(A)The bureau of
state hearings (BSH) shall 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 shall 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 shall complete an appeal summary. The summary consists of a prescribed
form (the JFS 04067 "Appeal Summary" (rev. 5/2001), or for a medicaid managed care plan or
"MyCare Ohio" plan the ODM 01959 "Appeal Summary for Managed
Care Plans" (rev. 7/2014)) 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 shall 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.
(C)County
conferences
(1)In order toTo avoid
unnecessary state hearings, the local agency shall 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 shall 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 shall 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 shall retract the notice of adverse action and/or decide the
question of the individual's entitlement to benefits,benefits or arrange to make that determination as
quickly as possible. The outcome of the county conference shall be recorded, in
writing, in the case record.
(3)The individual
need not have a county conference in order 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 must still be held unless a resolution is reached at the county
conference and the individual withdraws the hearing request in writing. Any
such withdrawal shall be signed and dated by both the individual and the local
agency representative, shall clearly set forth the resolution upon which the
withdrawal is based, and shall be forwarded to the assigned hearings section
within two business days. The local agency shall give one copy of the
withdrawal to the individual and retain one copy in the case file.
(4)The local
agency shall schedule a county conference for assistance groups contesting a
denial of expedited food assistancesupplemental 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
bureau of state hearings (BSH)BSH that a member has requested a state hearing, the
MCP or MCOP shall 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
shall 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."
(rev. 1/2015). The local agency may provide legal
services through a social services contract.
(F)Access to
documents and regulations
(1)The individual
and authorized representative shall 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 shall provide one copy of
each such document at no cost. The authorized representative must provide the
individual's signed authorization to the local agency before obtaining a copy
of case record material.
(3)Current program
manuals shall 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, shall not be
presented at the hearing nor affect the hearing officer's decision.
(6)When the
hearing involves work registration or employment and training, the individual
shall also be allowed to examine the employment and training component 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 shall
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 shall make the determination as to whether such subpoenas shall be
issued and whether subpoenaed individuals shall participate in person or by
telephone. If a subpoena request is denied, the reason for denial shall be
clearly explained in the state hearing decision.
(3)Subpoenas shall
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 shall 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 shall provide a
translation in accordance with the "Ohio Department
of Job and Family Services Language Access Policy" (rev. 4/3/2008) "Services LEP Drafting Guidelines" (rev. 5/2008)
at http://jfs.ohio.gov/civilrights/pdf/LEP_Policy_12.pdf.
https://jfs.ohio.gov/civilrights/pdf/LEP-Plan-Drafting-Guidelines-2.pdf
(J)Interpreters
for hearings
If an individual or authorized representative has limited
proficiency in English or communicates using sign language, the local agency
shall 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 insure 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 shall 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 shall be notified of the group hearing procedures
via the JFS 04059, along with the scheduling notice.
Effective: 4/1/2023
Five Year Review (FYR) Dates: 1/6/2023 and 04/01/2028
Certification: CERTIFIED ELECTRONICALLY
Date: 03/16/2023
Promulgated Under: 119.03
Statutory Authority: 3125.25, 5101.35
Rule Amplifies: 3125.25, 5101.35, 5160.011
Prior Effective Dates: 04/15/1975, 06/28/1976, 09/01/1976,
10/01/1978, 12/01/1979, 06/01/1980, 06/02/1980, 09/18/1980, 10/01/1981,
02/01/1982, 05/01/1982, 10/01/1982, 01/17/1983, 04/01/1983, 07/01/1983,
11/01/1983 (Temp.), 12/01/1983, 12/22/1983, 03/01/1984 (Temp.), 06/01/1984,
05/01/1985 (Emer.), 07/01/1985 (Emer.), 07/30/1985, 09/25/1985, 04/01/1986, 04/01/1987,
09/01/1987, 10/14/1988, 04/01/1989, 02/01/1992, 06/01/1993, 06/01/1997,
05/15/1999, 06/01/2003, 07/01/2009, 08/01/2010, 02/28/2014, 01/01/2018