(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 assistance 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 assistance 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 assistance 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 February 28, 2014July 1,
2017) 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, 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 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. 3/20031/2015).
(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, 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 assistance 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 "State Hearing Compliance" (rev. 5/2001)"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 action or lack of action by 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 unit within ODJFS administering theOhio department of medicaid managed
care program.
(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: 1/1/2018
Five Year Review (FYR) Dates: 10/17/2017 and 01/01/2023
Certification: CERTIFIED ELECTRONICALLY
Date: 12/22/2017
Promulgated Under: 119.03
Statutory Authority: 5101.35, 3125.25
Rule Amplifies: 3125.25, 5167.13, 5164.758, 5160.011, 5101.35
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