In order to comply with federal requirements that afford individuals the right to a state hearing when their request to terminate managed care plan membership for just cause has been denied, we are proposing to adopt a new rule, OAC rule 5101:6-2-36, and create a new notice, the JFS 01711, to be used for this type of denial. In addition to the creation of this new rule and form, a corresponding change has been made to the rule that identifies all of the grounds for requesting a state hearing.

Also included in the grounds for requesting a state hearing, is the right for a consumer to appeal a county board of mental retardation and developmental disabilities' decision regarding choice of provider. Section 5126.046(C) of the Revised Code includes a provision for appeal if a consumer determines that a county board that has Medicaid local administrative authority under division (A) of section 5126.055 of the Revised Code for home and community-based services violated the right established by this section of an individual to choose a provider that is qualified and willing to provide services to the individual.

The attached rules have been final filed, and will be effective May 31, 2004.

INSTRUCTIONS:

In Chapter 1000, State Hearings, please do the following:

Please remove and file as obsolete, OAC rule 5101:6-3-01, Grounds for requesting a state hearing, dated June 1, 2003, and replace with the corresponding rule to be effective May 31, 2004. (OAC 5101:6-3-01)

Please insert OAC rule 5101:6-2-36 effective to be effective May 31, 2004 immediately following OAC rule 5101:6-2-35.

Please remove the Table of Contents for the Appendix of the State Hearing Manual and replace with the corresponding Table of Contents

Please insert the JFS, 01711 in the Appendix of the State Hearing manual immediately following the State Hearing Scheduling Notice