(A)The following definitions
apply to rules 5101:6-50-01 to 5101:6-50-09 of the Administrative Code.
(1)"Affected
party" means a person whose interests are subject to an adjudication by ODJFS,
including providers and licensees.
(2)"Appellant"
means an affected party who has requested an adjudication hearing pursuant to Chapter
119. of the Revised Code.
(3)"Contract"
means any agreement through which ODJFS purchases goods or services from a vendor.
(4)"Department"
means the Ohio department of job and family services.
(5)"Depository
agent" means the office of legal and acquisition services
of ODJFS and its official mailing address for the purpose of receiving correspondence
or filings for any hearing held under authority of Chapter 5101:6-50 of the Administrative
Code.
(6)"Director"
means the director of ODJFS or the director's designee.
(7)"Final fiscal audit" means a medicaid
report of examination or a medicaid final settlement or a medicaid hospital final
settlement, including a final settlement in which Title V monies are offset against
medicaid monies proposed for adjudication by ODJFS.
(8)(7) "Grant" means an award of funds by ODJFS
to a public agency or private nonprofit corporationscorporation that does not include the purchase or lease
of services, materials, or supplies for ODJFS.
(9)(8) "Hearing" means a hearing held by ODJFS
in compliance with sections 119.06 to 119.13 of the Revised Code.
(10)(9)"Last known address" means
the most recent mailing address reported to ODJFS by the person in compliance with
requirements to provide the person's address.
(11)(10)"License" means any license,
permit, certificate, commission, or charter issued by ODJFS. License does not include
any arrangement whereby a person, institution, or entity furnishes medicaid services
under a provider agreement with ODJFS.
(12)(11)"Licensee" means any person,
institution, or entity, governmental or non-governmental, that furnishes services
under a license issued by ODJFS pursuant to statute.
(13)(12)"ODJFS" means the Ohio department
of job and family services.
(14)(13)"Order" means any final adjudication
of facts, issues, or amounts in controversy in any hearing conducted under the authority
of Chapter 5101:6-50 of the Administrative Code before ODJFS and any final disposition
or directive of the director regarding the rights, duties, privileges, benefits,
legal relationships, jurisdictional status, or standing of any affected party or
appellant.
(15)(14)"Person" means an individual,
a firm, a corporation, an association, an institution, a partnership, or an entity.
(16) "Provider" means any person, governmental
or non-governmental, that furnishes medicaid services under a provider agreement
with ODJFS.
(17) "Provider agreement" means a contract
between ODJFS and a person who provides medical services and supplies pursuant to
rules contained in division 5101:3 of the Administrative Code.
(B)Application of
procedures contained in Chapter 5101:6-50 of the Administrative Code
Chapter 5101:6-50 of the Administrative Code prescribes the procedures
to be followed in all hearings held before ODJFS pursuant to sections 119.06 to
119.13, 5103.03, 5103.12,and
5104.04, and 5164.38 of the Revised Code. The provisions
of Chapter 5101:6-50 of the Administrative Code are to be interpreted and construed
to achieve their general purpose of providing orderly and fair procedures for conducting
hearings before ODJFS. Section 1.14 of the Revised Code controls the computing of
time deadlines referenced in Chapter 5101:6-50 of the Administrative Code.
(C)Actions that do
not provide hearing rights under this chapter
Unless otherwise noted, Chapter 5101:6-50 of the Administrative Code
does not apply to circumstances that include, but are not limited to, the following:
(1)Acts of the director
or other officers of ODJFS that are ministerial in nature.
(2)Actions of ODJFS
that are subject to hearings under an administrative review procedure other than
the review provided by Chapter 119. of the Revised Code.
(3)Denial, termination, suspension, conversion,
or non-renewal of a provider agreement exempted from the hearing procedures of Chapter
119. of the Revised Code by division (D) of section 5164.38 of the Revised Code,
or by paragraph (A) of rule 5160-1-57 of the Administrative Code.
(4)Rate calculations, interim settlements,
overpayments, duplicate payments, payments for services not rendered, denied claims,
and claim adjustments that may be reconsidered by the appropriate ODJFS staff upon
written request by the affected provider to the deputy director of the office of
ODJFS where the contestation arose as set forth in paragraph (B) of rule 5160-1-57
of the Administrative Code or as set forth in rule 5160-2-07.12 or 5160-2-40 of
the Administrative Code.
(5)Reviews, notices of operational deficiency,
requests for records, and audits that do not result in an adjudication order as
provided in rule 5160-1-27 of the Administrative Code.
(6)(3) Actions involving in-home aides pursuant to Chapter
5104. of the Revised Code.
(7)(4) Hearings, authorized by section 5101.35 of the
Revised Code and rules in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code,
provided to applicants for, or recipients of, benefits under Ohio works first; prevention,
retention or contingency program; temporary assistance for needy families; food
assistance; medicaid; social services; adoptions; disability financial assistance;
residential state supplement payments; Titles IV-A, IV-B, IV-D, IV-E, XIX, XX, or
XXI of the Social Security Act (as in effect on 2/28/1410/1/2018), 49 Stat. 620 or other assistance programs; who
are aggrieved because of the actions of ODJFS, other state agencies, or of a county
department of job and family services, child support enforcement agency, public
children services agency, or other county agencies.
(8)(5) Except as provided in paragraph (D) of this rule,
disputes involving a Title XX social services contract entered into between ODJFS
or a county department of job and family services, public children services agency,
or child support enforcement agency and a contractor of services.
(9)(6) Personnel action appeals of employees of ODJFS
or of a county department of job and family services, public children services agency,
or child support enforcement agency.
(10)(7)Disputes involving the issuance, denial,
or termination of a contract, a grant, or an interagency agreement issued by ODJFS
or a protest filed with regard to a request for proposals issued by ODJFS.
(11)(8)Administrative actions taken by ODJFS
that involve program administration and funding affecting county departments of
job and family services, public children services agencies, or child support enforcement
agencies.
(12)(9)Appeals and disputes arising out of any
actions under section 5101.20, 5101.201, 5101.21, 5101.213, 5101.216, 5101.22, 5101.221,
5101.24, 5101.241, or 5101.242 of the Revised Code.
(13)(10)Actions and disputes involving the use
or access to funds administered under the Workforce Investment Act of 1998, 112
Stat. 936, 239 U.S.C.A. 2801, the Wagner-Peyser Act, 48 Stat. 113 (1933), 29 U.S.C.A.
49, and Chapters 4141. and 6301. of the Revised Code, or any other funds for which
the United States department of labor is responsible for direct or indirect oversight.
(D)Actions that provide
hearing rights under this chapter
Except as provided in paragraph (C) of this rule, those actions of
ODJFS that afford the right to a hearing pursuant to ODJFS authority provided in
Chapter 119. of the Revised Code include the proposal of the director to do the
following:
(1)Enter into or refuse to enter into a provider
agreement with a provider, or suspend, terminate, renew, or refuse to renew an existing
provider agreement, under circumstances where ODJFS is required by section 5164.38
of the Revised Code to issue an adjudication order in accordance with Chapter 119.
of the Revised Code.
(2)Take any action based upon a final fiscal
audit.
(3)(1) Refuse to issue a license, whether it is a renewal or a new license, unless a hearing
was held before the refusal to issue such license.
(4)(2) Suspend or revoke a license.
(5)(3) Require a person to obtain a license when the
person claims that the law does not impose such a requirement, except when ODJFS
pursues injunctive relief through division (H) of section 5104.04 of the Revised
Code.
(6)(4) Terminate, refuse to enter into, or refuse to
renew an agreement with a public children services agency or private child placing
agency under section 5103.12 of the Revised Code.
(E)See rule 5160-1-57 of the Administrative
Code for additional provisions specific to hearing rights of providers from proposed
actions of ODJFS to deny, terminate, or not renew a provider agreement.
(F)See Chapter 5101:6-51 of the Administrative
Code for additional provisions specific to hearing rights of providers from actions
taken pursuant to section 5164.58 of the Revised Code by state agencies under contract
with ODJFS.
Effective: 1/1/2019
Five Year Review (FYR) Dates: 10/3/2018 and 01/01/2024
Certification: CERTIFIED ELECTRONICALLY
Date: 12/10/2018
Promulgated Under: 119.03
Statutory Authority: 5161.02, 5101.02
Rule Amplifies: 119.06, 119.07, 119.09, 5101.24, 5103.03, 5103.12,
5104.03, 5104.04, 5164.02
Prior Effective Dates: 01/01/1983, 01/10/1987, 10/01/1987, 12/01/1987
(Emer.), 02/16/1988, 02/01/1999, 04/01/2004, 10/01/2008, 02/28/2014