Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-80 - Rights and Procedures Applicable to Medical Assistance Recipients
Section 5160-80-02 - Hearing requests
Universal Citation: OH Admin Code 5160-80-02
Current through all regulations passed and filed through September 16, 2024
(A) Making a request for hearing
(1)
A request for hearing must be submitted to the depository
agent in writing by the medical assistance recipient or by the medical
assistance recipient's authorized representative or attorney and shall be
subject to the requirements of this rule.
(2)
The request for
hearing shall address only the issue of whether the amount determined for
reimbursement of medical assistance paid by the department or county department
should be different than set forth in section
5160.37 of the Revised Code. The
hearing examiner shall freely grant leave to a medical assistance recipient or
to a medical assistance recipient's authorized representative or attorney to
amend the written hearing request if it fails to comply with this
requirement.
(3)
For a payment owed to the department or county
department on or after September 29, 2015, the following shall apply:
(a)
Before a medical
assistance recipient can make a hearing request, the medical assistance
recipient must receive from the department or county department a letter with a
final lien amount.
(b)
If the medical assistance recipient is requesting a
hearing pursuant to division (L)(1) or (L)(2) of section
5160.37 of the Revised Code, the
medical assistance recipient must provide the following information with the
hearing request, subject to documentation verification upon demand of the
department:
(i)
The total amount to be paid to resolve all claims of the
medical assistance recipient, including, but not limited to, medical expenses,
loss of income, loss of consortium, and pain and suffering.
(ii)
The amount that
has been collected as a result of the settlement, compromise, judgment, or
award giving rise to the department's or county department's claim for
reimbursement.
(iii)
The amount of attorney fees incurred to obtain the
settlement, compromise, judgment, or award.
(iv)
The amount of
costs and expenses incurred to obtain the settlement, compromise, judgment, or
award.
(c)
In addition to the information requested pursuant to
paragraph (A)(3)(b) of this rule, the medical assistance recipient requesting a
hearing pursuant to division (L)(1) or (L)(2) of section
5160.37 of the Revised Code
shall provide with the hearing request the following documentation:
(i)
A copy of all
written settlement agreements, compromises, judgments, or awards referenced in
paragraph (A)(3)(b) of this rule.
(ii)
If the medical
assistance recipient does not pay to the department or county department the
final lien amount, documentation from a bank or other financial institution
providing the account number and the amount being held in an escrow account or
an attestation from an attorney identifying the amount being held in an
interest on lawyers' trust account pursuant to division (L)(1) of section
5160.37 of the Revised
Code.
(d)
If the medical assistance recipient does not include
all of the information and documentation required in Paragraphs (A)3(b) and
(A)(3)(c) of this rule, the department shall send written notice to the medical
assistance recipient and the medical assistance recipient's attorney or
authorized representative listing the information and documentation not
provided. If the medical assistance recipient or the medical assistance
recipient's attorney or authorized representative fails to provide all the
requested information and documentation within thirty calendar days of the date
of mailing of the written notification, the department shall dismiss the
hearing request without prejudice.
(4)
Written
documentation of the appointment of an authorization representative by a
medical assistance recipient must accompany the hearing request made on the
medical assistance recipient's behalf by an authorized representative.
Attorneys may make a written hearing request on a medical assistance
recipient's behalf without providing written authorization. To obtain medical
assistance information or protected health information, an attorney
representing the medical assistance recipient must provide a written release
meeting the requirements of section
5160.45 of the Revised Code or
written documentation that the attorney is acting in the capacity as an
authorized representative.
(B) Time limit
(1)
For payments owed
to the department or county department on or after September 29, 2015, written
notification by the department or county department to the medical assistance
recipient of the final lien amount shall include a notice of the recipient's
right to request a hearing.
(2)
If a medical
assistance recipient does not elect to escrow or have placed in a lawyers'
trust account the final lien amount, a request for hearing must be made not
later than ninety calendar days after payment of the final lien amount to the
department or county department. When counting the days to determine whether an
appeal is timely, the date on which notice was mailed, sent by electronic
means, or otherwise provided is not counted. If the last day of the time period
falls on a Saturday, Sunday, or state or federal legal holiday, the time period
is extended to include the next workday.
(C) Determining whether a hearing request is timely made.
(1)
If a request for
hearing is made to the depository agent, the request is deemed to have been
made as follows:
(a)
If the request is mailed by certified mail, as of the
date stamped by the U.S. postal service on its receipt form (PS form 3800 or
any future equivalent postal service form).
(b)
If the request is
mailed by ordinary U.S. mail, as of the date of the postmark appearing upon the
envelope containing the request.
(c)
If the request is
mailed by ordinary U.S. mail and the postmark is illegible or fails to appear
on the envelope, as of the date of its receipt by the depository agent as
evidence by the agent's time stamp.
(2)
If a request is
made through the website designated by the department for making a hearing
request, the request is deemed to have been made when the request is
electronically recorded by the website.
(3)
If a request for
a hearing is made by facsimile transmission or by electronic mail to the
depository agent, the request is deemed to have been made as of the date of its
receipt as evidence by the receipt date generated by the facsimile transmission
or the date of receipt shown in the source code of the electronic mail received
by the depository agent.
(4)
If a request for a hearing is personally delivered to
the depository agent, the request is deemed to have been made as of the date of
its receipt by the depository agent's time stamp.
(5)
If a request for
a hearing is mailed, personally delivered, made by facsimile transmission, or
made by electronic mail to a person or address other than the depository agent
or otherwise not properly sent, the request is deemed to have been made as of
the date of its receipt by the depository agent as evidence by the depository
agent's time stamp.
(6)
The hearing request shall clearly identify the medical
recipient making the request by name, address and phone number. If a request is
made through a website designated by the department for making a hearing
request, the request shall provide the information required by the website to
identify the medical assistance recipient.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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