Current through all regulations passed and filed through September 16, 2024
(A) Definition
(1) A "request for a state hearing" is
defined as a clear expression, by the individual or authorized representative,
to the effect that he or she wishes to appeal a decision or wants the
opportunity to present his or her case to a higher authority. The request may
be either made orally, in writing, or electronically.
A state hearing may only be requested by or on behalf of an
individual applying for or receiving benefits. A state hearing may not be
requested by the local agency, the state agency, or another entity, such as a
managed care plan, acting for or in place of the local or state agency.
(2) Oral requests for a hearing
shall immediately be converted to a written record by the person to whom the
request is made. It is not appropriate to require the individual to submit a
written request once the desire for a hearing has been expressed orally.
Requests made by telephone must be made by the individual.
(3) Written authorization including, but not
limited to letters of guardianship or power of attorney, must accompany all
requests made on an individual's behalf by an authorized representative except:
(a) Upon a showing that such authorization
cannot be obtained because of the individual's death or incapacity, and that
the representative is, in fact, acting in the individual's best
interest.
(b) That an individual's
spouse or minor individual's parent or legal guardian may request a hearing on
behalf of the individual without written authorization.
(c) That a provider of long-term care may
request a hearing, without obtaining written authorization, to contest the
level of care assigned to the individual.
(4) Written authorization is nontransferable.
Unless paragraph (A)(3)(a) or (A)(3)(b) of this rule apply, documentary
evidence must be in the appellant's hearing record that the appellant, the
appellant's legal guardian, or the power of attorney has granted authorization
to another individual to represent the appellant in the hearings process.
Otherwise, the appellant is the only individual who can grant another
individual authorization to represent the individual.
(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.
