Current through all regulations passed and filed through September 16, 2024
(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issues under appeal, notice of dismissal of the withdrawn appeals may be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.
