This letter transmits ten amended rules for state hearings conducted by the Ohio Department of Job and Family Services (ODJFS) under Chapters 5101:6-1 to 5101:6-9 of the Ohio Administrative Code. The rules are effective August 1, 2010.

Rule 5101:6-1-01, entitled "State hearings - general," sets forth definitions and general provisions for state hearings. This rule was amended to update definitions and terminology. Changes to the rule include adding "a private or government entity administering, in whole or in part, a family services program" to the definition of "local agency," and updating terminology, such as changing "food stamps" to "food assistance."

Rule 5101:6-2-06, entitled "Notice of mass change in benefits," sets forth the changes in benefits to recipients of services from programs under the Ohio Department of Job and Family Services for which prior written notice of the changes is required, and sets forth the requirements for the content of the notice. This rule was amended to clarify and update policy. Changes to the rule include changing the title of the rule; adding clarifying language in regard to the notice for an adjustment in benefits, other than food assistance, due to a change in local agency policy; and inserting a reference to federal regulations in regard to the notice for a mass change in the food assistance program.

Rule 5101:6-2-35, entitled "Notice of a managed care plan's denial, reduction, suspension, or termination of a medical service," sets forth the hearing rights and requirements for notification regarding a Medicaid managed care plan's denial, reduction, suspension, or termination of a medical service. This rule was amended to update policy concerning notices to members of Medicaid managed care plans (defined in rule 5101:3-26-01 of the Administrative Code). There are two changes to the rule. The first change is removing the language that the managed care plan send to the unit within the Ohio Department of Job and Family Services administering the Medicaid managed care program, a copy of all notices of denial, reduction, suspension, and termination that the managed care plan sends to members of the managed care plan. That language is being removed because it is in rule 5101:3-26-08.4, and, therefore, is not needed in rule 5101:6-2-35. The second change is requiring the managed care plan to mail to the enrollee a notice of denial of payment whenever the provider is billing an enrollee for a service due to denial of payment by the managed care plan.

Rule 5101:6-2-37, entitled "Notices of enrollment, continued enrollment, or provider change denial for the managed care plan controlled substances and member management program," requires a Medicaid managed care plan to provide written notification and hearing rights when it enrolls an individual in the controlled substances and member management (CSMM) program, determines that enrollment for an individual already in the CSMM program should continue, or denies an individual's request for a change in that individual's designated provider. This rule was amended to update policy concerning notices to members of the CSMM program (defined in rule 5101:3-26-01 of the Administrative Code). There are two changes to the rule. The first change is removing the language that the managed care plan send to the unit within the Ohio Department of Job and Family Services administering the Medicaid managed care program, a copy of all notices of enrollment, continued enrollment, or provider change denial that the managed care plan sends to members of the managed care plan. That language is being removed because it is in rule 5101:3-26-08.4, and, therefore, is not needed in rule 5101:6-2-37. The second change is updating the revision dates for ODJFS forms referenced in the rule.

Rule 5101:6-3-01, entitled "Grounds for requesting a state hearing," sets forth the reasons an applicant for, or recipient of, services from programs administered by the Ohio Department of Job and Family Services, may request a state hearing. This rule was amended to clarify existing policy. Changes to the rule include rearrangement of existing rule content to enhance readability.

Rule 5101:6-3-02, entitled "State hearing requests," sets forth requirements concerning the method for requesting state hearings and the time limit for requests. This rule was amended to update terminology within the rule. The only changes to the rule are changes to update terminology, such as changing "food stamp" to "food assistance."

Rule 5101:6-4-01, entitled "Continuation of benefits when a state hearing is requested," sets forth the conditions where benefits will continue until a state hearing decision is rendered for a proposed adverse action. This rule was amended to update terminology and clarify policy relating to the administration of state hearings. Changes to the rule include changing "food stamp" to "food assistance," clarifying the definition of "reinstatement of benefits to the previous level" and clarifying the responsibilities of the bureau of state hearings and local agency in regard to the reinstatement of benefits, and clarifying the responsibilities of the child support enforcement agency (CSEA) while a state hearing decision is pending.

Rule 5101:6-5-01, entitled "Procedures prior to the state hearing," sets forth procedures that are to be carried out before the scheduled state hearing, including, but not limited to, hearing requests made to the bureau of state hearings; the local agency or medical determination unit preparing an appeal summary; the local agency arranging a county conference; the client and local agency being granted the right to legal representation at the state hearing; and the client with limited proficiency in English granted the right to request and have an interpreter at the hearing and to request and have translation of the written hearing decision. This rule was amended to clarify existing policy and to update the policy on county conferences relative to the appeal and grievance process for Medicaid managed care plans. Changes to the rule include rearranging existing rule content to enhance readability and adding the provision that, for a Medicaid managed care plan, the managed care plan appeal or grievance process substitutes for the county conference requirement.

Rule 5101:6-5-03, entitled "Denial and dismissal of state hearing requests," sets forth the reasons a request for a state hearing may be denied or dismissed, the time frame during which a request may be denied or dismissed, and the requirements for proper notice of the denial or dismissal. This rule was amended to update terminology within the rule. The only changes to the rule are changes to update terminology, such as changing "food stamp" to "food assistance," and updating the revision date of a JFS form cited in the rule.

Rule 5101:6-7-01, entitled "State hearing decisions," sets forth the responsibilities of the hearing authority, the time frame in which hearing decisions are required to be issued, the content of the hearing decision, notification to the person requesting the hearing, retention of the hearing record, and the binding effect of a hearing decision. This rule was amended to add an expedited hearing provision for state hearings that involve a Medicaid managed care plan. Changes to the rule include clarifying that the chief of the bureau of state hearings is a hearing authority; and adding that hearing decisions are required to be issued three working days from the date of the hearing request when the hearing request is from an enrollee of a Medicaid managed care plan; the enrollee, or the enrollee's authorized representative, claims that the request requires an expedited resolution; and the Bureau of State Hearings, Ohio Department of Job and Family Services, agrees that an expedited resolution is required.

Instructions: