in addition to the original to the individual. This requirement applies to notice at the time of application and to all subsequent hearing notices. A referral to social services for assistance in naming a responsible party may be appropriate.

(D) In counting the days contained in a timely appeal specified in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code, the date on which the notice was mailed, sent by electronic means, or otherwise provided is not counted.

If the last day for a timely appeal occurs on a Saturday, Sunday, or state or federal legal holiday, then the time period is extended to include the next workday.

(E) Local agencies may modify the format, but not the content, of state hearing notices mandated in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code to accommodate electronic generation of the notice. All such modifications will be approved by the bureau of state hearings.

(F) Definitions

As used in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code, the following terms will have the following meanings unless otherwise specified.

(1) "Agency" will refer to either the local agency, ODJFS, Ohio department of medicaid or it's designee.

(2) "Appellant" means an individual who is an applicant, participant, former participant, recipient, or former recipient of a family services program and is entitled by federal or state law to a hearing regarding a decision or order of the agency that administers the program.

(3) "Authorized representative" means an individual, eighteen years or older, who stands in the place of the appellant. The authorized representative may include a legal entity assisting in the application process. ODJFS may request proper identification from the authorized representative.

(4) "Benefits" will refer to benefits under any of the following programs:

(a) Public assistance.

(i) Refugee resettlement program.

(ii) Disability assistance.

(iii) OWF cash assistance.

(iv) Prevention, retention and contingency (PRC) program.

(v) Medicaid.

(vi) Temporary assistance to needy families (TANF) funded programs administered by local agencies or agents of ODJFS or the CDJFS.

(b) Supplemental nutrition assistance program (SNAP).

(d) State and federal adoption assistance programs.

(5) "Day" will refer to a twenty-four-hour calendar day unless otherwise indicated.

(6) "Electronic" has the same meaning as in section 1306.01 of the Revised Code.

(7) "Electronic equivalent" means an electronic version of an ODJFS form or application which has not been modified in any way other than format prior to completion and submission of that form to the administrative agency. The administrative agency is not required to accept forms that are materially altered.

(8) "Electronic signature" or "e-sign" has the same meaning as in section 1306.01 of the Revised Code.

(9) "Eligibility system" means a computer program determining benefit levels or amounts for individuals or families. Eligibility systems may also generate paper or electronic applications, forms, and notices related to the benefit determination or an action taken on the case of an individual or family.

(10) "Local agency" will refer to any of the following:

(a) The county department of job and family services (CDJFS), pursuant to section 5101.35 of the Revised Code.

(b) The county public children services agency (PCSA), pursuant to section 5101.35 of the Revised Code.

(d) A private or government entity administering, in whole or in part, a family services program benefit on behalf of ODJFS, a CDJFS, a PCSA, or as otherwise designated under law.

(11) "Social services" will refer to any or all of the following:

(a) Learning earning and parenting (LEAP), supportive services, and support services provided to participants in a work activity under the Ohio works first (OWF) program.

(b) Publicly funded child care services provided pursuant to Chapter 5101:2-16 of the Administrative Code.

(12) "Virtual" refers to a hearing that is scheduled through an online platform and attended via an online link with a computer or mobile device, or by telephone using an indentification number that is unique to the hearing.

Last updated January 17, 2025 at 7:54 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Chapter 5101:6-2 Notice

Ohio Adm.Code 5101:6-2-01 State hearings: notice at the time of application.

(A) At the time of application for benefits, the assistance group will be informed, in writing, of the right to a state hearing, of the method by which a state hearing may be requested, and that the case may be presented by the assistance group or by an authorized representative, such as legal counsel, relative, friend, or other spokesperson.

(B) The JFS 04059 "Explanation of State Hearing Procedures," or an Ohio department of job and family services approved equivalent, will be used to provide this notice.

(C) If the assistance group making a supplemental nutrition assistance program (SNAP) application speaks a language other than English, and if the local agency is required by rule 5101:4-1-05 of the Administrative Code to provide bilingual staff or interpreters who speak the appropriate language, the local agency will ensure that the hearing procedures are explained verbally in that language. If an oral explanation is provided in a language other than English, it should be noted in the case record comments. If a translated written explanation is provided in another language, in addition to noting that in the case record, a copy of the explanation should be maintained in the hard copy record.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-02 State hearings: notice of approval of an application for benefits.

(A) When the agency approves an application for public assistance or social services, the assistance group will be provided prompt written notice of the decision.

(1) The notice will contain:

(a) A clear and understandable statement of the action the agency has taken and the reasons for it, including the beginning date of aid and the amount of all benefits authorized.

(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) A telephone number to call about free legal services.

(2) The JFS 04074 "Notice of Approval of Your Application for Assistance," or an Ohio department of job and family services (ODJFS) approved equivalent, will be used.

(B) When the agency approves an application or reapplication for supplemental nutrition assistance program (SNAP) benefits, the assistance group will be provided written notice of the decision.

(1) The ODJFS electronic approval notices are the only notices that may be used for approval of applications and reapplications for SNAP benefits. When the agency approves an application or reapplication for SNAP benefits, the JFS 04074, will not be used.

(2) Timing of the notice will be in accordance with rule 5101:4-5-07 of the Administrative Code.

(3) The notice will contain:

(a) A clear and understandable statement of the action the agency has taken.

(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) The name and telephone number of the person to contact for more information.

(e) A telephone number to call about free legal services.

The notice will also include the amount of the allotment, the beginning and ending dates of the certification period, and any variations in the benefit level based on changes anticipated at the time of certification.

If the initial allotment contains both benefits for the month of application and the current month's benefits, the notice will explain that the initial allotment includes more than one month's benefits, and will indicate the monthly allotment for the remainder of the certification period.

(4) The agency may include with the notice a reminder of the assistance group's obligation to report changes in circumstances and the need to reapply for continued participation at the end of the certification period. Other information that may be useful to the assistance group also may be included.

(5) When an assistance group's application is approved on an expedited basis without verification, as provided in rule 5101:4-6-09 of the Administrative Code, the notice will be accompanied by an explanation that the assistance group will provide the verification that was previously waived.

(6) If the agency has elected to assign a longer certification period to an assistance group certified on an expedited basis, the notice will also be accompanied by an explanation of the special conditions of the longer certification period, as specified in rule 5101:4-6-09 of the Administrative Code.

(7) For assistance groups provided a notice of expiration at the time of certification, as required by rule 5101:4-7-07 of the Administrative Code, the notice of eligibility will be accompanied by a notice of expiration.

(8) The JFS 07401 "Notice of Pending Supplemental Nutrition Assistance Program (SNAP) Application," or an ODJFS approved equivalent, will be used.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-03 State hearings: notice of denial of an application for benefits.

(A) When the agency denies an application for or a requested change in public assistance or social services, the assistance group will be provided prompt written notice of the decision.

(1) The notice will contain:

(a) A clear and understandable statement of the action the agency has taken and the reasons for it.

(b) Citations of the applicable regulations.

(d) A telephone number to call about free legal services.

(2) The JFS 07334 "Notice of Denial of Your Application for Assistance," or an Ohio department of job and family services (ODJFS) equivalent, will be used.

(B) When the agency denies a supplemental nutrition assistance program (SNAP) application, reapplication or requested change in benefits, the assistance group will be provided written notice of the decision.

(1) The JFS 07334 "Notice of Denial of Your Application for Assistance," or an ODJFS approved equivalent will be used.

(2) Timing of the notice will be in accordance with rule 5101:4-5-07 of the Administrative Code.

(3) The notice will contain:

(a) A clear and understandable statement of the action the agency has taken 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) The name and telephone number of the person to contact for more information.

(e) A telephone number to call about free legal services.

(4) When the denial is caused by the assistance group's failure to take action to complete the application process, as described in rule 5101:4-5-07 of the Administrative Code, the notice will also explain:

(a) What action the assistance group will take to reactivate the application.

(b) That the case will be reopened without a new application if action is taken within thirty days of the mailing date of the denial notice.

(c) That the assistance group will submit a new application if, at the end of the thirty day period, the assistance group has not taken the needed action and wishes to participate in the program.

(5) When the agency is at fault for not completing the application process by the end of the second thirty day period, but the case file is not complete enough to reach an eligibility determination, the agency may deny the case, but the notice of denial will be accompanied by notification to the assistance group to file a new application and of its possible entitlement to benefits lost as a result of agency delay.

(6) See rule 5101:4-2-02 of the Administrative Code for additional information that will accompany the notice of denial for assistance groups with actual or potential categorical eligibility.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-04 State hearings: prior notice of adverse action.

When the agency intends to withhold, reduce, suspend, expunge, or terminate public assistance, social services, or supplemental nutrition assistance program (SNAP) within the certification period, or to change the manner or form of assistance to protective, vendor, or two-party payment, the assistance group will be provided prior written notice of the action. An electronic notice may replace a written notice, as permitted by federal law.

(A) The written notice will be sent electronically, by regular U. S. mail, or hand delivered no less than fifteen days prior to the effective date of the proposed action.

(B) The notice will contain:

(1) A clear and understandable statement of the proposed action 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) An explanation of the circumstances under which a timely hearing request will result in continued benefits.

(5) A telephone number to call about free legal services.

(C) The JFS 04065 "Prior Notice of Right to a State Hearing," or an Ohio department of job and family services (ODJFS) approved equivalent, will be used.

(D) If a change in the assistance group's circumstances requires reduction or termination of both public assistance and SNAP benefits, the agency will issue a single notice for both public assistance and SNAP actions.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-05 State hearings: exceptions to prior notice.

(A) Public assistance and social services

(1) Under the following circumstances, prior notice of adverse action is not required, but the assistance group will 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 will 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 will be informed, in writing, when the allowance is initiated, of the exact date upon which the allowance will automatically terminate.

(2) The notice will contain:

(a) A clear and understandable statement of the action being taken 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 will result in reinstated benefits.

(e) A telephone number to call about free legal services.

(3) The JFS 04085 "Prior Notice of Right to a State Hearing," or an Ohio department of job and family services (ODJFS) approved equivalent, will be used.

(B) Supplemental nutrition assistance program (SNAP)

Under the following circumstances, individual notices of adverse action will not be provided.

(1) The agency determines, based on reliable information, that all members of the assistance group have died.

(2) The agency determines, based on reliable information, that the assistance group has moved from the county.

(3) The assistance group has been receiving an increased allotment to restore lost benefits, the restoration is complete, and the assistance group was previously notified in writing of when the increased allotment would terminate.

(4) The assistance group jointly applied for public assistance and SNAP benefits, has been receiving SNAP benefits pending the approval of the public assistance grant, and was notified in writing at the time of certification that SNAP benefits would be reduced upon approval of the public assistance grant.

(5) An assistance group member is disqualified for an intentional program violation in accordance with rule 5101:4-8-15 of the Administrative Code, or the benefits of the remaining assistance group members are reduced or terminated to reflect the disqualification of that assistance group member.

(6) The agency has elected to assign a longer certification period to an assistance group which was certified on an expedited basis and for whom verification was postponed, under the provisions of rule 5101:4-6-09 of the Administrative Code.

The assistance group will have received written notice that the receipt of future benefits is contingent on its providing the verification that was initially postponed and that the agency may act on the verified information without further notice.

(7) The assistance group is converted from cash and/or SNAP electronic benefit transfer (EBT) benefit repayment to allotment reduction as a result of failure to make agreed upon repayment of an overissuance.

(8) The agency is terminating the eligibility of a resident of a drug or alcohol treatment center or a group living arrangement if the facility loses either its certification from the appropriate agency or agencies of the state of Ohio, as defined in rule 5101:4-6-01 of the Administrative Code, or has its status as an authorized representative suspended due to food and nutrition services (FNS) disqualifying it as a retailer.

(9) The assistance group voluntarily requests, in writing or in the presence of a caseworker, that its participation be terminated. If the assistance group does not provide a written request, the agency will send the assistance group a letter confirming the voluntary withdrawal. Written confirmation does not entail the same rights as a notice of adverse action except that the assistance group may request a state hearing.

(10) The agency determines, based on reliable information, that the assistance group will not be residing in the county and, therefore, will be unable to obtain its next allotment. The agency will inform the assistance group of its termination no later than its next scheduled issuance date. While the agency may inform the assistance group before its next issuance date, the agency will not delay terminating the assistance group's participation in order to provide advance notice.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-06 State hearings: notice of mass change in benefits.

(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 will 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 will be mailed or personally delivered no less than fifteen days prior to the processing of the action.

(2) The notice will 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 will 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," or an Ohio department of job and family services (ODJFS) approved equivalent, will be used. Local agencies will 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 will be duplicated exactly on any such local agency notice regarding a policy change that could be misapplied to individual circumstances, in accordance with rule 5101:6-3-01 of the Administrative Code.

(B) When a change in state or federal law or policy requires a mass change in SNAP, as described in rule 5101:4-7-03 of the Administrative Code, the assistance group will be provided notice of the action as prescribed by state hearings in accordance with 7 C.F.R. 273.12 (effective August, 1, 2024).

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-07 State hearings: notice of the right to a state hearing - child support services.

(A) Notice at the time of application

(1) Public assistance recipients will be informed, in writing, of the right to a state hearing. Notification will 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 will be informed, in writing, of the right to a state hearing. Notification will be mailed or personally delivered at the time an application is provided to the individual.

(3) The JFS 04059 "Explanation of State Hearing Procedures" will be used.

(B) Notice of acceptance or denial

(1) Within twenty days of receipt of a non-public assistance application for child support services, the CSEA will notify the applicant of acceptance or denial of the application.

(2) The JFS 07647 "Notice of Case Status Application" will be used.

(1) When the CSEA has determined that a request for modification is not supported, the CSEA will notify the requesting party of that determination.

(2) The notification will include the date and reason for the termination and will be accompanied by the JFS 04059.

(D) Notice of case closure

(1) The CSEA will notify the recipient of child support services in writing at least sixty days prior to taking administrative action to close the child support case when services are proposed for termination pursuant to rule 5101:12-10-70 of the Administrative Code.

(2) The JFS 07046 "Pending Case Closure Notice" will be used to provide notification of case closure.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-08 State hearings: notice whenever disagreement with an action or inaction is expressed.

(A) Whenever an assistance group disagrees with an agency action or lack of action, the agency will remind the assistance group of the right to request a state hearing via the JFS 04059 "Explanation of State Hearing Procedures." The published hearing rules will 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.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-20 State hearings: notice of overpayment/overissuance.

(A) When the local agency has determined that a cash benefit overpayment has occurred, responsible parties from whom repayment is being sought will be provided written notice of the overpayment determination.

Notice is also needed whenever a previous overpayment determination is revised to change the amount or period of the overpayment.

(1) The notice will 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.

(2) The benefit recovery notices, created and maintained by the Ohio department of job and family services and issued through the eligibility system, will be used.

(B) When the agency has determined that a supplemental nutrition assistance program (SNAP) overissuance has occurred, assistance groups from which repayment is being sought will be provided written notice of the overissuance determination.

Notice is also needed whenever a previous overissuance determination is revised to change the amount or period of the overissuance or to change the claim type from administrative error (AE) to inadvertent household error (IHE).

(1) The notice will contain:

(a) Citations of the applicable regulations.

(b) An explanation of the assistance group'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.

(c) A clear and understandable statement of the determination and the reasons for it, including the amount and period of the overpayment.

(d) A statement of how the claim was calculated, including any offsetting done to reduce the overpayment.

(e) A statement expressing the intent to collect from all adults in the assistance group when the overpayment occurred.

(f) A statement providing an opportunity to inspect and copy records related to the claim.

(g) An explanation of the available methods of repayment.

(h) A statement explaining that if the claim is not paid, it will be sent to other collection agencies who will use various collection methods.

(i) A statement explaining that, if not paid, the claim will be referred to the federal government for federal collection action.

(j) A statement explaining that if the claim becomes delinquent the assistance group may be subject to additional processing charges.

(k) The name and telephone number of a person to contact for more information.

(l) A telephone number to call about free legal services.

(2) For inadvertent household error, administrative error and intentional program violation claims, the assistance group will also be informed of the length of time it has to choose a method of repayment and notify the agency of its decision, and that its allotment will be reduced if it fails to agree to make restitution. For administrative error claims, the assistance group will also be informed of the availability of allotment reduction as a method of repayment if the assistance group prefers to use this method.

(3) The notice will provide space for the assistance group to indicate the method of repayment, a signature block, and an explanation of the assistance group's right to request renegotiation of any repayment schedule to which it has agreed should its economic circumstances change.

(4) The JFS 07442 "Food Assistance Repayment Agreement," or an Ohio department of job and family services equivalent, will be used.

(5) Notice is not needed when the overissuance involves possible fraud and has been referred to the county prosecutor.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-25 State hearings: notice of eligibility for lost supplemental nutrition assistance program (SNAP) benefits.

(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 will be provided prompt written notice of the agency's determination.

The notice will 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.

(B) If the assistance group claims that it is entitled to restoration of lost benefits but the agency, after reviewing the case file, does not agree, the assistance group will be provided prompt written notice of the denial of its request.

The notice will contain:

(1) A clear and understandable statement of the denial 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) The name and telephone number of the person to contact for more information.

(5) A telephone number to call about free legal services.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-26 State hearings: notice of approval, denial or delay of replacement supplemental nutrition assistance program (SNAP) benefits.

When the agency approves, denies, or delays an assistance group's request for replacement SNAP benefits, the assistance group will be provided written notice of the action.

(A) The notice will 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," whichever is later.

If a notice of delay was issued, the agency will issue an approval or denial notice within two business days from the date it receives the information which caused the delay.

(B) The notice will 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.

(C) The JFS 07235, "Action Taken on Your Request for Replacement of Food Assistance Benefits " or an Ohio department of job and family services (ODJFS) approved equivalent, will be used.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-30 State hearings: notice of medical determination.

(A) The JFS 04022 "Notice of Medical Determination and a Right to a State Hearing," or an Ohio department of medicaid (ODM) approved equivalent will 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 will 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 will 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 will send the notice to the individual and authorized representative, with a copy of the notice sent to the local agency.

(B) The notice will 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 individual's right to and the method of obtaining a state hearing.

(4) A telephone number to call about free legal services.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-31 State hearings: notice of denial of prior authorization for medical or dental services.

When a request for prior authorization for a medical or dental service is denied, the individual and authorized representative will be provided prompt written notice of the decision. Copies will also be sent to the provider and to the local agency.

(A) The notice will 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.

(B) A notice describing the denial of authorization for medical services will be used.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-32 State hearings: notice of adverse preadmission screening and resident review (PASRR) determinations.

(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 will 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 will 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 will contain:

(a) A clear and understandable statement of the determination and the reasons for it.

(b) Citations of the applicable regulations.

(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 will be sent to:

(a) The nursing facility.

(b) The individual's attending physician.

(d) The Ohio department of medicaid (ODM) (or designee).

(B) Notice of adverse resident review (RR) determination

When a resident of a nursing facility receives an adverse determination as the result of a resident review (RR) performed by MHAS or DODD, the determining agency will provide the affected individual with written notice of the determination.

(1) The notice will 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 will contain:

(a) A clear and understandable statement of the determination and the reasons for it.

(b) Citations of the applicable regulations.

(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 will be sent to:

(a) The nursing facility.

(b) The individual's attending physician.

(d) The ODM (or designee).

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-36 State hearings: notice of denial of just cause request for termination of managed care plan membership.

(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, will send a notice to an individual.

(B) The notice will 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.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-40 State hearings: coordinated services program state hearing and notice requirements.

(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.

(1) ODM or the MCP will provide written notice, not less than fifteen days before their proposed enrollment into the CSP. The notice will contain clear and understandable information describing:

(a) The effective date of the proposed enrollment into the CSP.

(b) The reason why ODM or the MCP is proposing enrollment.

(d) Where to get additional information regarding enrollment into the CSP, including the phone number for and availability of free legal services.

(e) Hearing rights as described in division 5101:6 of the Administrative Code, including the individual's rights to appeal the proposed enrollment through a state hearing.

(f) The method of and deadline for selecting a designated provider or pharmacy; otherwise, a designated provider or pharmacy will be selected by ODM or the MCP.

(2) If the individual requests a state hearing and the hearing request is received by either ODM or the MCP within the fifteen-day prior notice period set forth in rule 5101:6-4-01 of the Administrative Code, ODM or the MCP will enroll an individual into the CSP no sooner than the hearing decision mail date.

(D) Continued enrollment into the CSP.

(1) ODM or the MCP will provide written notice to the individual of the continued enrollment into the CSP. The notice will contain clear and understandable information describing:

(a) The effective date of the continued enrollment into the CSP.

(b) The reason why ODM or the MCP is continuing enrollment.

(d) Where to get additional information regarding continued enrollment into the CSP, including the phone number for and availability of free legal services.

(e) Hearing rights as described in division 5101:6 of the Administrative Code, including the individual's right to appeal the continuing enrollment through a state hearing.

(2) The individual requesting a timely hearing regarding continued enrollment into the CSP will continue to be enrolled in the CSP until the hearing decision is rendered in accordance with rule 5101:6-4-01 of the Administrative Code.

(E) Denial of designated provider or pharmacy.

(1) ODM or the MCP will provide written notice, to the individual when the individual's request for a designated provider or pharmacy change is denied. The notice will contain clear and understandable information describing:

(a) The name of the denied designated provider or pharmacy.

(b) The reason why ODM or the MCP is denying the request for a change.

(d) Where to get additional information regarding the denial of the designated provider change, including the phone number for and availability of free legal services.

(e) Hearing rights as described in division 5101:6 of the Administrative Code, including the right to appeal the denial through a state hearing.

(2) The individual requesting the hearing regarding the denial of designated provider or pharmacy change will continue assignment with the current designated provider or pharmacy until the hearing decision is rendered in accordance with rule 5101:6-4-01 of the Administrative Code.

Last updated January 17, 2025 at 4:45 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-2-51 Notice of interim assistance reimbursement.

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.

Last updated April 3, 2023 at 8:29 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Chapter 5101:6-3 Request for a State Hearing

Ohio Adm.Code 5101:6-3-01 State hearings: grounds for requesting a state hearing.

(A) The right to a state hearing is limited to actions by the Ohio department of job and family services (ODJFS), the Ohio department of medicaid (ODM), the local agency, or an agent of ODJFS, ODM, or the local agency. A hearing need not be granted when a change in state or federal law, or local agency policy adopted pursuant to options authorized in state law, requires automatic adjustments of benefits for classes of recipients. If the reason for the request is the misapplication of the change to the appellant's individual circumstances, hearing rights exist. The closure of fair hearing benefits is not grounds for requesting a state hearing nor subject to notice rights.

(B) The grounds for requesting a state hearing in regard to family services program benefits are as follows:

(1) An application for benefits has been denied, acted upon erroneously, or not acted upon with reasonable promptness.

(2) The agency has proposed or acted to reduce, suspend, terminate, expunge, or withhold benefits, or the assistance group believes that the level of benefits is not correct.

(3) A request for an adjustment in benefits has been denied, not acted upon, acted upon erroneously, or not acted upon with reasonable promptness.

(4) The agency has determined that an overpayment or overissuance has occurred, or the assistance group believes that the amount of the overpayment or overissuance is not correct.

(5) The individual disagrees with any decision, action, or lack of action involving work registration exemption status or requirements, or OWF work activity exemption status or participation.

A regular employee believes that the assignment of an Ohio works first (OWF) work activity participant violates the prohibition against displacement.

(6) A request for prior authorization of a medical service or additional therapeutic leave days has been denied, or the individual believes that the reviewing agency's decision on a request for pre-certification of a hospital admission or medical procedure is not correct.

(7) The individual or provider of long-term care believes that the level of care assigned, or the effective date of the level of care assigned, to the individual is not correct.

(8) The individual disagrees with a preadmission screening or resident review determination made by the Ohio department of mental health and addiction services or the Ohio department of developmental disabilities.

(9) The enrollment or decision to continue enrollment of the individual in the coordinated services program (CSP), or denial of the individual's request to change a CSP-designated provider.

(10) In regard to actions involving a medicaid managed care plan (MCP) or "MyCare Ohio" plan (MCOP):

(a) The individual disagrees with one of the following actions taken by a medicaid managed care plan:

(i) An MCP or MCOP appeal resolution decision based on an adverse benefit determination, as described in rules 5160-26-08.4 or 5160-58-08.4 of the Administrative Code, as applicable.

(ii) A managed care plan's enrollment or decision to continue enrollment of the individual in the coordinated services program (CSP), or denial of the individual's request to change a CSP-designated provider.

(iii) The plan's upholding the denial of payment for a medical service for which the individual is being billed.

(b) The individual disagrees with a decision of ODM that the individual does not meet an exclusion from mandatory managed care plan membership, or a decision to deny the individual's request for just cause termination of membership in an assigned managed care plan and enrollment in a different managed care plan.

(c) The MCP or MCOP fails to adhere to the notice and timing requirements for appeals set forth in rule 5160-26-08.4 or 5160-58-08.4 of the Administrative Code.

(11) The agency has denied payment for a medical service provided to an individual enrolled in the coordinated services program (CSP) by a nondesignated provider.

(12) The individual disagrees with any decision, action, or lack of action involving assistance under the supplemental security income (SSI) case management program.

(13) The individual feels that a county board that has medicaid local administrative authority under division (A) of section 5126.055 of the Revised Code for home and community-based services violated the right of an individual to choose a provider that is qualified and willing to provide services to the individual.

(14) In the medicaid program, either the institutionalized spouse or the community spouse may request a hearing concerning the following determinations:

(a) Community spouse monthly income allowance.

(b) Community spouse's minimum monthly maintenance needs allowance.

(d) Community spouse and institutionalized spouse total gross income.

(e) Spousal share of assessed resources.

(f) Current countable resources.

(g) Community spouse resource allowance.

(15) The individual disagrees with a decision to deny or discontinue self-direction in any of the applicable waiver programs administered by the ODM or its partner agencies.

(C) The grounds for requesting a state hearing in the child support (Title IV-D of the Social Security Act (as in effect on 8/1/2024)) program, by an applicant, recipient, or custodial parent are as follows:

(1) An application for child support services has been denied, acted upon erroneously, or not acted upon with reasonable promptness.

(2) The recipient believes that the child support enforcement agency (CSEA) has failed to use appropriate establishment or enforcement techniques.

(3) The custodial parent believes that child support collections have not been distributed or disbursed correctly or questions the accuracy of the arrears owed to ODJFS at termination of cash benefits.

(4) The custodial parent believes that child support payments, including payments owed to the custodial parent due to agency error, are not being issued with reasonable promptness.

(5) The custodial parent believes that the CSEA has failed to take action against an employer for failure to promptly forward payments withheld from the absent parent's wages.

(6) The custodial parent disagrees with the CSEA's decision to close the child support case.

(7) The custodial parent disagrees with the CSEA's decision to deny a modification request.

(D) The grounds for requesting a state hearing in the child support program by the noncustodial parent are as follows:

(1) Services for establishing paternity have been denied.

(2) The CSEA has refused to review the noncustodial parent's support order for modification.

(3) The noncustodial parent disagrees with the CSEA's decision to deny a modification request.

Last updated January 17, 2025 at 12:13 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-3-02 State hearings: state hearing requests.

(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.

(B) Time limit for all programs except for adverse benefit determination appeal resolution decision for either a managed care plan (MCP) or a "MyCare Ohio" (MCOP) plan.

(1) The individual shall be allowed ninety calendar days to request a hearing on any action or inaction.

For supplemental nutrition assistance program (SNAP), "action" shall include denial of a request for restoration of benefits lost more than ninety days but less than a year prior to the request for restoration.

(2) The ninety-day period begins on the day after the date the notice of action is mailed. The date of the hearing request is the date it is received by either the state or local agency.

(3) The ninety-day time limit does not apply unless the individual has received notice of hearing rights relative to the specific action or inaction being appealed, as specified in Chapter 5101:6-2 of the Administrative Code.

(4) Individuals who receive a resource assessment must request a hearing on the assessment no later than ninety days following the mailing date of the notice of approval or denial of the medicaid application.

(5) For SNAP, the assistance group may request a hearing at any time within the certification period to dispute its current level of benefits.

(C) Time limit for MCP or MCOP for adverse benefit determination appeal resolution decision. For issues related to an adverse benefit determination appeal resolution decision for either a (MCP) or (MCOP) plan, the individual shall have ninety calendar days from the mail date of the MCP or MCOP appeal resolution decision to request a state hearing.

(D) The freedom to request a state hearing shall not be limited, interfered with, or discouraged in any way. This applies not only to the local and state agency but also to entities, such as managed care plans, acting for or in place of the local or state agency. Local and state agency emphasis shall be on helping the individual to submit and process the request, and to prepare for the hearing.

(E) For SNAP, if the assistance group making the hearing request speaks a language other than English, and the local agency is required by rule 5101:4-1-05 of the Administrative Code to provide bilingual staff or interpreters who speak the appropriate language, the local agency shall ensure that the hearing procedures are explained orally in that language.

(F) Complaints concerning discrimination because of age, race, sex, religion, national origin, political beliefs, or handicap shall be referred to the Ohio department of job and family services (ODJFS) equal employment opportunity (EEO) officer for investigation.

If the complaint also concerns one of the issues listed in rule 5101:6-3-01 of the Administrative Code, it shall also be considered a state hearing request.

Last updated April 3, 2023 at 8:29 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Chapter 5101:6-4 Continuation of Benefits After Hearing Request

Ohio Adm.Code 5101:6-4-01 State hearings: continuation of benefits when a state hearing is requested.

(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 will 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 will 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 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 will be considered a denial, rather than a reduction, suspension, or termination, of service and continuation of benefits will not apply.

(B) When benefits are reduced, suspended, or terminated in violation of the provisions of paragraph (A) of this rule, benefits will be reinstated to the previous level.

(C) When the request for a state hearing is received by the state or local agency within ten calendar days after the effective date of the adverse action (the ten-day time limit does not apply to SNAP), and when good cause is shown for the delay in making the request, benefits will be reinstated to the previous level. "Reinstatement of benefits to the previous level" means that benefits will be reinstated retroactive to the date the benefits were reduced, suspended, or terminated.

(1) "Good cause" is defined as death in the immediate family, sudden illness, or injury of the individual or a member of the individual's immediate family, or other circumstances that reasonably prevented requesting a hearing within the timely notice period.

(2) SNAP benefits will not be reinstated when the assistance group has specifically waived continuation of benefits, or when the certification period has expired.

(D) When an adverse action was taken without prior notice, pursuant to paragraph (A) of rule 5101:6-2-05 of the Administrative Code, and when the hearing request is received by either the state or local agency within fifteen calendar days from the mailing date of the notice of adverse action, benefits will be reinstated to the previous level.

(E) When SNAP benefits are reduced or terminated because of a mass change, and when the assistance group's hearing request is received by either the state or local agency within fifteen calendar days from the mailing date of the mass change notice, SNAP benefits will be reinstated to the previous level if the following conditions are met:

(1) The reason for the assistance group's appeal is an erroneous application of the mass change to the individual case.

(2) The assistance group does not specifically waive its right to continuation of benefits.

(3) The SNAP certification period has not expired.

(F) If the need for reinstatement is discovered by the local agency, the local agency will authorize reinstatement within one workday of the date of discovery. If the need for reinstatement is discovered by the bureau of state hearings, the bureau will immediately order the responsible agency to reinstate benefits. All reinstatement orders will be in writing. The agency will respond to reinstatement orders by authorizing benefits within one workday of receipt of the order. Benefits so reinstated will continue until the state hearing decision is rendered unless one of the conditions in paragraph (A) of this rule is met.

(G) MCP or MCOP issues.

(1) When a hearing request involves an adverse benefit determination appeal resolution within the prior notice period, as described in rule 5160-26-08.4 or 5160-58-08.4 of the Administrative Code, the MCP or MCOP will be responsible for ensuring benefits are continued at or reinstated to the previous level until the services that were authorized by the MCP or MCOP are received or until the state hearing decision is issued, whichever date comes first.

(2) Service will be continued or reinstated when a timely hearing request is received unless the appellant's physician certifies, in writing to the bureau of state hearings, that continuation of the service would pose a substantial risk of adverse health consequences.

(3) Nothing in this rule will require an individual physician to continue a service for an enrollee if that physician believes that to do so would violate the provisions of section 4731.22 of the Revised Code.

(4) When a hearing request involving an MCP or MCOP's proposed enrollment in the coordinated services program (CSP), defined in rule 5160-20-01 of the Administrative Code, is received by the state or local agency within the prior notice period, the MCP or MCOP will not enroll the member in the CSP until the state hearing decision is issued.

(5) MCPs and MCOPs are not required to provide continuation of benefits except for the reasons outlined in paragraphs (G)(1) and (G)(4) of this rule.

(H) The denial or delay of replacement SNAP benefits, under the provisions of rule 5101:4-7-11 of the Administrative Code and paragraph (A)(1)(a) of rule 5101:6-5-02 of the Administrative Code, will remain in effect pending the state hearing decision. When a nonadverse action is needed, the agency will proceed with that action. In the child support program, the child support enforcement agency (CSEA) will continue to provide services, as otherwise appropriate, without regard to any hearing requests that have been made.

(I) When a hearing request involving ODJFS's proposed enrollment in the CSP, defined in rule 5160-20-01 of the Administrative Code, is received by the state or local agency within the prior notice period, ODJFS will not enroll the individual in the CSP until the state hearing decision is issued.

Last updated April 3, 2025 at 7:35 AM

History

Effective: April 3, 2025
Promulgated Under: 119.03

Chapter 5101:6-5 Pre-Hearing Procedures; Postponement, Denial, or Dismissal of Hearing

Ohio Adm.Code 5101:6-5-01 State hearings: procedures prior to the state hearing.

(A) The bureau of state hearings (BSH) will handle the receipt and processing of the request for a state hearing. When the hearing request is made to the local agency, the local agency will date stamp the request, retain a copy, and mail or transmit the request to "ODJFS, Bureau of State Hearings, P.O. Box 182825, Columbus, Ohio 43218-2825," or fax to 614-728-9574 or email to bsh@jfs.ohio.gov, within one business day from the date of receipt.

(B) The local agency proposing the action about which the individual requested the state hearing will complete an appeal summary. The summary consists of a prescribed form (the JFS 04067 "Appeal Summary," or for a medicaid managed care plan or "MyCare Ohio" plan the ODM 01959 "Appeal Summary for Managed Care Plans" ) and attachments, and is intended to provide a summary of all facts and documents relevant to the issue under appeal sufficient to demonstrate the basis for the local agency's action.

The local agency will file its appeal summary with the bureau of state hearings at least three business days prior to the scheduled hearing date, and also make it available to the individual or authorized representative at least three days prior to the hearing for inspection. Failure to do so may be considered good cause for postponing or continuing the hearing if the individual has been materially disadvantaged by the failure.

(1) To avoid unnecessary state hearings, the local agency will provide an opportunity for the individual to discuss and/or resolve disagreements with the local agency's actions or inaction.

(2) When an individual requests a county conference, the local agency will convene a conference presided over by the local agency's director or a designee. Both the local agency and the individual may bring whomever each reasonably wants to be at the conference. The issue to be decided by the presiding person will be whether the local agency can show, by a preponderance of the evidence, that its action or inaction was in accordance with applicable regulations. If not, the presiding person will retract the notice of adverse action and/or decide the question of the individual's entitlement to benefits or arrange to make that determination as quickly as possible. The outcome of the county conference will be recorded, in writing, in the case record.

(3) The individual need not have a county conference to have a state hearing, nor does the holding of a county conference, or the individual's failure to appear for one, diminish the right to a state hearing. A state hearing is still to be held unless a resolution is reached at the county conference and the individual withdraws the hearing request in writing. Any such withdrawal will be signed and dated by both the individual and the local agency representative, will clearly set forth the resolution upon which the withdrawal is based, and will be forwarded to the assigned hearings section within two business days. The local agency will give one copy of the withdrawal to the individual and retain one copy in the case file.

(4) The local agency will schedule a county conference for assistance groups contesting a denial of expedited supplemental assistance nutrition program (SNAP) within two business days, unless the assistance group requests that the county conference be scheduled later or states that it does not wish to have a county conference.

(D) Managed care plan (MCP) and "MyCare Ohio" plan process. Upon notification from the BSH that a member has requested a state hearing, the MCP or MCOP will notify BSH within three calendar days whether or not the member has exhausted the plan appeal resolution process, as described in rules 5160-26-08.4 and 5160-58-08.4 of the Administrative Code.

(E) Legal representation

All parties have the right to be represented by legal counsel at the state hearing. The local agency will provide the individual with information regarding free legal services in the community, as specified in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code and upon request from the appellant, via the JFS 04059 "Explanation of State Hearing Procedures." The local agency may provide legal services through a social services contract.

(F) Access to documents and regulations

(1) The individual and authorized representative will be provided reasonable time before the date of the hearing, as well as during the hearing, to examine the contents of the case file, as well as all records and documents to be used by the local agency at the hearing, except for confidential information protected from release.

(2) If the individual or authorized representative requests case record documents that are relevant to the issue under appeal, the local agency will provide one copy of each such document at no cost. The authorized representative is to provide the individual's signed authorization to the local agency before obtaining a copy of case record material.

(3) Current program manuals will be made available to the individual or authorized representative for review at the local agency.

(4) The local agency's failure to provide or allow access to the information, at least three days prior to scheduled hearing, as required by this paragraph, may be the basis for postponing or continuing the hearing.

(5) Confidential material protected from release, and other documents or records that the individual will not have an opportunity to contest or challenge, will not be presented at the hearing nor affect the hearing officer's decision.

(6) When the hearing involves work registration, the individual will also be allowed to examine the case file, except for confidential information (which may include test results) that the agency determines should be protected from release.

(7) When the hearing involves a managed care plan or "MyCare Ohio" plan, the provisions of paragraphs (F)(1), (F)(2), (F)(4), and (F)(5) of this rule will apply to the managed care plan and "MyCare Ohio" plan, its subcontracting providers, and all relevant records.

(G) Subpoenas

(1) Both the local agency and the individual or authorized representative may request in writing, at least five calendar days prior to the date of the state hearing, that ODJFS issue a subpoena to compel the presence of documents and witnesses that would not otherwise be available and that are essential to the requesting party's case.

(2) The hearing authority will make the determination as to whether such subpoenas will be issued and whether subpoenaed individuals will participate in person or by telephone. If a subpoena request is denied, the reason for denial will be clearly explained in the state hearing decision.

(3) Subpoenas will be served by mail. The payment of witness fees for attendance and travel is not required.

(4) When the hearing involves a managed care plan or "MyCare Ohio" plan, the managed care plan or "MyCare Ohio" plan will have the same subpoena rights as the local agency.

(H) Transportation

The local agency may provide transportation to the individual through a social services contract where a valid need for transportation exists.

(I) Translations of hearing decisions

If an individual or authorized representative requests that a hearing decision be translated, the bureau of state hearings will provide a translation.

(J) Interpreters for hearings

If an individual or authorized representative has limited proficiency in English or communicates using sign language, the local agency will provide an interpreter for the individual or authorized representative, at the request of the individual, authorized representative, or hearing authority. The bureau of state hearings will work with all local agencies to ensure interpreter services at a reasonable cost to the local agencies when it comes necessary to utilize such services.

(K) Group hearings

(1) The bureau of state hearings may respond to a series of individual state hearing requests by scheduling a single group hearing. Requests may be consolidated only when individual issues of fact are not disputed and where related issues of state or federal law are the sole issues being raised.

(2) In all group hearings, the rules governing individual hearings must be followed. Each individual will be permitted to present his or her own case or have his or her case presented by an authorized representative.

(3) Individuals scheduled for a group hearing will be notified of the group hearing procedures via the JFS 04059, along with the scheduling notice.

Last updated April 3, 2025 at 7:35 AM

History

Effective: April 3, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-5-02 State hearings: postponement of the state hearing.

(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.

(d) Postponement shall not extend the time limit for issuing a state hearing decision.

(2) Supplemental nutrition assistance program (SNAP)

(a) The assistance group is entitled to postponement of its scheduled hearing date, not to exceed thirty calendar days. A postponement shall be granted one time per appeal.

(b) If postponement is requested, state hearings shall reschedule the hearing at the earliest available time and date convenient to the assistance group.

(B) Postponement shall not affect continuation of assistance.

(C) When a request for postponement is denied, the individual or authorized representative must attend the scheduled hearing or be subject to dismissal as described in rule 5101:6-5-03 of the Administrative Code.

(D) The postponement rights described in paragraphs (A), (B) and (C) of this rule apply only to the individual, and not to the agency.

(E) The local agency, managed care plan, or "MyCare Ohio" plan may request one postponement not later than seven days prior to the hearing. No postponement will be granted if it will prevent state hearings from issuing the decision within applicable time limits.

Last updated April 3, 2023 at 8:30 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-5-03 State hearings: denial and dismissal of state hearing requests.

(A) The local agency shall not deny or dismiss any request for a state hearing. All requests shall be sent to the bureau of state hearings, in accordance with rule 5101:6-5-01 of the Administrative Code.

(B) When a state hearing request is denied or dismissed, the individual and authorized representative shall be provided written notice describing the denial or dismissal, with a copy to the local agency.

When a hearing request involves multiple issues, and when the appellant withdraws his or her request with regard to some but not all of the issues under appeal, notice of dismissal of the withdrawn appeals may be included in the JFS 04005 "State Hearing Decision" rather than provided via separate notice.

When the hearing request involves one of the medical determination issues listed in paragraph (C)(2) of rule 5101:6-6-01 of the Administrative Code, a copy of the notice shall be sent to the appropriate medical determination unit.

When the hearing request involves a managed care plan or "MyCare Ohio" plan, copies of the notice shall be sent to the managed care plan or "MyCare Ohio" plan and to the unit within the Ohio department of medicaid (ODM) administering the medicaid managed care programs.

(C) Except as provided in paragraph (D)(1) of this rule, a state hearing request may only be denied prior to the mailing of the JFS 04002 " Notice to Appear for a Scheduled Hearing," and only for the following reasons:

(1) The request is untimely, as defined by rule 5101:6-3-02 of the Administrative Code.

If the request indicates that proper notice was not received, the request shall be accepted and the issue of timeliness shall be determined as a preliminary matter at the hearing.

(2) The request was not made by the individual or authorized representative, or written authorization specifically designating the person making the request to act on the individual's behalf was not submitted with the request.

Such a denial must be consistent with the provisions of rule 5101:6-3-02 of the Administrative Code.

(3) The request concerns an issue that is not appealable under the provisions of rule 5101:6-3-01 of the Administrative Code.

If the issue as stated in the request is unclear, the bureau of state hearings shall request clarification from the individual.

(4) The sole issue of the request is a change in state or federal law, or local agency policy adopted pursuant to options authorized in state law, that requires automatic adjustments of benefits for classes of recipients, unless the reason for the request is the misapplication of the change to the appellant's individual circumstances.

(5) The request concerns the placement of the assistance group for the supplemental nutrition assistance program (SNAP) on an alternate issuance system or the length of time the assistance group remains on this system.

(6) It is clear that the issue has been previously decided through the state hearing process.

(D) After a state hearing request is scheduled.

(1) A state hearing request may be denied after it is scheduled:

(a) In accordance with rule 5101:6-10-1 of the Administrative Code,

(b) When the appellant has not exhausted all managed care plan appeal processes in accordance with rule 5160-26-08.4 of the Administrative Code, or

(c) When the appellant has not exhausted all "MyCare Ohio" plan appeal processes in accordance with rule 5160-58-08.4 of the Administrative Code.

(2) For any program or issue not identified in paragraph (D)(1) of this rule, a state hearing request may no longer be denied, but must be heard, or dismissed as described in paragraphs (E)(1) and (E)(2) of this rule. Dismissal of a state hearing request constitutes a binding decision on the hearing request.

(3) In the event that a dismissal notice is issued in error, it may be reversed by the hearing authority allowing for the state hearing process to continue.

(E) A request for a state hearing may be dismissed only for the following reasons:

(1) The appellant or authorized representative withdraws the hearing request, before the state hearing decision is issued.

(2) The request is abandoned. A state hearing request is "abandoned" when the individual or authorized representative fails, without good cause, to attend the state hearing. A "state hearing" is defined as the initial state hearing, a hearing that has been rescheduled, or a hearing that has been continued.

(a) When the hearing has been abandoned, the individual and authorized representative shall be notified that the hearing request will be dismissed if good cause for failing to attend is not shown within ten days of the mailing date of the notice.

(b) The hearing shall be rescheduled if the individual or authorized representative contacts the hearing authority, in writing or by telephone, within the ten-day period and establishes good cause.

(c) The request shall be dismissed as abandoned if the bureau of state hearings does not receive a showing of good cause within the ten-day period. The date of dismissal is the day after the ten-day period ends.

(d) If the individual contacts the hearing authority but fails to establish good cause, the individual shall be given written notice of that determination and of the right to and the method of obtaining an administrative appeal. Copies shall be sent to the local agency.

(e) "Good cause" is defined as death in the immediate family, sudden illness or injury of the individual or a member of the individual's immediate family, or other circumstances that reasonably prevented attendance at the hearing.

(f) The hearing authority shall have final authority to determine if good cause was timely shown. Verification of good cause may be required.

Last updated April 3, 2023 at 8:30 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Chapter 5101:6-6 Hearing Procedure

Ohio Adm.Code 5101:6-6-01 State hearings: scheduling and attendance.

(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.

(2) When a hearing request can be identified as involving a prevention retention and contingency (PRC) program issue, dealing with an emergent need, or a denial of expedited supplemental nutrition assistance program (SNAP), the hearing shall be scheduled and conducted more quickly than other requests, if necessary, so that the decision can be issued within the thirty-day period specified in rule 5101:6-7-01 of the Administrative Code.

(3) The hearings section shall expedite SNAP hearing requests from assistance groups, such as migrant farm workers, that plan to move from the county before the hearing decision would normally be issued.

(a) Hearing requests from these assistance groups shall be scheduled and conducted more quickly than other requests, if necessary, to enable them to receive a decision, and a restoration of benefits if appropriate, before they leave the county.

(b) To qualify, the assistance group must submit, in writing, if possible, its planned date of move. When this information is provided in an oral request, the local agency shall put the information in writing and forward it to the district hearings section with the hearing request, if possible, or immediately upon receipt.

(4) Hearings involving the determination of the community spouse resource allowance shall be conducted within thirty days of the date of the hearing request. This requirement shall not prevent the granting of otherwise appropriate postponements and continuances.

(5) When the hearing is conducted at the local agency, the local agency shall provide adequate accommodations where the hearing can be conducted in privacy, with the proper decorum, and with a minimum of distractions.

(B) The bureau of state hearings shall send written notice of the time, date, and place of the hearing to the individual and authorized representative, to the local agency, and to the medical determination units identified in paragraph (C)(1) of this rule, who may be participating, via use of a notice describing the date, place, and time of the state hearing.

(1) A copy of the scheduling notice shall be retained and included in the hearing record.

(2) This notice shall be mailed at least ten calendar days prior to the date of the hearing, unless the appellant or authorized representative requests less advance notice to expedite scheduling. Expedited hearings may be granted at the discretion of the hearing authority.

(3) When the hearing request involves a managed care plan or "MyCare Ohio" plan, copies of the scheduling notice shall be sent to the managed care plan or "MyCare Ohio" plan and upon request to the Ohio department of medicaid.

(4) The scheduling notice shall:

(a) Provide the name, address, and telephone number of the person to notify if the individual cannot attend the hearing.

(b) Explain that the hearing request will be dismissed if the appellant or authorized representative fails, without good cause, to appear for the hearing.

(c) Explain state hearing procedures and provide other information necessary for the individual's understanding of the proceedings and the effective presentation of his or her case.

(d) Explain that the appellant or representative may examine the case file prior to the hearing.

(1) Attendance at the hearing is limited to the following:

(a) The agency representative.

(b) The individual and/or authorized representative.

(d) Witnesses called by the individual and the agency to present relevant testimony.

(e) Other persons, only if the individual agrees and if their attendance does not interfere with the orderly conduct of the hearing.

(2) When the hearing involves one of the medical determination issues listed in this paragraph, the agency representative shall be an employee of the medical determination unit or agency, or an agent of that office.

(a) Medical determination issues include the following:

(i) Prior authorization for medical services.

(ii) Need for long-term care.

(iii) Determination of disability and incapacity.

(iv) Precertification of hospital admissions and medical procedures.

(v) Preadmission screening and resident review (PASRR) determinations made by the Ohio department of mental health and addiction services and the Ohio department of developmental disabilities.

(vi) Coordinated services program (CSP) issues, including enrollment, continued enrollment, denial of a requested designated provider change, and denial of payment for services by a nondesignated provider.

(vii) Home and community-based services (HCBS) waiver determinations.

(viii) County board of developmental disabilities actions.

(b) The medical determination unit shall participate in the hearing, either in person or by telephone.

(c) If the medical determination unit is to participate in the hearing by telephone, such participation shall be as described in rule 5101:6-6-04 of the Administrative Code.

(3) When the hearing involves a managed care plan or "MyCare Ohio" plan, a representative of the managed care plan or "MyCare Ohio" plan shall participate in the hearing as the agency representative.

The managed care plan or "MyCare Ohio" plan representative shall participate in the hearing either in person or by telephone.

If the managed care plan or "MyCare Ohio" plan representative participates in the hearing by telephone, such participation shall be as described in rule 5101:6-6-04 of the Administrative Code.

(4) Any disputes regarding attendance shall be resolved by the hearing officer prior to the hearing.

Last updated April 3, 2023 at 8:31 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-6-02 State hearings: rights and responsibilities of the participants.

(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.

(d) Advance arguments without undue interference.

(e) Question or refute any testimony or evidence, including the opportunity to confront and cross-examine adverse witnesses.

(1) State hearings shall be conducted by an impartial Ohio department of job and family services (ODJFS) hearing officer who has no personal stake or involvement in the case and was not directly involved in the initial determination being appealed. The hearing officer shall be under the direction and supervision of the bureau of state hearings.

(2) The hearing officer shall not consult with either party concerning the substance of the case prior to the hearing, except for review of the hearing request and appeal summary.

(3) Hearings are normally virtually. The hearing officer shall assure that the hearing can be conducted in privacy, with the proper decorum, and with a minimum of distractions.

(4) The hearing officer shall regulate attendance at the hearing in accordance with rule 5101:6-6-01 of the Administrative Code. If space is limited, witnesses may be called into the hearing room one at a time.

(5) The hearing officer shall begin the hearing by starting the recording equipment and providing the following introductory information:

(a) The name and role of the hearing officer, the case name, and the appeal number.

(b) How the hearing will be conducted, including the order of presentation and questioning.

(d) Who will issue the decision.

(e) How the parties will be notified of the decision.

(f) Where the complete hearing record will be kept after the decision is issued.

(g) The available appeal rights.

(6) After the opening remarks, the hearing officer shall state the issue to be heard, as it appears on the hearing request. The issue shall always be whether the agency's action or inaction was in accordance with applicable regulations. The hearing officer shall entertain requests from either party to amend the issue as stated. Amendment is appropriate so long as it does not substantially alter the nature of the issue or the ability of the parties to address the issue at the hearing. Any amendment of the issue as stated on the hearing request shall be formally recorded.

(7) The hearing officer shall ask both parties for any additional issues and shall rule on their inclusion in the hearing. An additional issue may be heard only if both parties agree, and if the hearing officer determines that both parties are prepared to address the additional issue and that there is adequate time to do so.

(8) The hearing officer shall record the name and role of each person in attendance and shall administer an oath or affirmation to all who intend to offer testimony. If the appellant or authorized representative declines to take the oath or affirmation, the hearing officer shall abandon the hearing in accordance with paragraph (E)(2) of rule 5101:6-5-03 of the Administrative Code. An attorney serving as an authorized representative shall only be required to take the oath or affirmation if the attorney testifies.

(9) The hearing officer shall regulate the order of presentation by the parties. Normally, the agency presentation will be made first, subject to questioning by the individual and the hearing officer, followed by the individual's presentation, subject to questioning by the agency and the hearing officer. Both parties will then be allowed a brief closing statement.

(10) In regulating the conduct of the hearing, the hearing officer is responsible for developing the fullest possible record upon which to base all necessary findings of fact. Each party shall be treated fairly and impartially and given adequate opportunity to address the issues. The hearing officer has an affirmative obligation to assist unrepresented individuals in understanding the nature of the issue and the regulations that relate to it, and in presenting testimony and evidence necessary to address all relevant factual questions. The hearing officer shall take an active part in questioning the parties and the evidence presented, insofar as that is necessary to develop the fullest possible record.

(11) After all relevant testimony and evidence has been presented, the hearing officer shall determine whether a sufficient record has been developed upon which to make the decision. If not, the hearing officer may either order that the hearing be continued to a later date or leave the record open for the submission of additional evidence.

(a) Where relevant and useful, the hearing officer may order an independent medical assessment or professional evaluation.

(b) If the hearing is to be continued to a later date, the hearing officer shall schedule the continuance at the earliest possible date acceptable to all parties and shall formally record the new date and time, as well as the specific purpose of the continuance. Notification of the parties at the hearing shall be followed by written notification via state hearing scheduling notice.

(c) If the record is to be left open to allow the submission of additional documentary evidence, the hearing officer shall formally record the nature and purpose of the additional evidence and shall establish the earliest possible realistic deadline for its submission to the hearing officer.

(d) Additional evidence submitted prior to the deadline shall be forwarded to the other party with notice of the deadline for response. Evidence submitted after the deadline may be returned to the submitting party with notice that it will not be used in reaching the decision.

(e) The hearing officer shall also have the authority to reconvene the hearing if the nature of the additional evidence or response requires. When the record has been left open for submission of additional evidence by the agency, the individual shall always be afforded the right to rebut such evidence in person at a reconvened hearing if he or she chooses.

(f) When the record has been left open, the hearing decision shall so indicate, and shall record the resulting submissions or failure to submit, as well as the substance of any rebuttal.

(12) If assistance has been continued due to a timely appeal, the hearing officer shall determine, prior to adjourning the hearing, whether the sole issue is one of state or federal law and not one of fact or judgment.

(13) The hearing officer shall close the hearing by informing the parties when they can expect the written decision, adjourning the hearing, and turning off the recording equipment.

(14) Following the hearing, the hearing officer shall not discuss the substance of the case with either party, unless at a supplemental hearing at which both parties are present.

(15) Finally, the hearing officer shall prepare the JFS 04005 "State Hearing Decision," to include the issue, findings of fact, conclusions of policy, and recommendations, and submit it to the assigned hearing authority for issuance.

Last updated April 3, 2023 at 8:31 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-6-03 State hearings: recording the hearing.

(A) All state hearings will be recorded by the hearing officer. The recording will be started at the beginning of the hearing and will continue until the hearing is concluded. There will be no testimony or other proceedings off the record. The recording will not be altered or edited in any manner or for any reason.

(B) The recording of the hearing will not be a part of the official hearing record. The recording will 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 will 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 will respond to such requests within two business days whenever possible, and will provide the copy free of any charge. Nonreceipt of a copy of a recording within the administrative appeal period will 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 will 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.

Last updated January 17, 2025 at 1:08 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Chapter 5101:6-7 Hearing Decisions

Ohio Adm.Code 5101:6-7-01 State hearings: state hearing decisions.

(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 will 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 will have previously participated in the agency decision being appealed, nor will the hearing authority and the hearing officer who conducted the hearing be the same person.

(B) Timely issuance

(1) Hearing decisions involving public assistance, social services, and child support services will be issued within ninety calendar days from the date of the hearing request. No extension of the ninety-day requirement is permitted because the individual requests a delay in the scheduling of the hearing.

(2) Hearing decisions involving the prevention, retention and contingency (PRC) program will be issued within sixty calendar days from the date of the hearing request.

(3) Hearing decisions involving supplemental nutrition assistance program (SNAP) will be issued within sixty calendar days from the date of the hearing request, with the following exceptions:

(a) When the hearing has been postponed, as described in rule 5101:6-5-02 of the Administrative Code, the sixty day time limit will be extended by as many days as the hearing was postponed.

(b) Hearing decisions involving a denial of expedited SNAP will be issued within thirty calendar days from the date of the hearing request.

(c) When the hearing has been requested in response to the simultaneous proposal of public assistance and SNAP adverse actions, the hearing decision will be issued according to public assistance timeliness standards.

(4) Hearing decisions involving the medicaid program will be issued within ninety calendar days from the date of the hearing request. This period will be reduced to three working days in the following instance:

(a) The hearing request is from an enrollee of a medicaid managed care plan or "MyCare Ohio" plan; and

(b) The enrollee, or the enrollee's authorized representative, claims that the request requires an expedited resolution because taking the time for a standard resolution could seriously jeopardize the enrollee's life or health or ability to attain, maintain, or regain maximum function; and

(1) The hearing officer's findings of fact will be based exclusively on the evidence introduced at the hearing, or after the hearing and subject to examination and rebuttal by both parties as described in rule 5101:6-6-02 of the Administrative Code.

(a) The hearing officer may be guided, but will not be bound, by the Ohio Rules of Evidence in conducting hearings and in making findings of fact. The hearing officer will consider all relevant evidence offered at the hearing.

(b) Hearsay evidence may be considered by the hearing officer in arriving at the findings of fact. However, such evidence needs to be be critically evaluated, since it is not given under oath and cannot be cross-examined to test the perception, memory, and veracity of the declarant.

Direct evidence will normally be given more weight than hearsay evidence when the two are in conflict.

(c) It will be the responsibility of the agency to show, by a preponderance of the evidence, that its action or inaction was in accordance with rules of the Administrative Code.

(d) The hearing officer's findings of fact will be binding upon the hearing authority. However, the hearing authority may return the case to the hearing officer if it is determined that additional facts not already established by the hearing officer are essential to a correct decision or if the evidence relied upon was taken in violation of rule 5101:6-6-02 of the Administrative Code.

(2) The hearing officer's conclusions of policy and recommendations will be based solely on rules of the Administrative Code, or local agency policy adopted pursuant to options authorized in state law, except when these regulations and policies are silent and reference to the Revised Code or other statutory source is necessary to resolve the issue.

(a) When a hearing is regarding the prevention, retention and contingency (PRC) program, the hearing officer's conclusions of policy and recommendations will be based on the PRC statement of policies if it was submitted at the hearing and if the submitted plan was effective as of the date of the action being appealed.

(b) The hearing authority will review conclusions and recommendations by the hearing officer and adopt them when they constitute a correct application of the appropriate regulations.

(c) The hearing authority will amend conclusions and recommendations that do not correctly apply the appropriate regulations, clearly explaining the reason and basis for any such amendment.

(3) The hearing decision will address the issues raised in the request or otherwise included upon agreement of all parties, subject to the conditions of rule 5101:6-3-01 of the Administrative Code.

If it is discovered at the hearing that the request or issue meets one of the denial criteria in rule 5101:6-5-03 of the Administrative Code, the decision will overrule the appeal on that basis.

(4) When a hearing request involves multiple issues, and when the appellant withdraws, in writing, notice of dismissal of the withdrawn appeals, as indicated by rule 5101:6-5-03 of the Administrative Code, may be included in the hearing decision.

(a) If the appellant withdraws some, but not all of the appeals, because there is no longer need for review by a higher authority on those appeals, the withdrawal is to be included in the decision, requiring no additional action on those appeals.

(b) If during the hearing, the appellant withdraws some or all of the issues under appeal, contingent upon some corrective action agreed to by the agency, the hearing officer will issue a state hearing decision, indicating that agreement and requiring the agency to comply with the action as agreed to during the hearing. This decision will be issued via the JFS 04005 "State Hearing Decision."

(D) Content

The hearing decision will separately set forth the issue or issues to be decided, the hearing officer's findings of fact, conclusions of policy and recommendations, and the decision and order.

(1) The issue section will fully describe the action or lack of action being appealed. It will include the date and specific nature of the action, including benefit amounts where appropriate, as well as the specific eligibility factor on which the action was based and will include a summary of the hearing officer's recommendations for resolution of the issue. When multiple issues are involved, they will be set forth separately and numbered for reference in the remainder of the decision.

(2) The procedural matters will first address such preliminary matters as delays due to postponement, resolution of disputes as to standing, and amendments or additions to the issue or issues as stated on the agency's written notice or in the hearing request, the dates the appeal summary was received by the bureau of state hearings and the appellant, continuation of benefits (if applicable), and status of subpoena request (if applicable).

(3) The findings of fact will follow procedural matters. The findings of fact will be clear and orderly chronological discussion of the facts and events relevant to the issue.

(4) The conclusions of policy will cite and summarize relevant portions of rules of the Administrative Code and other applicable regulations as necessary and will clearly demonstrate how they apply to the facts established. The decision will clearly indicate the basis for each such finding, to include discussion of the relative weight given to conflicting evidence in arriving at the decision as to where the preponderance of evidence lies.

SNAP decisions will also cite applicable federal regulations.

Budget computations, where relevant, will be clearly set forth.

(5) The hearing officer's recommendations will separately indicate the outcome of the appeal on each issue addressed, sustaining those in which the agency is found to have acted incorrectly, overruling those in which the agency's action was correct, and, if the provisions of paragraph (C)(4) of this rule apply, dismissing those that have been withdrawn in writing. Clear instructions to the parties will be given when additional action is necessary to resolve the matter at issue.

Compliance will be ordered, via the JFS 04068 "Order of Compliance Notice," as necessary to assure that the individual promptly receives all benefits ordered by a favorable decision.

(6) The decision and order, signed by the hearing authority, will indicate adoption or amendment of the hearing officer's recommendations, whether each issue is sustained or overruled, and whether compliance is ordered.

(E) Notification

(1) The individual and authorized representative will be provided with the written state hearing decision via the JFS 04005. The decision will provide notice of the right to and the method of obtaining an administrative appeal. A copy of the decision will also be sent to the local agency electronically, as an e-mail attachment.

(2) When the hearing involves one of the medical determination issues listed in paragraph (C)(1) of rule 5101:6-6-01 of the Administrative Code, a copy of the decision will also be sent to the medical determination unit.

(3) When the hearing involves a managed care plan or "MyCare Ohio" plan, copies of the decision will also be sent to the managed care plan or the "MyCare Ohio" plan, and upon request to the Ohio department of medicaid.

(F) Hearing record

The state hearing decision, together with documents introduced at the hearing and all papers and requests filed in the proceeding, will constitute the exclusive record. The hearing record will be maintained by the bureau of state hearings in accordance with applicable record retention requirements. It will be made available for review by the individual and authorized representative upon request. The local agency will be provided a copy upon request as well.

(G) Library of decisions

The chief of the bureau of state hearings will maintain a library of all state hearing decisions. The decisions will be available for public inspection and copying, subject to applicable disclosure safeguards.

(H) Binding effect

State hearing decisions will be binding on the agency or managed care plan or "MyCare Ohio" plan for the individual case for which the decision was rendered.

Last updated January 17, 2025 at 12:33 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-7-02 State hearings: standards for revising community spouse income and resource allowances at a state hearing.

(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 will 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 will be tailored to the circumstance of significant financial duress and may be time-limited as appropriate to the circumstance.

(1) An existing community spouse resource allowance may not be revised in a hearing decision if the income of the institutionalized spouse, minus the personal needs allowance, is adequate to raise the income of the community spouse to the minimum monthly maintenance needs allowance. The minimum monthly maintenance needs allowance standard periodically increases, which may create a need for additional income to be diverted from the institutionalized spouse to the community spouse. An additional allocation of resources will not be made to the community spouse when the minimum monthly maintenance needs allowance standard increases unless the institutionalized spouse's income, minus personal needs allowance, is inadequate to raise the income of the community spouse to the minimum monthly maintenance needs allowance.

(2) If either the community spouse or the institutionalized spouse establishes at a state hearing that the existing community spouse resource allowance, in relation to the amount of income generated for the community spouse by the allowance, is inadequate to raise the community spouse's income to the minimum monthly maintenance needs allowance in effect at the time of the hearing, the hearing decision will substitute for the allowance an amount adequate to provide such a minimum monthly maintenance needs allowance.

(3) Procedure for determining a substituted community spouse resource allowance

(a) The substitute community spouse resource allowance needed to meet the deficit between the minimum monthly maintenance needs allowance and income available to the community spouse will be based on the cost of a single premium lifetime immediate monthly payment annuity (SPLIMPA) with monthly payments equal to the deficit, excluding income currently generated by both spouse's countable resources. Either spouse will produce at the hearing three written SPLIMPA cost estimates from three different commercial sources that are each designed to produce monthly payments as closely equal to the deficit as is practicable. Upon request the local agency will offer assistance obtaining the estimates. Estimates of an annuity that is a delayed payment annuity, a time-period certain, an annuity with a death benefit, or an annuity that guarantees return of the principle is not a SPLIMPA and cannot be used to determine the amount of additional resources needed.

(b) The amounts of the three estimates will be averaged to determine the average cost of a SPLIMPA. The average of the three SPLIMPA estimates will include the cost of a SPLIMPA that generates income equal to the difference between the minimum monthly maintenance needs allowance, and the total income of the community spouse and institutionalized spouse less the personal needs allowance. If the averaged cost of the SPLIMPA is less than the current community spouse resource allowance, the allowance will not be changed by the hearing decision. If the averaged cost of the SPLIMPA is more than the current community spouse resource allowance, the allowance will be substituted with the averaged cost.

(c) Neither the community spouse nor the institutionalized spouse will be required to purchase a SPLIMPA as a result of the application of this rule at a state hearing. However, if a substituted community spouse resource allowance has been granted through a state hearing that applied this rule, the income that was projected by the approved SPLIMPA average will be deemed to the community spouse whenever a determination or redetermination of the monthly income allowance is computed.

(D) An appeal requested in accordance with this rule for a revision in a monthly minimum maintenance needs allowance or community spouse resource allowance may be overruled if a community spouse or institutionalized spouse has not made a reasonable effort to qualify for any available source of income or resources that would make the revision unnecessary in whole or in part.

Last updated January 17, 2025 at 12:33 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-7-03 State hearings: implementation of the hearing decision.

(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.

(B) Promptness

(1) Decisions that order action favorable to the individual

(a) For decisions involving public assistance, social services or child support services, compliance shall be achieved within fifteen calendar days from the date the decision is issued, but in no event later than ninety calendar days from the date of the hearing request.

(b) For decisions involving the supplemental nutrition assistance program (SNAP), any increase in benefits must be reflected in the SNAP allotment within ten calendar days of receipt of the decision, even if the local agency must provide a supplement, outside the normal issuance cycle.

The local agency may take longer than ten days if it elects to make the decision effective in the assistance group's normal issuance cycle, provided that issuance will occur within sixty calendar days of the date of the hearing request. If the local agency elects to follow this procedure, the benefit increase may be reflected in the normal issuance cycle or with a supplementary issuance.

(c) Compliance shall be promptly reported to the bureau of state hearings, via a notice certifying the agency's compliance with the state hearing decision and accompanied by appropriate documentation substantiating compliance is met.

When the hearing decision orders action to be taken by a managed care plan or a "MyCare Ohio" plan, each shall also send a copy of the notice certifying the agency's compliance with the state hearing decision, to ODM.

(2) Decisions that authorize action adverse to the individual

(a) The agency shall implement the decision promptly, if still appropriate.

(b) When the adverse action results in a decrease in the assistance group's SNAP benefits, the decrease shall be reflected in the next issuance cycle following receipt of the hearing decision.

(1) For decisions involving public assistance, social services or child support services, compliance shall be considered achieved on the date eligibility, payment, or services are authorized or other action ordered by the hearing decision is taken.

(2) For decisions involving SNAP, compliance shall be considered achieved on the date the action is reflected in the assistance group's SNAP allotment.

(D) Underpayments/under issuances

(1) When the decision determines that the individual has been improperly denied benefits or has received fewer benefits than were due, any underpayments must be corrected in accordance with rules 5101:1-23-60 and/or 5101:4-8-03 of the Administrative Code.

(2) The local agency shall restore SNAP benefits to assistance groups that are leaving the county before the departure whenever possible. If benefits are not restored prior to departure, the local agency shall forward an authorization of the benefits to the assistance group or to the new county if this information is known.

The new county shall accept an authorization and issue the appropriate benefits whether the notice is presented by the assistance group or received directly from another county.

(E) Overpayments/over issuances

(1) Overpayments related to the appeal are subject to collection in accordance with rule 5101:1-23-70 of the Administrative Code.

(2) When the appeal involves SNAP, a claim against the assistance group for any over issuance related to the appeal must be prepared in accordance with rule 5101:4-8-15 of the Administrative Code.

(F) Prior authorization issues

(1) When a hearing decision reverses a denial of prior authorization for medical service and authorizes the service, the approval unit shall approve the prior authorization, using the normal prior authorization procedure. The approval notification sent to the provider shall be accompanied by a copy of the hearing decision.

(2) When a hearing decision reverses a denial of prior authorization for additional therapeutic leave days for a medicaid recipient with a developmental disabilities (DD) level of care in a long-term care facility, the bureau of state hearings shall send a copy of the decision to the long-term care facility. The hearing decision constitutes authorization for the additional leave days.

(G) Precertification issues

When a hearing decision changes a review agency's decision on a request for precertification of a hospital admission or medical procedure, the bureau of state hearings shall send a copy of the decision and a notice certifying the agency's compliance with the state hearing decision to the review agency.

The review agency shall certify those hospital days or medical procedures authorized by the decision using the normal precertification procedure, complete the notice certifying the agency's compliance with the state hearing decision, and send it to state hearings.

(H) Coordinated services program (CSP) issues

When a hearing decision changes a decision by the recipient monitoring and review section concerning proposed or continued enrollment in the CSP or denial of a request for a change of designated provider, the bureau of state hearings shall send a copy of the decision to the recipient monitoring and review section. The recipient monitoring and review section shall take the actions ordered by the decision, complete the notice certifying the agency's compliance with the state hearing decision, and send it to state hearings.

(I) Preadmission screening resident review (PASRR) issues

When a hearing decision changes a preadmission screening (PAS) or resident review (RR) determination made by the Ohio department of mental health and addiction services or the Ohio department of developmental disabilities, the hearing decision shall constitute the revised PAS or RR determination.

Last updated April 3, 2023 at 8:32 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Chapter 5101:6-8 Administrative Appeal

Ohio Adm.Code 5101:6-8-01 State hearings: administrative appeal of the state hearing decision.

(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.

(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.

(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.

(2) A "request for an administrative appeal" is defined as a clear expression, by the individual or authorized representative, to the effect that he or she wishes to appeal a state hearing decision or a decision of the hearing authority to deny or dismiss a state hearing request.

(3) The request must be in writing and signed by the individual or authorized representative.

Written authorization must accompany all requests made on the individual's behalf by an authorized representative, unless the representative was the authorized representative of record at a previous stage in the proceedings, or unless one of the conditions described in rule 5101:6-3-02 of the Administrative Code is met.

(4) The request must be received by the bureau of state hearings, within fifteen calendar days from the date the decision being appealed was issued.

(D) Continuing assistance

The filing of an administrative appeal request will not automatically stay implementation of the initial state hearing decision, denial, or dismissal. However, the bureau of state hearings may choose to exercise the department's inherent authority to delay implementation of a decision when an administrative appeal appears to be meritorious and when the appeal cannot be processed to completion in time to prevent loss of benefits to the individual. In these situations, the bureau of state hearings shall issue a written directive to the local agency, with a copy to the individual and to the appropriate office. Such an interim order, either to stay implementation or to reinstate assistance, shall not constitute a decision on the merits of the appeal, but only serves to preserve the status quo until a decision on the merits can be made.

(E) Dismissal

(1) An administrative appeal request may be dismissed because:

(a) It is not made by the individual or authorized representative, as required by paragraph (C)(3) of this rule.

(b) It is not timely, as defined by paragraph (C)(4) of this rule.

(2) The bureau of state hearings shall provide written notice of dismissal to the individual and authorized representative. Copies shall be provided to the local agency for inclusion in the case file and to the appropriate office.

(F) Docketing

Once an administrative appeal request has been accepted, the bureau of state hearings shall docket the appeal, assigning it to an administrative appeal hearing examiner.

(G) If the administrative appeal hearing examiner determines that the original decision and the appeal request do not contain sufficient information upon which to decide the appeal, the official hearing record and/or the recording of the hearing may be reviewed. The hearing examiner will not convene a new hearing.

(H) Administrative appeal hearing examiners

Administrative appeals shall be assigned to and decided by an impartial administrative appeal hearing examiner who has no personal stake or involvement in the case and was not directly involved in the initial decision being appealed.

This person shall be an attorney assigned to the bureau of state hearings and delegated authority by the ODJFS director.

Decisions of the hearing examiner shall be subject to approval by the ODJFS director or a designee.

(I) Administrative appeal decisions

(1) After reviewing the initial decision, the individual's appeal request, and the hearing record and/or recording if appropriate, the hearing examiner, subject to review and approval in accordance with paragraph (H) of this rule, shall issue an administrative appeal decision which addresses the issues of fact and law raised in the appeal request.

(2) Administrative appeal decisions shall be issued within fifteen calendar days from the date of the administrative appeal request.

(3) The administrative appeal decision shall affirm the initial decision when the hearing examiner determines that the initial decision contains no error affecting the outcome of the appeal (except as noted in paragraph (I)(6) of this rule).

(4) The administrative appeal decision shall reverse the initial decision when the hearing examiner determines that the initial decision contains an error which resulted in an outcome adverse to the individual. Administrative appeal decisions which reverse the initial decision shall contain instructions concerning corrective action and shall require compliance via JFS 04068 "Order of Compliance Notice" when appropriate.

(5) The administrative appeal decision shall vacate the initial decision and remand the case to the original hearing officer when the hearing examiner determines that the record developed does not contain sufficient information to decide the appeal.

(a) If benefits were continuing due to a timely hearing request, an administrative appeal decision that vacates the original decision and remands the case to the hearings section has the effect of preserving or reactivating the individual's procedural right to continuation of benefits. The agency is responsible for responding immediately to a vacate and remand decision and ensuring that benefits are continued. If the original decision has been implemented, the agency shall immediately reinstate benefits to the previous level.

(b) If the factual determination for which the case is being remanded can be made by reviewing the existing hearing record, a supplemental hearing is not necessary. If the existing record is not sufficient, a supplemental hearing shall be convened. If the administrative appeal decision specifically requires the convening of a supplemental hearing, that order shall be followed.

(c) Supplemental hearings shall be scheduled on a priority basis. Written notice shall be provided and shall be accompanied by a copy of the administrative appeal decision and any further instructions necessary to ensure that all parties understand the purpose and scope of the supplemental hearing.

(d) If the individual or authorized representative fails, without good cause, to appear for a supplemental hearing, the hearing officer shall review the existing hearing record to determine if the facts for which the case was remanded are already established therein.

(i) If so, a supplemental decision shall be issued, clearly indicating that a supplemental hearing was scheduled but the individual did not appear, that the record was reviewed, and that the necessary additional facts were established from that review. This shall be followed by the appropriate conclusions of policy and recommendations based on those facts.

(ii) If some or all of the additional facts cannot be established from the record, a supplemental decision shall be issued, clearly indicating that the individual did not appear for the supplemental hearing and that the hearing record was reviewed but was silent as to one or more of the factual issues for which the case was remanded. This shall be followed by the appropriate conclusions of policy and recommendations based on the facts that are available.

(iii) If the individual does not appear for the supplemental hearing, no discussion of the merits of the appeal shall occur between the hearing officer and the agency.

(6) In no event shall the administrative appeal process result in a determination more adverse to the individual than was contained in the initial decision being appealed.

(7) The individual and authorized representative shall be provided with the written administrative appeal decision, which shall include notice of the right to judicial review, or other appeal rights, as appropriate. Copies of the decision shall be sent to the local agency and to the appropriate office.

When the administrative appeal involves one of the medical determinations listed in paragraph (C)(2) of rule 5101:6-6-01 of the Administrative Code, a copy of the decision shall also be sent to the medical determination unit.

When the administrative appeal involves a managed care plan or "MyCare Ohio" plan, copies of the decision shall also be sent to the managed care plan or "MyCare Ohio" plan and upon request to the Ohio department of medicaid.

(J) Administrative appeal hearing record

The administrative appeal decision, together with all requests, documents, and correspondence filed in the proceeding, shall constitute the exclusive administrative appeal hearing record. The record shall be compiled, certified and maintained by the bureau of state hearings in accordance with applicable record retention requirements and made available for review by the individual and authorized representative.

(K) Library of administrative appeal decisions

The bureau of state hearings shall maintain a library of all administrative appeal decisions. The decisions shall be available for public inspection and copying, subject to applicable disclosure safeguards.

(L) Finality

(1) An administrative appeal decision that affirms or reverses the initial decision being appealed shall constitute the final and binding administrative decision on the issue(s) involved.

(2) An administrative appeal decision that vacates the original decision and remands the case to the assigned hearings section does not constitute a final administrative resolution, since the supplemental decision issued on remand shall be subject to further administrative appeal.

(M) Compliance

Compliance with administrative appeal decisions shall be in accordance with rule 5101:6-7-03 of the Administrative Code.

Last updated April 3, 2023 at 8:32 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-8-02 State hearings: county reviews.

(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 will 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 will 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 will not stay the implementation of the state hearing decision nor will 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 will 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 will issue a county review decision, within thirty days from the date the request for review is received. Copies of the review decision will be sent to all hearing supervisors and hearing officers in state hearings, the relevant policy areas and the local agency.

(B) The medical determination units identified in rule 5101:6-6-01 of the Administrative Code, may also request county review of a state hearing decision to which they are a party by following the procedures outlined in paragraph (A) of this rule. The written request, either in hard copy or via e-mail however, will be submitted by the chief of the bureau that retains administrative responsibility for that unit.

(C) State hearings will maintain a library of all county review decisions. The decisions will be available for public inspection and copying, subject to applicable disclosure safeguards.

Last updated January 17, 2025 at 1:23 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Chapter 5101:6-9 Further Appeal

Ohio Adm.Code 5101:6-9-01 State hearings: further appeal rights.

(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.

(2) Residents of the state of Ohio shall appeal to the court of common pleas in the county in which they reside. Individuals who do not reside in the state of Ohio shall appeal to the court of common pleas in Franklin county, Ohio.

(3) Judicial review is available only to the individual, and not to the local agency.

(4) Notice of appeal

(a) The individual shall mail a notice of appeal to the "Ohio Department of Job and Family Services, Office of Legal and Acquisition Services, 30 East Broad Street 31st Floor, Columbus, Ohio 43215-3414." The individual shall also file notice of appeal with the appropriate court of common pleas.

(b) In accordance with section 5101.35 of the Revised Code, the mailing and filing of notice of appeal shall be no later than thirty calendar days after the date the office of legal and acquisition service mails the administrative appeal decision. However, the court may extend the time for mailing and filing notice when good cause is shown. The extension shall not exceed six months from the date the office of legal and acquisition services mails the administrative appeal decision.

(c) The notice of appeal shall state the names of the individual and the Ohio department of job and family services (ODJFS), the docket number and the date of the administrative appeal decision from which appeal is being made, and the grounds upon which it is being appealed.

(5) Hearing record

Upon receipt of the notice of appeal, the office of legal and acquisition services shall certify the records to the court.

(6) Recording/transcript of the hearing

(a) The individual or authorized representative may request a copy of the recorded hearing from the office of legal and acquisition services.

Such requests must be in writing and received by the office of legal and acquisition services within thirty calendar days following the filing of the notice of appeal.

One copy of the recording shall be provided, within two workdays whenever possible, free of any charge.

(b) If the court orders ODJFS to file a transcript of the state hearing, in accordance with section 5101.35 of the Revised Code, ODJFS shall do so within thirty days of the date of the order.

(7) Implementation of the court order

(a) Upon receipt of the order of the court, the office of legal and acquisition services shall immediately forward a copy to the appropriate agency.

(b) The agency shall be responsible for promptly and fully implementing the order.

(c) If implementation of the order is the responsibility of the local agency, the office of legal and acquisition services shall send a copy of the order to state hearings, which shall be responsible for assuring prompt and full implementation of the order.

(d) When the appeal involves a managed care plan or "MyCare Ohio" plan, the office of legal and acquisition services shall immediately forward a copy to the managed care plan or "MyCare Ohio" plan and the Ohio department of medicaid (ODM).

The managed care plan or "MyCare Ohio" plan shall be responsible for promptly and fully implementing the order.

ODM shall be responsible for assuring prompt and full implementation of the order.

(B) Appeal of certain issues to the U.S. department of labor

(1) Administrative appeal decisions involving complaints by regular employees about violation of the regular employee displacement prohibitions, and complaints by Ohio works first (OWF) participants about on-the-job working conditions, workers compensation coverage or work experience program (WEP) wage rates, may be appealed to the U.S. department of labor. Judicial review, as described in paragraph (A) of this rule, does not apply to this category of administrative appeal decisions.

(2) Appeal must be made within twenty days of receipt of the administrative appeal decision.

(3) The appeal must be sent to:

	"Chief Docket Clerk
	Office of Administrative Law Judges
	Suite 400
	800 K Street NW
	Washington, DC 20001-8002"

(4) The appeal must contain:

(a) The full name, address, and telephone number of the individual.

(b) The provisions of the Social Security Act (as in effect on 1/1/2022) or regulations believed to have been violated.

(d) A copy of the administrative appeal decision being appealed.

(5) In addition, the individual must send a copy of the appeal, as well as any brief in support of the appeal, to each of the following:

(a)

	"Assistant Secretary for Employment and Training
	U.S. Department of Labor
	200 Constitution Avenue, NW
	Washington, DC 20210"

(b)

	"Assistant Secretary for Administration for Children and Families
	Department of Health and Human Services
	370 L'Enfant Promenade, SW, 6th Floor
	Washington, DC 20447"

(6) Upon receipt of an appeal, the office of administrative law judges will request the entire hearing record from ODJFS.

(a) Upon receipt of such a request, the office of legal and acquisition services shall request the original of the complete state hearing record, as defined in rule 5101:6-7-01 of the Administrative Code, and the original of the complete administrative appeal hearing record, as defined in rule 5101:6-8-01 of the Administrative Code.

(b) Upon receipt of the state hearing record and the administrative appeal hearing record, the office of legal and acquisition services shall certify the records to the office of administrative law judges.

(7) Upon notification of the decision of the office of administrative law judges, the office of legal and acquisition services shall immediately forward copies to the appropriate local agency and state hearings. State hearings shall be responsible for assuring prompt and full implementation of the decision.

Last updated April 3, 2023 at 8:33 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Chapter 5101:6-10 Hearings for the Comprehensive Case Management and Employment Program

Ohio Adm.Code 5101:6-10-01 State hearings: hearings for the comprehensive case management and employment program.

(A) This rule describes the hearing process for an individual who has been referred for or received comprehensive case management and employment program (CCMEP) services. Nothing in this rule would preclude an appellant from pursuing appeal rights under Section 181(c) of the Workforce Innovation and Opportunity Act (WIOA), Pub. L. No. 113-128 (as in effect on December 1, 2019) or 45 C.F.R. 205.10 (as in effect on January 1, 2022) for "Temporary Assistance for Needy Families" (TANF).

(B) Definitions.

(1) "Appellant," for the purposes of this rule, means an individual who has been referred for CCMEP services, or who is already receiving CCMEP services, who appeals to the bureau of state hearings any CCMEP-related dispute, and includes an individual younger than age eighteen, if the individual is represented by a parent, legal guardian or custodian, or authorized representative.

(2) "Authorized representative" has the same meaning as described in rule 5101:6-1-01 of the Administrative Code.

(3) "Exit notice" means a written notice of adverse action terminating CCMEP eligibility in accordance with rule 5101:14-1-06 of the Administrative Code.

(4) "Federal timeliness period" means the date on which a state hearing request is first received by the bureau of state hearings plus ninety calendar days. If the ninetieth calendar day falls on a weekend or holiday, then the next business day shall be the ninetieth day for the purpose of timeliness.

(5) "Individual" means any person, who at the time of initial enrollment is at least age fourteen but not more than age twenty-four years, who is referred for CCMEP services, or who is already receiving CCMEP services; and, if the person is under age eighteen, includes the person's parent, legal guardian or custodian, or authorized representative.

(6) "Informal conference" means a meeting facilitated by the "Equal Opportunity Officer" (EOO) or the EOO designee during which the facts and circumstances attending a complaint are examined in an effort to informally resolve a complaint.

(7) "Issued" and "mailed," when used in reference to notices, decisions, and other documents, means the date the document is sent by either electronic mail or U.S. mail, or hand-delivered, whichever is earlier.

(8) "Local agency" means a county department of job and family services, a workforce development agency, or both. A local agency may also be considered a lead agency for the purposes of this rule.

(9) "Local area" has the same meaning as described in Section 3 of WIOA.

(10) "Local hearing" means a quasi-judicial forum convened and presided over by the local agency hearing officer.

(11) "Parent" means a natural or adoptive parent, or stepparent.

(12) "Services" has the same meaning as described in paragraph (E) of rule 5101:14-1-02 of the Administrative Code.

Any individual referred for CCMEP services, receiving CCMEP services, or who believes he or she should have been receiving CCMEP services, may file a complaint and/or request a hearing, as described in paragraph (D) of this rule, whenever the individual believes the local agency has failed to fulfill its duties, as described in Chapter 5101:14-1 of the Administrative Code. Any such request may be verbal or in writing and identify how the alleged violation of Chapter 5101:14-1 of the Administrative Code affects the individual's receipt of CCMEP services.

(D) Complaint and appeal process for CCMEP.

(1) The complaint and appeal process described in this rule shall not apply to an individual who receives an Ohio works first (OWF) sanction termination notice, as described in rule 5101:1-3-15 of the Administrative Code, as an OWF sanction appeal may be pursued in accordance with rule 5101:6-3-01 of the Administrative Code.

(2) Process for appeals when an exit notice is received, as described in rule 5101:14-1-06 of the Administrative Code.

(a) In the event the individual receives an exit notice from the local agency, the individual shall be permitted to appeal by requesting a state hearing. The individual shall be provided ninety calendar days from the date the CCMEP exit notice is mailed to submit a timely state hearing request. If the ninetieth day falls on a weekend or holiday, then the next business day shall be recorded as the ninetieth day. The appellant may withdraw the state hearing request at any time prior to a state hearing being held or a decision being issued.

(b) Exit notices or notifications issued by the bureau of state hearings, the local area, or the local agency may be sent by either U.S. mail or its electronic equivalent, or hand delivered to the individual.

(3) Except as provided in paragraphs (D)(1) and (D)(2) of this rule, the process for all CCMEP-related complaints and appeals shall be as provided:

(a) An individual who wishes to file a CCMEP-related complaint shall first file a complaint with the local agency with sufficient details to identify the parties and to describe generally the alleged actions, practices, or violations that caused the complaint to be filed. The individual is to file the complaint within three hundred sixty-five days of the date of the CCMEP-related incident that caused the dispute. Within ten calendar days of the date the complaint is received, the local agency shall hold an informal conference with the individual.

(b) If a satisfactory resolution is not reached through the informal conference, the local agency shall afford the individual an opportunity for a local hearing. If the individual requests a local hearing, the local agency shall assign an independent, objective, and impartial individual (preferably a third party) to schedule and hold a local hearing and issue a decision within sixty calendar days of the date the CCMEP-related complaint was initially filed.

(c) If a timely local hearing decision is issued, and either the individual or local agency disagrees with the decision, then that party may appeal by requesting a state hearing with the bureau of state hearings. A request for a state hearing shall be made within ninety calendar days of the date the local hearing decision is issued by the independent, objective, and impartial individual designated by the local agency.

(d) If, within sixty calendar days of the date the individual first files a timely complaint with the local agency, the local agency fails to conduct the informal conference or local hearing, or issue the local hearing decision, then the individual shall be permitted to request a state hearing directly with the bureau of state hearings. A state hearing request made under this provision shall be made either within three hundred sixty-five calendar days of the date of the initial CCMEP-related incident that caused the complaint to be filed with the local agency, or within one hundred fifty calendar days of the date the complaint was timely filed with the local agency, whichever date comes later.

(E) Denial notices sent by the bureau of state hearings shall be issued to the appellant and, when applicable, to the local agency, in writing or by its electronic equivalent, as permitted by federal law. Denials of state hearing requests for CCMEP shall occur when:

(1) The request is not timely, as described in paragraph (D) or (J)(2)(c) of this rule.

(2) The request was not made by the appellant, or his/her authorized representative.

(3) The issue is not appealable as a basis described in paragraph (C) of this rule.

(4) The sole issue is a change in federal or state policy.

(5) The issue was previously decided through the state hearing process.

(6) The appellant has not complied with paragraphs (D)(3)(a) and (D)(3)(b) of this rule, and a scheduling notice was issued in error.

(F) An appellant who fails to participate on the day of the scheduled state hearing date may not be rescheduled without providing evidence of good cause, as defined in rule 5101:6-5-03 of the Administrative Code. The appellant shall have ten calendar days from the mailing date of the abandonment notice to provide evidence of good cause. Any denial of good cause shall be sent by the bureau of state hearings to the appellant in writing or by its electronic equivalent, as permitted by federal law.

(G) The state hearing shall be conducted in accordance with rules 5101:6-6-01 to 5101:6-6-04 of the Administrative Code.

(H) The state hearing decision shall be processed in accordance with rule 5101:6-7-01 of the Administrative Code, except for the timely issuance provision. The state hearing decision shall be issued within the federal timeliness period.

(I) When a state hearing officer issues a decision ordering compliance, the local agency shall have fifteen calendar days or the federal timeliness period, whichever is less, to comply with the order. Compliance is achieved upon review and approval of the compliance documentation demonstrating the hearing officer's recommendations have been followed by the local agency.

(J) Second level appeal rights.

(1) Appeal to the U.S. department of labor. If the state hearing decision identifies the services as being funded under WIOA, the party adversely affected by the decision may appeal to the department of labor, as described in Section 181(c) of WIOA.

(a) The appellant or local agency shall file the appeal request with the "U.S. Department of Labor Secretary" by certified mail, return receipt requested. The appellant shall also send a copy of the appeal by U.S. mail to the:

(i) "Employment and Training Regional Administrator," and the

(ii) "Ohio Department of Job and Family Services, Bureau of State Hearings."

(b) Upon receipt of the department of labor response, for those issues not addressed by the department of labor, the appellant may request an administrative appeal as described in paragraph (J)(2) of this rule.

(2) Requesting an administrative appeal.

(a) The appellant may request an administrative appeal if the appellant disagrees with the outcome of the state hearing decision and the state hearing decision identifies the service as being funded under TANF.

(b) An administrative appeal may also be requested:

(i) If the appellant disagrees with:

(a) A denial of a state hearing request; or

(b) The denial of a good cause exception; or

(ii) For any issues appealed to the department of labor, which the department of labor declined to address.

(c) The appellant shall have fifteen calendar days from the mailing date of any decision described in paragraph (J)(2)(a) or (J)(2)(b) of this rule to request an administrative appeal. The administrative appeal must be in writing. The appellant may withdraw the administrative appeal request at any time prior to an administrative appeal decision being issued.

(d) The administrative appeal process is outlined in rule 5101:6-8-01 of the Administrative Code. However, the administrative appeal decision must be issued within the federal timeliness period for CCMEP administrative appeals.

(e) When an administrative appeal examiner issues an administrative appeal decision ordering compliance, the local agency shall have fifteen calendar days or the federal timeliness period, whichever is less, to comply with the order. Compliance is achieved upon review and approval of the compliance documentation demonstrating the administrative appeal examiner's recommendations have been followed by the local agency.

(K) A missed deadline by either the local agency or the bureau of state hearings does not preclude an appellant who was referred for or received services funded under WIOA from making a complaint to the department of labor pursuant to Section 181(c) of WIOA.

(L) An appellant who was referred for or received services funded under TANF and disagrees with the administrative appeal decision may pursue further appeal rights, as described in rule 5101:6-9-01 of the Administrative Code.

(M) Local agency responsibilities. The CCMEP local agency shall do all of the following:

(1) Provide the individual notice of his or her CCMEP hearing rights and issue any required notices to the individual.

(2) Assist the individual, at the individual's request, in drafting and filing the initial complaint, as described in paragraph (D)(3) of this rule and provide the appellant the opportunity to first utilize the informal conference and local hearing to address CCMEP issues, as described in paragraphs (D)(3)(a) and (D)(3)(b) or this rule.

(3) Assist the individual, at the individual's request, in initiating a state hearing request, when the individual receives services under paragraph (D)(2) of this rule.

(4) Utilize the CCMEP rules outlined in Chapter 5101:14-1 of the Administrative Code to address CCMEP complaints and hearings. If the issue cannot be resolved using rules found in Chapter 5101:14-1 of the Administrative Code, the local agency may utilize the CCMEP program plan submitted in accordance with Chapter 5101:14-1 of the Administrative Code.

(5) Submit an electronic state hearing request to the bureau of state hearings via the state hearings electronic hearings and appeals tracking system within twenty-four hours of receipt of the state hearing request.

(6) Prepare an appeal summary and, upon request, make it available to the appellant at least three business days in advance of the scheduled state hearing. In addition, the local agency shall submit the appeal summary to the bureau of state hearings via the electronic hearings and appeals tracking system at least three business days in advance of the scheduled hearing.

(7) Follow through with the hearing authority's final administrative decision and order, including compliance and due dates, as instructed in the state hearing decision. Compliance with the state hearing decision is required even if a second level appeal is filed under paragraph (J)(1) of this rule.

Last updated April 3, 2023 at 8:33 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Chapter 5101:6-20 Administrative Violations

Ohio Adm.Code 5101:6-20-01 State hearings - disqualification for an intentional program violation.

(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.

(C) The local agency is responsible for investigating any case alleging an intentional program violation, regardless of the suspected individual's current eligibility status, and for ensuring that appropriate cases are acted upon either through administrative disqualification procedures or referral for prosecution.

(D) Local agencies are encouraged to refer for prosecution those individuals suspected of committing an intentional program violation, particularly if the value of benefits involved is large or if the individual is suspected of committing more than one act of intentional program violation.

(1) The local agency will confer with its legal representative to determine the types of cases which will be accepted for possible prosecution.

(2) Local agencies will also encourage local prosecutors to recommend to the courts that a disqualification penalty, as provided for by rule 5101:6-20-03 of the Administrative Code, be imposed in addition to any other civil or criminal penalties for such violations.

(E) Administrative disqualification procedures will be initiated in the following situations:

(1) The local agency believes the facts of the case do not warrant civil or criminal prosecution.

(2) The facts of the case were previously referred for prosecution but were declined by the appropriate legal authority.

(3) No action was taken on a previously referred case within a reasonable time and the referral was formally withdrawn by the local agency.

(F) The local agency will not initiate administrative disqualification procedures against an individual currently being referred for prosecution or subsequent to any action taken against the individual by the prosecutor or the court, if the factual issues of the case arise out of the same, or related, circumstances.

(1) Such action by the court will include receiving a complaint of an intentional program violation.

(2) Such action by the prosecutor will include the filing of a complaint in court or presentation of the case to a grand jury, regardless of whether the grand jury returns an indictment.

(3) The prosecutor's independent review and investigation of a referred case will not, by itself, constitute such action.

(G) The local agency will not initiate administrative disqualification procedures against an accused individual when a previous administrative disqualification hearing on the same, or related, circumstances was decided in the accused individual's favor.

(H) In proceeding against an individual, the local agency will coordinate any corresponding actions taken under the OWF, PRC and SNAP programs where the factual issues arise from the same or related circumstances.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-02 State hearings - definition of an intentional program violation.

(A) In the Ohio works first (OWF) program, an intentional program violation will 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.

(B) In the supplemental nutrition assistance program (SNAP), an intentional program violation will consist of an action by an individual, for the purpose of using, presenting, transferring, acquiring, receiving, or possessing SNAP benefits that is intentionally:

(1) A false or misleading statement, or a misrepresentation, concealment or withholding of facts; or

(2) Any act that constitutes a violation of the Food Stamp Act (as in effect on October 1, 2018), the SNAP regulations, or any state statute relating to the use, presentation, transfer, acquisition, receipt, or possessing or trafficking of SNAP benefits, or the electronic benefit transfer (EBT) card.

(C) In the prevention, retention and contingency (PRC) program, an intentional program violation will consist of an action by an individual, for the purpose of establishing eligibility for PRC benefits 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.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-03 State hearings: penalties for an intentional program violation.

(A) Under the provisions of rule 5101:6-20-01 of the Administrative Code, individuals who have been found to have committed an intentional program violation (IPV) either through an administrative disqualification hearing, a federal, state, or local court, or who have signed either a waiver of right to an administrative disqualification hearing, or a disqualification consent agreement in cases referred for prosecution will be ineligible for the following periods:

(1) Disqualified from Ohio works first (OWF) or prevention, retention and contingency (PRC) until the cost of the fraudulent assistance is repaid in full.

(2) Disqualified from the supplemental nutrition assistance program (SNAP) for twelve months for the first violation except as provided in paragraphs (A)(5) to (A)(8) of this rule.

(3) Disqualified from SNAP for twenty-four months for the second violation except as provided in paragraphs (A)(5) to (A)(8) of this rule.

(4) Disqualified from SNAP permanently for the third violation except as provided in paragraphs (A)(5) to (A)(8) of this rule.

(5) Court conviction: controlled substance violation

Individuals found by a federal, state, or local court to have used or received SNAP benefits in a transaction involving the sale of a controlled substance (as defined in section 102 of the Controlled Substances Act, 21 U.S.C. 802 (as in effect on October 1, 2018) will be ineligible to participate in the program for a period of twenty-four months upon the first occasion of such a violation and permanently upon the second occasion of such a violation.

(6) Trafficking SNAP benefits of five hundred dollars or more

An individual will be permanently disqualified if he/she is convicted by a federal, state, or local court of trafficking SNAP benefits for an aggregate amount of five hundred dollars or more.

For purposes of this rule, "trafficking" is defined as fraudulently using, transferring, altering, acquiring or possessing SNAP benefits or presenting SNAP benefits for payment or redemption knowing the same to have been fraudulently obtained or transferred for cash or consideration other than eligible food. "Acquiring SNAP benefits" does not include providing false information as part of the certification, reapplication, or reporting changes processes.

(7) Court conviction: firearms, ammunition, or explosives violation

Individuals found by a federal, state, or local court to have used or received SNAP benefits in a transaction involving the sale of firearms, ammunition, or explosives will be permanently ineligible to participate in the program upon the first occasion of such violation.

(8) Receipt of multiple benefits simultaneously

An individual will be ineligible to participate in SNAP for a ten-year period if the individual is found, through an administrative disqualification hearing, a federal, state, or local court, or who has signed either a waiver of right to administrative disqualification hearing or a disqualification consent agreement in cases referred for prosecution, of having made a fraudulent statement or representation with respect to the identity or place of residence of the individual in order to receive multiple benefits simultaneously under SNAP.

(B) The same act of an intentional program violation repeated over a period of time will not be separated so that separate penalties can be imposed.

(C) For SNAP, only the individual found to have committed an intentional program violation will be disqualified, and not the entire assistance group, but for PRC and OWF assistance groups determined to have received fraudulent assistance, all individuals who were members of the assistance group at the time of receipt of the fraudulent assistance will be disqualified.

(D) During the disqualification period, the disqualified individual's needs will not be taken into account in determining the assistance group's eligibility or amount of assistance; however, all income and resources of the disqualified individual will be considered available to the assistance group.

(E) The disqualification period will begin as specified in rule 5101:6-20-17, 5101:6-20-30, 5101:6-20-40, or 5101:6-20-50 of the Administrative Code, as applicable, regardless of whether the individual is eligible for the program at that time.

(F) Once a disqualification penalty has been imposed against a currently eligible individual, it will continue uninterrupted until complete regardless of the eligibility of the disqualified individual's assistance group.

(G) Any period for which a disqualification penalty is imposed will remain in effect, without possibility of an administrative stay, unless and until the finding upon which the penalty was based is reversed by a court of appropriate jurisdiction.

(H) The disqualified individual and each person who was an adult member of the disqualified individual's assistance group, if any, will continue to be responsible for repayment of the overpayment/overissuance which resulted from the individual's intentional program violation, regardless of their current eligibility for program benefits.

(I) The disqualification of an individual for an intentional program violation in one county or state is valid in another county or state.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-04 State hearings: notification at application.

(A) The local agency will 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 will be in clear, prominent, and bold-face lettering on the JFS 07200s "Request for Cash, Food, and Medical Assistance" and the JFS 07501s "Program Enrollment & Benefit Information," or an Ohio department of job and family services notice. .

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-10 State hearings: initiating an administrative disqualification hearing.

(A) To initiate an administrative disqualification hearing, the local agency will complete and submit a JFS 04060 "Referral for Administrative Disqualification Hearing," or an Ohio department of job and family services notice, to the bureau of state hearings.

(B) The JFS 04060 will 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 will be completed for each.

(D) If an individual is suspected of an intentional program violation in more than one program, a separate JFS 04060 will be completed for each.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-11 State hearings: consolidation of an administrative disqualification hearing with a state hearing.

(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 will 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 outlined 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 will 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 will apply.

(F) When an administrative disqualification hearing is combined with a state hearing, separate decisions will be issued for the administrative disqualification and state hearing issues, using the JFS 04007 "Administrative Disqualification Hearing Decision" , and the JFS 04005 "State Hearing Decision," or their approved Ohio department of job and family services equivalents. The JFS 04005 and JFS 04007 forms are both generated in the hearings and appeals tracking system (HATS X).

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-12 State hearings: advance notice of the administrative disqualification hearing.

(A) The bureau of state hearings will 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 will be provided by one of the following methods:

(1) Certified mail - return receipt requested.

Notice provided by this method will be mailed certified mail - return receipt requested.

(2) Personal service.

Notice provided by this method will 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 will 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 will be made a part of the hearing record. Failure to make delivery will be similarly recorded.

(3) Residence service.

Notice provided by this method will 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 will 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 will be made a part of the hearing record. Failure to make delivery will be similarly recorded.

(C) In addition to delivery by one of the methods described in paragraph (B) of this rule, notice will simultaneously be sent by ordinary mail.

(D) The notice will be accompanied by the JFS 04058 "Explanation of Administrative Disqualification Hearing Procedures" and by the JFS 04026 "Waiver of Administrative Disqualification Hearing," or their approved ODJFS equivalents.

(E) The notice, in conjunction with the JFS 04058, will include the following:

(1) The date, time, and place of the hearing.

(2) A statement of the charges against the individual.

(3) A summary of the evidence, and how and where the evidence can be examined.

(4) A statement of the individual's right to request a postponement of the hearing.

(5) A warning that the decision will be based solely on the information provided by the local agency if the individual or authorized representative fails, without good cause, to appear at the hearing.

(6) A statement that the individual or representative will have ten days from the date of the hearing to contact the hearings section and present good cause for failure to appear in order to receive a new hearing.

(7) A description of the penalties that can result from a determination that the individual has committed an intentional program violation, and a statement of which penalty is applicable to the individual.

(8) A statement that the hearing does not preclude collection of the overpayment/overissuance.

(9) An explanation that the individual may waive the right to an administrative disqualification hearing, under the provisions of rule 5101:6-20-30 of the Administrative Code.

(10) A statement that the accused individual has the right to remain silent concerning the charges, and that anything said or signed by the individual concerning the charges can be used against the individual in a court of law.

(11) A statement that the individual may obtain a copy of the department's published hearing rules from the local agency upon request.

(12) A telephone number to call about free legal services.

(F) In all cases, the JFS 04061 "Notice to Appear for an Administrative Disqualification Hearing," or an approved ODJFS equivalent, will be used. The JFS 04061 is generated in the hearings and appeals tracking system (HATS X).

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-13 Effect of a pending administrative disqualification hearing.

(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.

Last updated April 3, 2023 at 8:34 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-14 State hearings - failure to attend the administrative disqualification hearing.

(A) If the accused individual or authorized representative fails, without good cause, to appear at the hearing, the hearing will still be conducted, without the individual being represented, if:

(1) The bureau of state hearings has proof of either receipt or refusal to accept delivery of the advance notice of the administrative disqualification hearing provided as required by paragraph (B) of rule 5101:6-20-12 of the Administrative Code, or

(2) Certified mail delivery of the advance notice of the administrative disqualification hearing, as described in rule 5101:6-20-12 of the Administrative Code, is returned unclaimed and the ordinary mailing of the advance notice, required by rule 5101:6-20-12 of the Administrative Code, does not return undelivered.

(B) Even though the individual is not represented, the hearing officer will consider the evidence carefully and determine, based on clear and convincing evidence, whether an intentional program violation was committed.

(C) When good cause for failure to appear is based upon non-receipt of the advance notice of the hearing required by rule 5101:6-20-12 of the Administrative Code, the individual or authorized representative will have thirty days from the date of the hearing decision to contact the hearing authority and present good cause for failing to attend.

In all other instances, the individual or authorized representative will have ten days from the date of the hearing to contact the hearing authority and present good cause for failing to attend.

The hearing officer will enter the good cause determination into the hearing record.

(D) When the hearing officer finds that an intentional program violation was committed but good cause for failure to appear is subsequently shown, the hearing decision will be vacated and a new hearing scheduled.

(1) In this instance, the bureau of state hearings will immediately notify the local agency and order discontinuation of the disqualification and reinstatement of assistance if otherwise appropriate.

(2) The new hearing will be scheduled in accordance with rule 5101:6-20-12 of the Administrative Code.

(3) The original hearing officer may conduct the new hearing.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-15 State hearings: administrative disqualification hearing procedures.

(A) The following provisions apply to the administrative disqualification hearing process:

(1) The accused individual and authorized representative will be provided access to documents and regulations in accordance with rule 5101:6-5-01 of the Administrative Code.

(2) The accused individual, the authorized representative and the local agency have the right to request the issuance of subpoenas in accordance with rule 5101:6-5-01 of the Administrative Code.

(3) The local agency may provide transportation to the accused individual in accordance with rule 5101:6-5-01 of the Administrative Code.

(4) The time and place of the administrative disqualification hearing will be in accordance with rule 5101:6-6-01 of the Administrative Code.

(5) The accused individual is entitled to one postponement of the scheduled hearing.

(a) The request for postponement will be received by the bureau of state hearings at least ten days prior to the date of the scheduled hearing.

(b) The hearing will not be postponed for more than thirty days.

(B) The following provisions apply to the conduct of the administrative disqualification hearing:

(1) The accused individual and the local agency have the right to be represented by legal counsel in accordance with rule 5101:6-5-01 of the Administrative Code.

(2) The administrative disqualification hearing will be conducted informally, in accordance with rule 5101:6-6-02 of the Administrative Code.

(3) Attendance at the administrative disqualification hearing will be limited, in accordance with rule 5101:6-6-01 of the Administrative Code.

(4) Administrative disqualification hearings will be recorded in accordance with rule 5101:6-6-03 of the Administrative Code.

(5) The role of the agency representative at the administrative disqualification hearing will be as described in rule 5101:6-6-02 of the Administrative Code.

(6) The accused individual and/or authorized representative will have the rights described in rule 5101:6-6-02 of the Administrative Code.

(7) The role of the hearing officer at the administrative disqualification hearing will be as described in paragraph (C) of rule 5101:6-6-02 of the Administrative Code, except that paragraphs (C)(14) and (C)(15) of rule 5101:6-6-02 of the Administrative Code do not apply.

(8) At the hearing, the hearing officer will advise the accused individual and representative that they may refuse to answer questions during the hearing.

(9) Once the administrative disqualification hearing has begun, the accused individual may no longer waive the right to a hearing. If the local agency or the bureau of state hearings has not received a signed JFS 04026 "Waiver of Administrative Disqualification Hearing," or an approved Ohio department of job and family services equivalent, prior to the time of the scheduled hearing, the hearing officer will proceed with the hearing and render a written decision.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-16 State hearings: administrative disqualification hearing decisions.

(A) The bureau of state hearings is responsible for preparing and issuing administrative disqualification hearing decisions under the authority of the director of the Ohio department of job and family services (ODJFS). The bureau of state hearings will designate hearing authorities to review the findings, conclusions, and recommendations of the hearing officers and to issue decisions under the authority of the ODJFS director.

(1) No person designated as the hearing authority will have previously participated in the local agency decision being appealed, nor will the hearing authority and the hearing officer who conducted the hearing be the same person.

(2) Administrative disqualification hearing decisions will be issued within ninety days of the mailing date of the JFS 04061 "Notice to Appear for an Administrative Disqualification Hearing," or an ODJFS approved equivalent. The JFS 04061 form is generated in the hearings and appeals tracking system (HATS X).

(3) If the hearing was postponed, under the provisions of rule 5101:6-20-15 of the Administrative Code, the ninety-day time limit will be extended by as many days as the hearing was postponed.

(B) The hearing officer's findings of fact will be based exclusively on the evidence introduced at the hearing, or, if the accused individual was represented at the hearing, after the hearing and subject to examination and rebuttal by both parties as described in rule 5101:6-6-02 of the Administrative Code.

(1) The hearing officer may be guided, but will not be bound, by the Ohio Rules of Evidence (as in effect on August 1, 2024) in conducting hearings and in making findings of fact. The hearing officer will consider all relevant evidence offered at the hearing.

(2) Hearsay evidence may be considered by the hearing officer in arriving at the findings of fact. However, such evidence will be critically evaluated, since it is not given under oath and cannot be cross-examined to test the perception, memory, and veracity of the declarant.

(3) Direct evidence will normally be given more weight than hearsay evidence when the two are in conflict. Whenever possible, the hearing officer will avoid basing a finding of fact solely on hearsay evidence.

(4) It will be the responsibility of the local agency to show, by clear and convincing evidence, that the accused individual committed an intentional program violation.

(5) The hearing officer's findings of fact will be binding upon the hearing authority. However, the hearing authority may remand the case to the hearing officer if the hearing authority determines that additional facts not already established by the hearing officer are essential to a correct decision, or if the evidence relied upon was taken in violation of paragraph (B) of this rule.

(6) The scope of the remand will be limited to those additional facts which the hearing authority deems necessary. The remand will not be the occasion for a new determination of any of the facts already established.

(C) The hearing officer's conclusions of policy and recommendations will be based solely on rules of the Administrative Code, except when these regulations are silent and reference to the Revised Code or other statutory source is necessary to resolve the issue.

(1) The hearing authority will review conclusions and recommendations by the hearing officer, and adopt them when they constitute a correct application of the appropriate regulations.

(2) The hearing authority will amend conclusions and recommendations that do not correctly apply the appropriate regulations, clearly explaining the reason and basis of any such amendment.

(D) The administrative disqualification hearing decision will be limited to determining whether the accused individual committed an intentional program violation and whether the sanction period being proposed is appropriate.

(E) The administrative disqualification hearing decision will separately set forth the issue, the hearing officer's findings of fact, conclusions of policy and recommendations, and the decision and order.

(1) The issue section will include the programs for which administrative disqualification is proposed, the length of the proposed disqualification period, and a brief statement of the alleged activity upon which the local agency has based its proposal. When disqualification in multiple programs has been proposed, they will be stated separately in the issue statement, and treated separately in the remainder of the decision.

(2) When the disqualification hearing has been combined with a state hearing, the state hearing issues will be decided in a separate state hearing decision, not in the administrative disqualification hearing decision. Both decisions will be issued at the same time.

(3) Procedural matters, such as delays due to postponement or amendments to the issue, will be followed by a clear and orderly chronological discussion of the facts and events relevant to the issue. Findings of fact upon which all parties agree will normally be set forth first, followed by discussion and resolution of factual disputes. The decision will clearly indicate the basis for each such finding, to include discussion of the relative weight given to the conflicting evidence in arriving at the decision.

(4) The conclusions of policy will cite and summarize relevant portions of departmental rules or program manuals, and other applicable regulations as necessary, and will clearly demonstrate how they apply to the facts established.

(5) The hearing officer's recommendations will address each program for which administrative disqualification is proposed and will state whether or not the accused individual is found to have committed an intentional program violation. When the hearing officer recommends that the accused individual be disqualified, the hearing officer will state the length of the disqualification period to be imposed.

(6) When disqualification is ordered, compliance will be necessary, via the JFS 04068 "Order of Compliance," or an ODJFS approved equivalent.

(7) The decision and order, signed by the hearing authority, will indicate adoption or amendment of the hearing officer's recommendations and whether the accused individual is found to have committed an intentional program violation. If the accused individual is to be disqualified, it will state the program(s) for which disqualification will be implemented and the length of the disqualification period to be imposed.

(F) The individual and authorized representative will be provided with a written administrative disqualification hearing decision via the JFS 04007 "Administrative Disqualification Hearing Decision," or an ODJFS approved equivalent. The JFS 04007 form is generated in the hearings and appeals tracking system (HATS X). A copy of the decision will be sent to the local agency.

When the disqualification hearing is combined with a state hearing, a separate decision will be issued for the state hearing issue(s) in accordance with rule 5101:6-7-01 of the Administrative Code, using the JFS 04005 "State Hearing Decision," or an ODJFS approved equivalent. The JFS 04005 form is generated in the hearings and appeals tracking system (HATS X).

(G) The administrative disqualification hearing decision, together with documents introduced at the hearing and all papers and requests filed in the proceeding, will constitute the exclusive record. The hearing record will be compiled and maintained by the bureau of state hearings in accordance with applicable record retention requirements and made available for review by the individual and authorized representative.

(H) The bureau of state hearings will maintain a library of all administrative disqualification hearing decisions. The decisions will be available for public inspection and copying, subject to applicable disclosure safeguards.

(I) Administrative disqualification hearing decisions will be binding on the local agency for the individual case for which the decision was rendered.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-17 State hearings: implementation of the administrative disqualification hearing decision.

(A) Disqualification

(1) When the hearing decision finds that the accused individual has committed an intentional program violation, he or she will be disqualified in accordance with rule 5101:6-20-03 of the Administrative Code.

(2) Prior to implementing the disqualification, the local agency will provide the individual the JFS 04062 "Notice of Disqualification for Intentional Program Violation," or an approved Ohio department of job and family services (ODJFS) equivalent, in accordance with rule 5101:6-20-18 of the Administrative Code.

(3) The disqualification period will be implemented as follows:

(a) For Ohio works first (OWF) and prevention, retention and contingency (PRC), the period will begin no later than the first day of the second month following the date the JFS 04062 is mailed.

(b) For supplemental nutrition assistance program (SNAP), the period will begin with the first month which follows the date the JFS 04062 is mailed.

(B) Compliance

(1) The local agency is responsible for promptly and fully implementing adverse administrative disqualification hearing decisions. The bureau of state hearings is responsible for monitoring timely compliance.

(2) When an administrative disqualification hearing decision finds an intentional program violation, the "compliance required" box on the decision form will be checked, and a JFS 04068 "Order of Compliance," or an ODJFS approved equivalent, will be sent to the local agency with the decision.

(3) After implementing the disqualification, the local agency will promptly notify the bureau of state hearings of the action taken, using the JFS 04068.

(4) Compliance will be considered achieved on the date the disqualification is reflected in the assistance group's benefits.

(5) If the individual is not eligible for the program at the time the disqualification period is to begin, the local agency will report that fact on the JFS 04068 and compliance will be considered achieved.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-18 State hearings: notice of disqualification for an intentional program violation.

(A) The local agency will provide an individual found to have committed an intentional program violation a written notice of disqualification.

(1) If more than one member of an assistance group is to be disqualified, a separate disqualification notice will be provided to each individual.

(2) A copy of the disqualification notice will also be sent to the bureau of state hearings and to the appropriate fraud control specialist.

(B) The notice will be mailed or personally delivered no later than five business days after the local agency's receipt of the administrative disqualification hearing decision, court decision, waiver or consent agreement upon which disqualification is to be based.

(1) The name of the individual to be disqualified.

(2) The program(s) from which the individual is to be disqualified.

(3) The basis for the disqualification.

(4) The effective date and period of disqualification.

(5) A statement that the disqualification period will begin at once, regardless of whether the individual is currently receiving benefits.

(6) Notice to the remaining assistance group members, if any, of the benefits they will receive during the disqualification period.

In the supplemental nutrition assistance program (SNAP), the notice may alternatively inform the remaining assistance group members that they will reapply because the certification period has expired.

(D) The disqualification notice will be accompanied by a JFS 07442 "Food Assistance Repayment Agreement," or an approved Ohio department of job and family services (ODJFS) equivalent, unless that form has already been provided.

(E) In all instances, the JFS 04062 "Notice of Disqualification for Intentional Program Violation," or an ODJFS approved equivalent,, will be used.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-19 Opportunity for appeal of an administrative disqualification.

(A) No further administrative appeal procedures exist after an adverse administrative disqualification hearing decision, or after the individual waives the right to an administrative disqualification hearing and a disqualification penalty has been imposed.

(B) The disqualification penalty cannot be changed by a subsequent state hearing decision.

(C) Individuals who disagree with an administrative disqualification hearing decision have the right to appeal that decision to the court of common pleas, in accordance with rule 5101:6-9-01 of the Administrative Code.

(D) If the determination of intentional program violation (IPV) is reversed by a court, the local agency shall reinstate the individual in the program(s) from which he or she was disqualified, if otherwise eligible, and shall restore benefits that were lost as a result of disqualification. Compliance with these decisions shall be monitored by the bureau of state hearings.

Last updated April 3, 2023 at 8:34 AM

History

Effective: April 1, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-30 State hearings: waiver of administrative disqualification hearing.

(A) An individual suspected of having committed an intentional program violation will be provided written notice that he or she can waive the right to an administrative disqualification hearing.

(1) The local agency will provide the notice at least fifteen days prior to referring the case to the Ohio department of job and family services (ODJFS) for an administrative disqualification hearing.

Prior to providing notice, the local agency will ensure, through a review by someone other than the eligibility worker assigned to the individual's case, that the evidence against the individual warrants disqualification.

In cases where reliable information indicates that the individual has left the project area, the waiver notice may be mailed, to the accused individual's last known address, at the same time the referral is sent to ODJFS.

(2) The bureau of state hearings will also provide the notice along with the advance notice of the administrative disqualification hearing.

(B) The notice will be accompanied by the JFS 04058 "Explanation of Administrative Disqualification Hearing Procedures," or an Ohio department of job and family services (ODJFS) approved equivalent.

(1) A statement of the charges against the individual.

(2) A summary of the evidence, and how and where the evidence can be examined.

(3) A description of the penalties for an intentional program violation and a statement of which penalty is applicable to the individual.

(4) For notice sent by the local agency prior to referral, the time period within which the signed waiver will be received by the local agency to prevent initiation of the referral.

(5) A statement that the head of the assistance group will also sign the waiver when the accused individual is not the head of the assistance group.

(6) A statement that the accused individual has the right to remain silent concerning the charges, and that anything said or signed by the individual concerning the charges can be used against the individual in a court of law.

(7) An opportunity for the accused individual to specify whether or not he or she admits to the facts as presented by the local agency.

(8) A statement that signing the waiver will result in disqualification and a reduction in benefits for the period of disqualification, even if the accused individual does not admit to the facts as presented by the local agency.

(9) A statement that the waiver does not preclude collection of the fraudulent overpayment/overissuance.

(10) For supplemental nutrition assistance program (SNAP), each person who was an adult member of the assistance group when the overpayment or trafficking occurred is responsible for repayment of the overpayment/overissuance.

(11) The name and telephone number of the person to contact for more information.

(12) A telephone number to call about free legal services.

(13) A statement that the individual may obtain a copy of the department's published hearing rules from the local agency upon request.

(D) In all instances, the JFS 04026 "Waiver of Administrative Disqualification Hearing," or an ODJFS approved equivalent, will be used.

(E) To waive the disqualification hearing, the accused individual will sign and return the waiver so that it is received by the local agency or by the bureau of state hearings prior to the disqualification hearing.

(F) When the individual suspected of an intentional program violation signs and returns the JFS 04026 so that it is received prior to the disqualification hearing, the local agency will disqualify the individual in accordance with rule 5101:6-20-03 of the Administrative Code, regardless of whether or not the individual admits to the facts as presented by the local agency.

A copy of the JFS 04026 will be filed in the individual's case record.

(G) Prior to implementing the disqualification, the local agency will provide the individual a JFS 04062 ""Notice of Disqualification for Intentional Program Violation," or an ODJFS approved equivalent, in accordance with rule 5101:6-20-18 of the Administrative Code.

(H) The disqualification period will be implemented as follows:

(1) For Ohio works first (OWF) and prevention, retention and contingency (PRC), the period will begin no later than the first day of the second month following the date the JFS 04062 is mailed.

(2) For SNAP, the period will begin with the first month which follows the date the JFS 04062 is mailed.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-40 State hearings: disqualification consent agreement.

(A) The local agency has the option of establishing procedures to allow an individual suspected of an intentional program violation to sign a disqualification consent agreement. Local agencies are encouraged to use this option for those cases in which a determination of guilt is not obtained from a court because:

(1) The accused individual has met the terms of a court order.

(2) The accused individual was not prosecuted because he or she met the terms of an agreement with the prosecutor.

(B) Those counties that choose the option identified in paragraph (A) of this rule will enter into an agreement with the county prosecutor that provides for giving the individual advance written notification of the consequences of signing a disqualification consent agreement.

(1) For individuals accused of committing an intentional program violation in the Ohio works first (OWF) and prevention, retention and contingency (PRC) programs, a statement that signing the agreement constitutes an admission of guilt.

(2) A statement for the accused individual to sign indicating that he or she understands the consequences of signing the agreement.

(3) A statement that the head of the assistance group will also sign the agreement if the accused individual is not the head of the assistance group.

(4) A statement that signing the agreement will result in disqualification and a reduction in benefits for the period of disqualification, even though the individual was not found guilty of civil or criminal misrepresentation or fraud.

(5) A description of the penalties for an intentional program violation, and a statement of which penalty or penalties will be imposed if the individual signs the agreement.

(6) For supplemental nutrition assistance program (SNAP), each person who was an adult member of the assistance group when the overpayment or trafficking occurred is responsible for repayment of the overpayment/overissuance.

(D) In the OWF and PRC programs, the disqualification consent agreement will be confirmed by the court.

(E) The local agency may use the JFS 04027 "Disqualification Consent Agreement" or a similar, county-developed form which meets the requirements of this rule.

(F) When signed, a copy of the disqualification consent agreement will be given to the individual, a copy provided to the local agency to be filed in the individual's case record, and a copy sent to the bureau of state hearings.

(G) When the individual suspected of an intentional program violation signs a disqualification consent agreement, he or she will be disqualified in accordance with rule 5101:6-20-03 of the Administrative Code, unless contrary to the court order.

(H) Prior to implementing the disqualification, the local agency will provide the individual a JFS 04062 "Notice of Disqualification for Intentional Program Violation," or an Ohio department of job and family services approved equivalent, in accordance with rule 5101:6-20-18 of the Administrative Code.

(I) The disqualification period will be implemented as follows:

(1) For OWF and PRC, the period will begin no later than the first day of the second month following the date the JFS 04062 is mailed.

(2) For SNAP, the period will begin within forty-five days of the date the individual signed the disqualification consent agreement.

(3) If the court imposes a disqualification period or specifies the date for initiating the disqualification period, the local agency will disqualify the individual in accordance with the court order.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5101:6-20-50 State hearings: disqualification from the supplemental nutrition assistance program (SNAP) based on court action.

(A) If a court finds that an individual committed an intentional program violation, the local agency will disqualify the individual in accordance with the court order.

(B) Prior to implementing the disqualification, the local agency will provide the individual a JFS 04062 "Notice of Disqualification for Intentional Program Violation," or an approved Ohio department of job and family services equivalent, in accordance with rule 5101:6-20-18 of the Administrative Code.

(C) If the court fails to impose a disqualification or a disqualification period, the local agency will impose a disqualification period, in accordance with rule 5101:6-20-03 of the Administrative Code, unless contrary to the court order.

(D) If the court orders disqualification but fails to specify a date for initiating the disqualification period, the period will begin within forty-five days of the date of the court order.

Last updated January 17, 2025 at 12:19 AM

History

Effective: January 17, 2025
Promulgated Under: 119.03

Ohio Administrative Code 5101:6 — Department of Job and Family Services | Hearings

Chapter 5101:6-1 General Provisions

Ohio Adm.Code 5101:6-1-01 State hearings: general.

Chapter 5101:6-2 Notice

Ohio Adm.Code 5101:6-2-01 State hearings: notice at the time of application.

Ohio Adm.Code 5101:6-2-02 State hearings: notice of approval of an application for benefits.

Ohio Adm.Code 5101:6-2-03 State hearings: notice of denial of an application for benefits.

Ohio Adm.Code 5101:6-2-04 State hearings: prior notice of adverse action.

Ohio Adm.Code 5101:6-2-05 State hearings: exceptions to prior notice.

Ohio Adm.Code 5101:6-2-06 State hearings: notice of mass change in benefits.

Ohio Adm.Code 5101:6-2-07 State hearings: notice of the right to a state hearing - child support services.

Ohio Adm.Code 5101:6-2-08 State hearings: notice whenever disagreement with an action or inaction is expressed.

Ohio Adm.Code 5101:6-2-20 State hearings: notice of overpayment/overissuance.

Ohio Adm.Code 5101:6-2-25 State hearings: notice of eligibility for lost supplemental nutrition assistance program (SNAP) benefits.

Ohio Adm.Code 5101:6-2-26 State hearings: notice of approval, denial or delay of replacement supplemental nutrition assistance program (SNAP) benefits.

Ohio Adm.Code 5101:6-2-30 State hearings: notice of medical determination.

Ohio Adm.Code 5101:6-2-31 State hearings: notice of denial of prior authorization for medical or dental services.

Ohio Adm.Code 5101:6-2-32 State hearings: notice of adverse preadmission screening and resident review (PASRR) determinations.

Ohio Adm.Code 5101:6-2-36 State hearings: notice of denial of just cause request for termination of managed care plan membership.

Ohio Adm.Code 5101:6-2-40 State hearings: coordinated services program state hearing and notice requirements.

Ohio Adm.Code 5101:6-2-51 Notice of interim assistance reimbursement.

Chapter 5101:6-3 Request for a State Hearing

Ohio Adm.Code 5101:6-3-01 State hearings: grounds for requesting a state hearing.

Ohio Adm.Code 5101:6-3-02 State hearings: state hearing requests.

Chapter 5101:6-4 Continuation of Benefits After Hearing Request

Ohio Adm.Code 5101:6-4-01 State hearings: continuation of benefits when a state hearing is requested.

Chapter 5101:6-5 Pre-Hearing Procedures; Postponement, Denial, or Dismissal of Hearing

Ohio Adm.Code 5101:6-5-01 State hearings: procedures prior to the state hearing.

Ohio Adm.Code 5101:6-5-02 State hearings: postponement of the state hearing.

Ohio Adm.Code 5101:6-5-03 State hearings: denial and dismissal of state hearing requests.

Chapter 5101:6-6 Hearing Procedure

Ohio Adm.Code 5101:6-6-01 State hearings: scheduling and attendance.

Ohio Adm.Code 5101:6-6-02 State hearings: rights and responsibilities of the participants.

Ohio Adm.Code 5101:6-6-03 State hearings: recording the hearing.

Chapter 5101:6-7 Hearing Decisions

Ohio Adm.Code 5101:6-7-01 State hearings: state hearing decisions.

Ohio Adm.Code 5101:6-7-02 State hearings: standards for revising community spouse income and resource allowances at a state hearing.

Ohio Adm.Code 5101:6-7-03 State hearings: implementation of the hearing decision.

Chapter 5101:6-8 Administrative Appeal

Ohio Adm.Code 5101:6-8-01 State hearings: administrative appeal of the state hearing decision.

Ohio Adm.Code 5101:6-8-02 State hearings: county reviews.

Chapter 5101:6-9 Further Appeal

Ohio Adm.Code 5101:6-9-01 State hearings: further appeal rights.

Chapter 5101:6-10 Hearings for the Comprehensive Case Management and Employment Program

Ohio Adm.Code 5101:6-10-01 State hearings: hearings for the comprehensive case management and employment program.

Chapter 5101:6-20 Administrative Violations

Ohio Adm.Code 5101:6-20-01 State hearings - disqualification for an intentional program violation.

Ohio Adm.Code 5101:6-20-02 State hearings - definition of an intentional program violation.

Ohio Adm.Code 5101:6-20-03 State hearings: penalties for an intentional program violation.

Ohio Adm.Code 5101:6-20-04 State hearings: notification at application.

Ohio Adm.Code 5101:6-20-10 State hearings: initiating an administrative disqualification hearing.

Ohio Adm.Code 5101:6-20-11 State hearings: consolidation of an administrative disqualification hearing with a state hearing.

Ohio Adm.Code 5101:6-20-12 State hearings: advance notice of the administrative disqualification hearing.

Ohio Adm.Code 5101:6-20-13 Effect of a pending administrative disqualification hearing.

Ohio Adm.Code 5101:6-20-14 State hearings - failure to attend the administrative disqualification hearing.

Ohio Adm.Code 5101:6-20-15 State hearings: administrative disqualification hearing procedures.

Ohio Adm.Code 5101:6-20-16 State hearings: administrative disqualification hearing decisions.

Ohio Adm.Code 5101:6-20-17 State hearings: implementation of the administrative disqualification hearing decision.

Ohio Adm.Code 5101:6-20-18 State hearings: notice of disqualification for an intentional program violation.

Ohio Adm.Code 5101:6-20-19 Opportunity for appeal of an administrative disqualification.

Ohio Adm.Code 5101:6-20-30 State hearings: waiver of administrative disqualification hearing.

Ohio Adm.Code 5101:6-20-40 State hearings: disqualification consent agreement.

Ohio Adm.Code 5101:6-20-50 State hearings: disqualification from the supplemental nutrition assistance program (SNAP) based on court action.

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