(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
shall 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 shall have previously participated in the
agency decision being appealed, nor shall 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 shall be issued within seventy calendar days from the date of the
hearing request. No extension of the seventy-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 shall be
issued within thirty calendar days from the date of the hearing request.
(3)Hearing
decisions involving food assistancesupplemental nutrition assistance program (SNAP) shall 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 shall be extended by as many days
as the hearing was postponed.
(b)Hearing
decisions involving a denial of expedited food
assistanceSNAP shall 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 food assistanceSNAP adverse actions, the hearing decision shall be
issued according to public assistance timeliness standards.
(4)Hearing
decisions involving the medicaid program shall be issued within seventy
calendar days from the date of the hearing request. This period shall 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
(c)The bureau of
state hearings agrees that an expedited resolution is required.
(C)Basis
(1)The hearing
officer's findings of fact shall 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 shall not be bound, by the Ohio Rules of Evidence
(as in effect on July 1, 2017 2022) in conducting hearings and in making findings of
fact. The hearing officer shall 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 must 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 shall normally be given more weight than hearsay
evidence when the two are in conflict.
(c)It shall 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 shall 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 shall 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 shall 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 shall review conclusions and recommendations by the hearing officer,officer and adopt
them when they constitute a correct application of the appropriate regulations.
(c)The hearing
authority shall 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 shall 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 shall 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 required 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 course of the 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 shall 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 shall be
issued via the JFS 04005 "State Hearing Decision."
(rev. 1/2015).
(D)Content
The hearing decision shall 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 shall fully describe the action or lack of action being appealed. It
shall 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 shall include a summary of the hearing officer's
recommendations for resolution of the issue. When multiple issues are involved,
they shall be set forth separately and numbered for reference in the remainder
of the decision.
(2)The procedural
matters shall 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 shall follow procedural matters. The findings of fact shall be clear
and orderly chronological discussion of the facts and events relevant to the
issue.
(4)The conclusions
of policy shall cite and summarize relevant portions of rules of the
Administrative Code and other applicable regulations as necessary,necessary and shall clearly demonstrate how they apply
to the facts established. The decision shall 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.
Food assistanceSNAP decisions shall also cite applicable federal
regulations.
Budget computations, where relevant, shall be clearly set forth.
(5)The hearing
officer's recommendations shall 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 shall be
given when additional action is necessary to resolve the matter at issue.
Compliance shall be required, via the JFS 04068 "Order of
Compliance Notice," (rev.
1/2015), 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, shall indicate adoption or
amendment of the hearing officer's recommendations, whether each issue is
sustained or overruled, and whether compliance is required.
(E)Notification
(1)The individual
and authorized representative shall be provided with the written state hearing
decision via the JFS 04005. The decision shall provide notice of the right to and
the method of obtaining an administrative appeal. A copy of the decision shall
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
shall 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 shall 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, shall
constitute the exclusive record. The hearing record shall 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 shall be provided a
copy upon request as well.
(G)Library of
decisions
The chief of the bureau of state hearings shall maintain a
library of all state hearing decisions. The decisions shall be available for
public inspection and copying, subject to applicable disclosure safeguards.
(H)Binding effect
State hearing decisions shall be binding on the agency or
managed care plan or "MyCare Ohio" plan for the individual case for
which the decision was rendered.
Effective: 4/1/2023
Five Year Review (FYR) Dates: 11/30/2022 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, 5164.758, 5167.13
Prior Effective Dates: 07/01/1976, 07/01/1979, 06/01/1980,
06/02/1980, 09/19/1980, 10/01/1981, 05/01/1982, 05/02/1982, 10/01/1982,
07/01/1983, 11/01/1983 (Temp.), 01/01/1984, 10/01/1984 (Emer.), 11/15/1984
(Emer.), 02/01/1985 (Emer.), 02/04/1985, 05/02/1985, 07/30/1985, 04/01/1987,
10/14/1988 (Emer.), 12/22/1988, 04/01/1989, 11/01/1989 (Emer.), 01/29/1990,
10/01/1991, 06/01/1993, 06/01/1997, 10/01/1997 (Emer.), 12/30/1997, 05/15/1999,
04/01/2000, 06/01/2003, 09/29/2006 (Emer.), 12/18/2006, 09/01/2008, 08/01/2010,
02/28/2014, 01/01/2018