Chapter 5101:6-2 Notice

5101:6-2-01 State hearings: notice at the time of application.

(A) At the time of application for benefits, the assistance group shall be informed, in writing, of the right to a state hearing, of the method by which a state hearing may be requested, and that the case may be presented by the assistance group or by an authorized representative, such as legal counsel, relative, friend, or other spokesperson.

(B) JFS 04059 "Explanation of State Hearing Procedures" (rev. 10/2008), or its computer-generated equivalent, shall be used to provide this notice.

(C) If the assistance group making a food assistance application speaks a language other than English, and if the local agency is required by rule 5101:4-1-05 of the Administrative Code to provide bilingual staff or interpreters who speak the appropriate language, the local agency shall ensure that the hearing procedures are explained verbally in that language. If an oral explanation is provided in a language other than English, it should be noted in the case record comments. If a translated written explanation is provided in another language, in addition to noting that in the case record, a copy of the explanation should be maintained in the hard copy record.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3125.25 , 5101.35
Rule Amplifies: 3125.25 , 5101.35 , 5160.011
Prior Effective Dates: 9/1/76, 4/1/80, 6/2/80, 9/19/80, 10/1/81, 5/1/82, 10/1/82, 4/1/83, 11/1/83 (Temp), 1/1/84, 3/1/84 (Temp), 6/1/84, 10/3/84 (Temp), 12/22/84, 4/1/87, 6/1/93, 6/1/03, 9/1/08

5101:6-2-02 State hearings: notice of approval of an application for benefits.

(A) When the agency approves an application for public assistance or social services, the assistance group shall be provided prompt written notice of the decision.

(1) The notice shall contain a clear and understandable statement of the action the agency has taken and the reasons for it, including the beginning date of aid and the amount of all benefits authorized, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a county conference and a state hearing, and contain a telephone number to call about free legal services.

(2) JFS 04074 "Notice of Approval of Your Application for Assistance" (rev. 9/2011), or the Ohio department of job and family services (ODJFS) computer-generated approval notice, shall be used.

(B) When the agency approves an application or reapplication for food assistance benefits, the assistance group shall be provided written notice of the decision.

(1) The ODJFS computer-generated approval notices are the only notices that may be used for approval of applications and reapplications for food assistance benefits. When the agency approves an application or reapplication for food assistance benefits, the JFS 04074, any version shall not be used.

(2) Timing of the notice shall be in accordance with rule 5101:4-5-07 of the Administrative Code.

(3) The notice shall contain a clear and understandable statement of the action the agency has taken, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a county conference and a state hearing, and contain the name and telephone number of the person to contact for more information and a telephone number to call about free legal services.

The notice shall include the amount of the allotment, the beginning and ending dates of the certification period, and any variations in the benefit level based on changes anticipated at the time of certification.

If the initial allotment contains both benefits for the month of application and the current month's benefits, the notice shall explain that the initial allotment includes more than one month's benefits, and shall indicate the monthly allotment for the remainder of the certification period.

(4) The agency may include with the notice a reminder of the assistance group's obligation to report changes in circumstances and the need to reapply for continued participation at the end of the certification period. Other information that may be useful to the assistance group also may be included.

(5) When an assistance group's application is approved on an expedited basis without verification, as provided in rule 5101:4-6-09 of the Administrative Code, the notice shall be accompanied by an explanation that the assistance group must provide the verification that was waived.

(6) If the agency has elected to assign a longer certification period to an assistance group certified on an expedited basis, the notice shall also be accompanied by an explanation of the special conditions of the longer certification period, as specified in rule 5101:4-6-09 of the Administrative Code.

(7) For assistance groups provided a notice of expiration at the time of certification, as required by rule 5101:4-7-07 of the Administrative Code, the notice of eligibility shall be accompanied by a notice of expiration.

(8) JFS 07401 "Notice of Pending Food Assistance Application" (rev. 6/2013), or its computer-generated equivalent, shall be used.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3125.25 , 5101.35
Rule Amplifies: 3125.25 , 5101.35 , 5160.011
Prior Effective Dates: 6/2/80, 4/1/87, 4/1/89, 6/1/93, 6/1/03, 12/15/08

5101:6-2-03 State hearings: notice of denial of an application for benefits.

(A) When the agency denies an application for or a requested change in public assistance or social services, the assistance group shall be provided prompt written notice of the decision.

(1) The notice shall contain a clear and understandable statement of the action the agency has taken and the reasons for it, cite the applicable regulations, explain the individual's right to and the method of obtaining a county conference and a state hearing, and contain a telephone number to call about free legal services.

(2) JFS 07334 "Notice of Denial of Your Application for Assistance" (rev. 9/2011), or the Ohio department of job and family services (ODJFS) computer-generated denial notice, shall be used.

(B) When the agency denies an application or reapplication for or a requested change in food assistance benefits, the assistance group shall be provided written notice of the decision.

(1) The ODJFS computer-generated denial notices are the only notices that may be used for denial of applications for food assistance benefits.

(2) Timing of the notice shall be in accordance with rule 5101:4-5-07 of the Administrative Code.

(3) The notice shall contain a clear and understandable statement of the action the agency has taken and the reasons for it, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a county conference and a state hearing, and contain the name and telephone number of the person to contact for more information and a telephone number to call about free legal services.

(4) When the denial is caused by the assistance group's failure to take action to complete the application process, as described in rule 5101:4-5-07 of the Administrative Code, the notice shall also explain what action the assistance group must take to reactivate the application, that the case will be reopened without a new application if action is taken within thirty days of the mailing date of the denial notice, and that the assistance group must submit a new application if, at the end of the thirty-day period, the assistance group has not taken the needed action and wishes to participate in the program.

(5) When the agency is at fault for not completing the application process by the end of the second thirty-day period, but the case file is not complete enough to reach an eligibility determination, if the agency chooses to deny the case, the notice of denial shall be accompanied by notification to the assistance group to file a new application and of its possible entitlement to benefits lost as a result of agency delay.

(6) See rule 5101:4-2-02 of the Administrative Code for additional information that must accompany notice of denial for assistance groups with actual or potential categorical eligibility.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3125.25 , 5101.35
Rule Amplifies: 3125.25 , 5101.35 , 5160.011
Prior Effective Dates: 6/2/80, 4/1/87, 4/1/89, 6/1/93, 6/1/03, 12/15/08

5101:6-2-04 State hearings: prior notice of adverse action.

When the agency intends to withhold, reduce, suspend, or terminate public assistance, social services, or food assistance within the certification period, or to change the manner or form of assistance to protective, vendor, or two-party payment, the assistance group shall be provided prior written notice of the action.

(A) The notice shall be mailed or personally delivered no less than fifteen calendar days prior to the effective date of the proposed action.

(B) The notice shall contain a clear and understandable statement of the proposed action and the reasons for it, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a county conference and a state hearing, explain the circumstances under which a timely hearing request will result in continued benefits, and contain a telephone number to call about free legal services.

(C) JFS 04065 "Prior Notice of Right to a State Hearing" (rev. 5/2001), or its computer-generated equivalent, shall be used.

(D) If a change in the assistance group's circumstances requires reduction or termination of both public assistance and food assistance benefits, the agency shall issue a single notice for both public assistance and food assistance actions.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3125.25 , 5101.35
Rule Amplifies: 3125.25 , 5101.35 , 5160.011
Prior Effective Dates: 9/1/76, 4/1/80, 6/2/80, 12/1/80, 10/1/81, 1/18/82, 5/1/82, 7/1/82, 10/1/82, 1/1/83, 4/1/83, 8/1/83, 11/1/83 (Temp), 1/1/84, 3/1/84 (Temp), 6/1/84, 10/1/84 (Temp), 10/3/84 (Emer), 12/22/84, 8/20/86 (Emer), 11/15/86, 1/16/87 (Emer), 4/1/87, 4/6/87, 7/1/87 (Emer), 9/27/87, 4/1/89, 11/1/90, 6/1/93, 6/1/03, 9/1/08

5101:6-2-05 State hearings: exceptions to prior notice.

(A) Public assistance and social services

(1) Under the following circumstances, prior notice of adverse action is not required, but the assistance group shall be provided written notice on or before the effective date of the action and the agencies are not required to continue fair hearing benefits.

(a) The agency has factual information confirming the death of an individual, or of the payee when there is no relative available to serve as a new payee.

(b) The agency receives a clear, written statement, signed by the individual, that he or she no longer wishes to receive benefits, or that gives information that requires reduction or termination, and indicates that the individual understands that this must be the consequence of supplying the information.

In no way does this exception permit the preparation of any type of blanket statement to be signed at the time of application or at any other time that would allow the agency to take action at some future date without providing prior notice.

(c) The agency determines, based on reliable information, that the individual has been admitted or committed to an institution where he or she is ineligible for further benefits.

(d) The agency determines, based on reliable information, that the individual has been placed in skilled nursing care, intermediate care, or long-term hospitalization where he or she is ineligible for further benefits.

(e) The assistance group's whereabouts are unknown and agency mail directed to the assistance group has been returned by the post office indicating no known forwarding address.

However, the assistance group's benefit must be made available if the assistance group's whereabouts become known during the period covered by the returned benefit.

(f) The agency determines, based on reliable information, that the assistance group has moved to another state.

(g) A child is removed from the home as a result of a judicial determination or is voluntarily placed in foster care by the child's legal guardian.

(h) A special allowance, or supportive service, granted for a specific period is terminated at the end of the specified period. The assistance group must be informed, in writing, when the allowance is initiated, of the exact date upon which the allowance will automatically terminate.

(2) The notice shall contain a clear and understandable statement of the action being taken and the reasons for it, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a county conference and a state hearing, explain the circumstances under which a timely hearing request will result in reinstated benefits, and contain a telephone number to call about free legal services.

(3) JFS 04085 "Prior Notice of Right to a State Hearing (Adequate Notice)" (rev. 5/2001), or its computer-generated equivalent, shall be used.

(B) Food assistance

Under the following circumstances, individual notices of adverse action shall not be provided.

(1) The agency determines, based on reliable information, that all members of the assistance group have died.

(2) The agency determines, based on reliable information, that the assistance group has moved from the county.

(3) The assistance group has been receiving an increased allotment to restore lost benefits, the restoration is complete, and the assistance group was previously notified in writing of when the increased allotment would terminate.

(4) The assistance group jointly applied for public assistance and food assistance benefits, has been receiving food assistance benefits pending the approval of the public assistance grant, and was notified in writing at the time of certification that food assistance benefits would be reduced upon approval of the public assistance grant.

(5) An assistance group member is disqualified for intentional program violation in accordance with rule 5101:4-8-15 of the Administrative Code, or the benefits of the remaining assistance group members are reduced or terminated to reflect the disqualification of that assistance group member.

(6) The agency has elected to assign a longer certification period to an assistance group which was certified on an expedited basis and for whom verification was postponed, under the provisions of rule 5101:4-6-09 of the Administrative Code.

The assistance group must have received written notice that the receipt of future benefits is contingent on its providing the verification that was initially postponed and that the agency may act on the verified information without further notice.

(7) The assistance group is converted from cash and/or food assistance electronic benefit transfer (EBT) benefit repayment to allotment reduction as a result of failure to make agreed upon repayment of an overissuance.

(8) The agency is terminating the eligibility of a resident of a drug or alcohol treatment center or a group living arrangement if the facility loses either its certification from the appropriate agency or agencies of the state of Ohio, as defined in rule 5101:4-6-01 of the Administrative Code, or has its status as an authorized representative suspended due to food and nutrition services (FNS) disqualifying it as a retailer.

(9) The assistance group voluntarily requests, in writing or in the presence of a caseworker, that its participation be terminated. If the assistance group does not provide a written request, the agency shall send the assistance group a letter confirming the voluntary withdrawal. Written confirmation does not entail the same rights as a notice of adverse action except that the assistance group may request a state hearing.

(10) The agency determines, based on reliable information, that the assistance group will not be residing in the county and, therefore, will be unable to obtain its next allotment. The agency shall inform the assistance group of its termination no later than its next scheduled issuance date. While the agency may inform the assistance group before its next issuance date, the agency shall not delay terminating the assistance group's participation in order to provide advance notice.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 9/1/76, 4/1/80, 6/2/80, 12/1/80, 10/1/81, 1/18/82, 5/1/82, 7/1/82, 10/1/82, 1/1/83, 4/1/83, 8/1/83, 11/1/83 (Temp), 1/1/84, 3/1/84 (Temp), 6/1/84, 10/1/84 (Emer), 10/3/84 (Emer), 12/22/84, 8/20/86 (Emer), 11/15/86, 4/1/87, 1/16/87 (Emer), 4/6/87, 7/1/87 (Emer), 9/28/87, 5/1/88, 11/1/87, 4/1/89, 11/1/90, 6/1/93, 5/15/99, 6/1/03, 9/1/08

5101:6-2-06 State hearings: notice of mass change in benefits.

(A) When a change in state law, federal law, or local agency policy adopted pursuant to options authorized in state law requires automatic adjustment of benefits , the assistance group shall be provided prior written notice of the action. The exception to this rule is some classes of food assistance recipients for which federal law does not require notification.

(1) The notice shall be mailed or personally delivered no less than fifteen calendar days prior to the processing of the action.

(2) The notice shall contain a clear and understandable statement of the proposed action and the reasons for it, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a county conference and a state hearing, explain the circumstances under which a timely hearing request will result in continued benefits, and contain a telephone number to call about free legal services.

(3) When a change in state or federal law requires such an adjustment statewide, the JFS 04025 "Important Notice about your Welfare Benefits" (rev. 5/2001), its computer-generated equivalent, or other notice specifically developed and designated by the Ohio department of job and family services (ODJFS), shall be used. Local agencies shall receive instructions concerning notice prior to implementation of the change.

(4) When a change in local agency policy requires such an adjustment, the local agency is responsible for developing the content of the notice, in accordance with paragraph (A)(2) of this rule. The language under "Your Right to a State Hearing" contained on the JFS 04025 must be duplicated exactly on any such local agency notice regarding a policy change that could be misapplied to individual circumstances, in accordance with paragraph (A) of rule 5101:6-3-01 of the Administrative Code.

(B) When a change in state or federal law or policy requires a mass change in the food assistance program, as described in rule 5101:4-7-03 of the Administrative Code, the assistance group shall be provided notice of the action as prescribed by state hearings in accordance with 7 C.F.R. 273.12 (effective January 1, 2013).

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 9/1/76, 4/1/80, 6/2/80, 4/1/81, 10/1/81, 5/1/82, 10/1/82, 4/1/83, 9/24/83, 11/1/83 (Temp), 3/1/84 (Temp), 10/3/84 (Emer), 12/22/84, 8/16/85 (Emer), 1/1/86, 8/20/86 (Emer), 11/15/86, 4/10/87 (Emer), 6/22/87, 4/1/89, 11/1/90, 2/1/92, 6/1/93, 6/1/03, 9/1/08, 8/1/10

5101:6-2-07 State hearings: notice of the right to a state hearing - child support services.

(A) Notice at the time of application

(1) Public assistance recipients shall be informed, in writing, of the right to a state hearing. Notification shall be mailed or personally delivered within five workdays of the date of receipt of a referral made by the public assistance agency to the child support enforcement agency (CSEA).

(2) Individuals who are not public assistance recipients who request child support services shall be informed, in writing, of the right to a state hearing. Notification shall be mailed or personally delivered at the time an application is provided to the individual.

(3) JFS 04059 "Explanation of State Hearing Procedures" (rev. 10/2008), shall be used.

(B) Notice of acceptance or denial

(1) Within twenty calendar days of receipt of a non-public assistance application for child support services, the CSEA shall notify the applicant of acceptance or denial of the application.

(2) JFS 07647 "Notice of Case Status Application" (rev. 4/1996), shall be used.

(C) Notice of termination of a support order

(1) When the CSEA has determined, after notification by one of the parties, that reason exists to terminate a support order, the CSEA shall notify the other party of that determination.

(2) When the CSEA alone has determined that reason exists to terminate a support order, the CSEA shall notify both parties of that determination.

(3) The notification shall include the date and reason for the termination and shall be accompanied by JFS 04059 .

(D) Notice of case closure

(1) The CSEA shall notify the recipient of child support services in writing at least sixty calendar days prior to taking administrative action to close the child support case.

(2) JFS 07647 , shall be used to provide notification of case closure.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3125.25 , 5101.35
Rule Amplifies: 3125.25 , 5101.35
Prior Effective Dates: 10/1/91, 6/1/93, 6/1/03, 9/1/08

5101:6-2-08 State hearings: notice whenever disagreement with an action or inaction is expressed.

(A) Whenever an assistance group expresses disagreement with an agency action or lack of action, the agency shall remind the assistance group of the right to request a state hearing via JFS 04059 "Explanation of Hearing Procedures" (rev. 10/2008). The published hearing rules shall also be made available upon request.

(B) When denial or termination of benefits is the action with which the assistance group has expressed disagreement, a reapplication for benefits as well as a hearing request may be appropriate.

(C) The provisions of this rule do not apply to county public children services agencies (PCSAs) except insofar as the action or inaction complained of involves programs to which state hearing rights apply, in accordance with rules 5101:6-1-01 and 5101:6-3-01 of the Administrative Code.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 4/1/87, 6/1/93, 6/1/03, 9/1/08

5101:6-2-09 Supplemental sanction notice. [Rescinded].

Rescinded eff 9-1-08

5101:6-2-20 State hearings: notice of overpayment/overissuance.

(A) When the local agency has determined that a cash benefit overpayment has occurred, responsible parties from whom repayment is being sought shall be provided written notice of the overpayment determination.

Notice is also required whenever a previous overpayment determination is revised to change the amount or period of the overpayment.

(1) The notice shall contain a clear and understandable statement of the determination and the reasons for it, including the amount and period of the overpayment and any offsetting done to reduce it, cite the applicable regulations, explain the available methods of repayment and the individual's right to and the method of obtaining a county conference and a state hearing, unless there has already been a state hearing on the issue, and contain a telephone number to call about free legal services.

(2) The benefit recovery notices, created and maintained by the Ohio department of job and family services and issued through the eligibility system, shall be used.

(B) When the agency has determined that a food assistance overissuance has occurred, assistance groups from which repayment is being sought shall be provided written notice of the overissuance determination.

Notice is also required whenever a previous overissuance determination is revised to change the amount or period of the overissuance or to change the claim type from administrative error (AE) to inadvertent household error (IHE).

(1) The notice shall contain a clear and understandable statement of the determination and the reasons for it, including the amount and period of the overissuance and any offsetting done to reduce it, cite the applicable regulations, explain the available methods of repayment and the assistance group's right to and the method of obtaining a county conference and a state hearing, unless there has already been a state hearing on the issue, and contain the name and telephone number of the person to contact for more information and a telephone number to call about free legal services.

(a) A clear and understandable statement of the determination and the reasons for it, including the amount and period of the overpayment.

(b) A statement of how the claim was calculated, including any offsetting done to reduce the overpayment.

(c) A statement expressing the intent to collect from all adults in the assistance group when the overpayment occurred.

(d) A statement providing an opportunity to inspect and copy records related to the claim.

(e) An explanation of the available methods of repayment.

(f) A statement explaining that if the claim is not paid, it will be sent to other collection agencies who will use various collection methods.

(g) A statement explaining that, if not paid, the claim will be referred to the federal government for federal collection action.

(h) A statement explaining that if the claim becomes delinquent the assistance group may be subject to additional processing charges.

(i) The name and telephone number of a person to contact for more information.

(2) For inadvertent household error, administrative error and intentional program violation claims, the assistance group shall also be informed of the length of time it has to choose a method of repayment and notify the agency of its decision, and that its allotment will be reduced if it fails to agree to make restitution. For administrative error claims, the assistance group shall also be informed of the availability of allotment reduction as a method of repayment if the assistance group prefers to use this method.

(3) The notice shall provide space for the assistance group to indicate the method of repayment, a signature block, and an explanation of the assistance group's right to request renegotiation of any repayment schedule to which it has agreed should its economic circumstances change.

(4) JFS 07442 "Food Assistance Repayment Agreement" (rev. 11/2008), or its electronic equivalent shall be used.

(5) Notice is not required when the overissuance involves possible fraud and has been referred to the county prosecutor.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35
Prior Effective Dates: 9/1/76, 4/1/80, 6/2/80, 10/1/81, 5/1/82, 7/1/82, 3/20/83, 4/1/83, 7/1/83 (Temp), 8/1/83, 8/19/83, 9/24/83, 11/1/83 (Temp), 1/1/84, 3/1/84 (Temp), 6/1/84, 10/3/84 (Emer), 12/22/84, 4/1/86, 1/16/87 (Emer), 4/1/87, 4/6/87, 9/1/87, 7/1/88 (Emer), 9/25/88, 4/1/89, 2/1/90, 10/1/90, 6/1/93, 9/1/94, 10/1/96, 10/1/97 (Emer), 12/30/97, 6/1/03, 9/1/08

5101:6-2-25 State hearings: notice of eligibility for lost food assistance benefits.

(A) If the agency determines that a loss of food assistance benefits has occurred and that the assistance group is or may be entitled to restoration of those benefits, the assistance group shall be provided prompt written notice of the agency's determination.

The notice shall contain a clear and understandable statement of the amount and period of the underissuance, any offsetting that was done and the method of restoration, explain the assistance group's right to and the method of obtaining a county conference and a state hearing, contain the name and telephone number of the person to contact for more information, and contain a telephone number to call about free legal services.

(B) If the assistance group claims that it is entitled to restoration of lost benefits but the agency, after reviewing the case file, does not agree, the assistance group shall be provided prompt written notice of the denial of its request.

The notice shall contain a clear and understandable statement of the denial and the reasons for it, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a county conference and a state hearing, contain the name and telephone number of the person to contact for more information, and contain a telephone number to call about free legal services.

(C) Approval and/or denial notices for lost food assistance benefits are generated through the eligibility system.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35
Prior Effective Dates: 6/2/80, 10/1/81, 3/20/83, 7/1/83 (Temp), 8/1/83, 8/19/83, 4/1/84 (Temp), 6/1/84, 1/16/87 (Emer), 4/6/87, 4/1/89, 10/1/90, 6/1/93, 6/1/03, 9/1/08

5101:6-2-26 State hearings: notice of approval, denial or delay of replacement food assistance benefits.

When the agency approves, denies, or delays an assistance group's request for replacement food assistance benefits, the assistance group shall be provided written notice of the action.

(A) The notice shall be mailed or personally delivered no less than ten calendar days from the date the loss was reported, fifteen days if the issuance was made by certified or registered mail, or within two working days after the agency receives the signed JFS 07222, "Statement Requesting Replacement of Food Assistance Benefits," (rev. 3/2010), whichever is later.

If a notice of delay was issued, the agency shall issue an approval or denial notice within two working days from the date it receives the information which caused the delay.

(B) The notice shall contain a clear and understandable statement of the decision and the reasons for it, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a county conference and a state hearing, and contain a telephone number to call about free legal services.

(C) JFS 07235 "Action Taken on Your Request for Replacement of Food Assistance Benefits" (rev. 12/2012), or its computer-generated equivalent, shall be used.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35
Prior Effective Dates: 2/1/95, 6/1/03, 9/1/08

5101:6-2-30 State hearings: notice of medical determination.

(A) JFS 04022 "Notice of Medical Determination and Right to a State Hearing," (rev. 3/2002), or its computer-generated equivalent shall be mailed or personally delivered to the individual and authorized representative in the following situations:

(1) When, as the result of a preadmission review for long-term care, the local agency receives an authorization of a level of care that assigns a noninstitutional level of care, or a level of care that is different from the specific level of care certified by the individual's physician, the local agency shall send notice to the individual and authorized representative, with a copy of the notice filed in the individual's case record.

Notice is not required when the assigned level of care is different from the level of care certified by the individual's physician, but the individual is or will be placed in a facility with dual certification to provide the assigned level of care.

(2) When a request for prior authorization for additional hospital stays, visits, or therapeutic leave days beyond thirty days for a medicaid individual with a developmental disability level of care is denied, the local agency shall send the notice to the individual and authorized representative, with a copy of the notice filed in the individual's case record.

(3) When a review agency denies or modifies a request for precertification of a hospital admission or medical procedure, the review agency shall send the notice to the individual and authorized representative, with a copy of the notice sent to the local agency.

(B) The notice shall contain a clear and understandable statement of the decision and the reasons for it, cite the applicable regulations, explain the individual's right to and the method of obtaining a state hearing, and contain a telephone number to call about free legal services.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 9/1/76, 4/1/80, 10/1/81, 5/1/82, 7/1/82, 4/1/83, 9/24/83, 11/1/83 (Temp), 12/1/83, 1/1/84, 3/1/84 (Temp), 6/1/84, 10/3/84 (Emer), 12/22/84, 4/1/86, 4/1/87, 9/1/87, 7/1/88 (Emer), 9/25/88, 10/1/89, 2/1/90, 4/1/91, 6/1/93, 11/1/94, 6/1/03 , 9/1/08

5101:6-2-31 State hearings: notice of denial of prior authorization for medical or dental services.

When a request for prior authorization for a medical or dental service is denied, the individual and authorized representative shall be provided prompt written notice of the decision. Copies shall also be sent to the provider and to the local agency.

(A) The notice shall contain a clear and understandable statement of the action taken and the reasons for it, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a state hearing, and contain a telephone number to call about free legal services.

(B) A notice describing the denial of authorization for medical services or its computer-generated equivalent shall be used.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 9/1/76, 4/1/80, 10/1/81, 5/1/82, 7/1/82, 4/1/83, 11/1/83
(Temp), 12/1/83, 1/1/84, 3/1/84 (Temp), 6/1/84, 10/3/84 (Emer), 12/22/84, 4/1/86, 4/1/87, 9/1/87, 7/1/88 (Emer), 9/25/88, 10/1/89, 2/1/90, 4/1/91, 6/1/93, 11/1/94, 6/1/03 , 9/1/08

5101:6-2-32 State hearings: notice of adverse preadmission screening and resident review (PASRR) determinations.

(A) Notice of adverse preadmission screening (PAS) determination When an applicant for admission to a nursing facility, or the pre-admission screening system providing options and resources today, (PASSPORT) waiver, receives an adverse determination as the result of a preadmission screening (PAS) performed by the Ohio department of mental health and addiction services ( MHAS) or the Ohio department of developmental disabilities (DODD), MHAS or DODD shall provide the affected individual with written notice of the determination in accordance with rules 5122-21-03 and 5123:2-14-01 of the Administrative Code.

(1) The notice shall be mailed or personally delivered to the individual and his or her legal guardian and/or authorized representative, at the time the adverse determination is made.

(2) The notice shall contain a clear and understandable statement of the determination and the reasons for it, cite the applicable regulations, outline the implications of the decision for admission to the facility or the PASSPORT waiver, explain the individual's right to and the method of obtaining a state hearing, and contain a telephone number to call about free legal services.

(3) Copies of the notice shall be sent to the nursing facility; to the individual's attending physician; to the discharging hospital; to the bureau of community services, Ohio department of job and family services (ODJFS) (or designee); and, if the individual is a medicaid applicant or recipient, to the county department of job and family services (CDJFS).

(B) Notice of adverse resident review (RR) determination When a resident of a nursing facility receives an adverse determination as the result of a resident review (RR) performed by MHAS or DODD , the determining agency shall provide the affected individual with written notice of the determination.

(1) The notice shall be mailed or personally delivered to the individual and his or her legal guardian and/or authorized representative at the time the adverse determination is made.

(2) The notice shall contain a clear and understandable statement of the determination and the reasons for it, cite the applicable regulations, outline the implications of the decision for continued residence in the facility, explain the individual's right to and the method of obtaining a state hearing, and contain a telephone number to call about free legal services.

(3) Copies of the notice shall be sent to the nursing facility; to the individual's attending physician; to the discharging hospital; to the bureau of community services, ODJFS (or designee); and, if the individual is a medicaid applicant or recipient, to the CDJFS.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 6/1/97, 10/1/02, 9/1/08

5101:6-2-35 State hearings: notice of a managed care plan's denial, reduction, suspension, or termination of a medical service.

A managed care plan, as defined in rule 5160-26-01 of the Administrative Code, shall inform an affected individual and any authorized representative of the individual on file with the managed care plan by providing notice of its denial, reduction, suspension, or termination of a medical service, as described in this rule.

(A) Timing of notice

(1) The managed care plan shall mail or personally deliver notice of denial at the time the decision to deny the service is made.

(2) The managed care plan shall mail or personally deliver to the enrollee a notice of denial of payment whenever the provider bills an enrollee for a service due to denial of payment by the managed care plan.

If an enrollee contacts the managed care plan and indicates that he or she has received a bill, and not received proper notice, as required by this rule, and the managed care plan's response is to uphold the denial of payment, the managed care plan shall mail or personally deliver notice at that time.

(3) The managed care plan shall mail or personally deliver notice of reduction, suspension, or termination no later than fifteen calendar days prior to the effective date of the proposed action.

(4) If the decision to deny, reduce, suspend, or terminate service or affirm billing of an enrollee due to the managed care plan's denial of payment for the service, is the result of a managed care plan grievance, notice of that decision shall be mailed or personally delivered at the time the grievance is decided.

(B) "Reduction, suspension or termination" of a service means that the service is being reduced from the level authorized, suspended or terminated, prior to the expiration of the prescribed period. If, upon the expiration of a period of authorized service, the enrollee requests further services, denial of that request shall be considered a denial, rather than a reduction, suspension, or termination, of service and continuation of benefits as described in rule 5101:6-4-01 of the Administrative Code will not apply.

(C) The notice shall contain a clear and understandable statement of the action and the reasons for it, cite the applicable regulations, explain the individual's right to and the method of obtaining a state hearing, explain the circumstances under which a timely hearing request will result in continued services, and contain a telephone number to call about free legal services.

(D) For denial of a medical service, the JFS 04043 "Notice of Denial of Medical Services by Your Managed Care Plan," (rev. 7/2009), shall be used. For reduction, suspension, or termination of a medical service, the JFS 04066 "Notice of Reduction, Suspension, or Termination of Medical Services by Your Managed Care Plan," (7/2009), shall be used. For denial of payment, the JFS 04046 "Notice of Denial of Payment for Medical Services by Your Managed Care Plan," (rev. 7/2009), shall be used.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 11/1/89 (Emer), 1/29/90, 10/1/90, 6/1/93, 6/1/97, 10/1/97 (Emer), 12/30/97, 10/1/02, 9/1/08, 7/1/09, 8/1/10

5101:6-2-36 State hearings: notice of denial of just cause request for termination of managed care plan membership.

(A) Following the bureau of managed health care's determination that the request does not meet one of the criteria for just cause termination of managed care plan membership, the Ohio department of medicaid bureau of managed care must send a notice to an individual.

(B) The notice shall contain a clear and understandable statement that the request was denied, explain why the request for just cause termination of managed care plan membership did not meet the criteria for just cause termination of managed care plan membership, cite the applicable regulations, explain the individual's right to and the method of obtaining a state hearing, and contain a telephone number to call about free legal services.

(C) JFS 01711 "Notice of Right to Terminate Membership in Your Managed Care Plan for Just Cause," (rev. 8/2003), shall be used.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 5/31/04, 9/1/08

5101:6-2-37 [Rescinded]Notices of enrollment, continued enrollment, or provider change denial for the managed care plan controlled substances and member management program.

Effective: 01/01/2012
R.C. 119.032 review dates: 10/14/2011
Promulgated Under: 119.03
Statutory Authority: 5101.35 , 5111.02 , 5111.17
Rule Amplifies: 5101.35 , 5111.16 , 5111.17 , 5111.172
Prior Effective Dates: 5/1/09, 8/1/10

5101:6-2-40 State hearings: coordinated services program state hearing and notice requirements.

(A) The purpose of this rule is to describe the process by which the Ohio department of

medicaid (ODM) or a medicaid managed care plan (MCP), as described in rule 5160-26-01 of the Administrative Code, informs an individual of notice and hearing rights for the medicaid coordinated services program (CSP).

(B) Definitions.

(1) "Authorized representative" means a person, eighteen years or older, who stands in place of the individual. The authorized representative may include a legal entity. ODM may request proper identification from the authorized representative.

(2) "Coordinated services program (CSP)," has the same meaning as described in rule 5160-20-01 of the Administrative Code.

(3) "Individual," for the purpose of this rule, means a recipient who is currently receiving medicaid services, either through fee-for-service or through an MCP.

(4) "Designated pharmacy" has the same meaning as described in rule 5160-20-01 of the Administrative Code.

(5) "Designated provider" has the same meaning as described in rule 5160-20-01 of the Administrative Code.

(C) Proposed enrollment into the CSP.

(1) Not less than fifteen days before enrolling the individual into the CSP, ODM or the MCP shall provide written notice, or its electronic equivalent, to the individual of the proposed enrollment into the CSP. The notice shall contain clear and understandable information describing:

(a) The effective date of the proposed enrollment into the CSP;

(b) The reason why ODM or the MCP is proposing enrollment;

(c) The appropriate Administrative Code citation(s) supporting the decision of ODM or the MCP;

(d) Where to get additional information regarding enrollment into the CSP, including the phone number for and availability of free legal services;

(e) Hearing rights as described in division 5101:6 of the Administrative Code, including the individual's rights to appeal the proposed enrollment through a state hearing; and

(f) The method of and deadline for selecting a designated provider or pharmacy; otherwise, a designated provider or pharmacy will be selected by ODM or the MCP.

(2) If the individual requests a state hearing and the hearing request is received by either ODM or the MCP within the fifteen-day prior notice period set forth in rule 5101:6-4-01 of the Administrative Code, ODM or the MCP shall enroll an individual into the CSP no sooner than the hearing decision mail date.

(D) Continued enrollment into the CSP.

(1) ODM or the MCP shall provide written notice, or its electronic equivalent, to the individual of the continued enrollment into the CSP. The notice shall contain clear and understandable information describing:

(a) The effective date of the continued enrollment into the CSP;

(b) The reason why ODM or the MCP is continuing enrollment;

(c) The appropriate Administrative Code citation(s) supporting the decision of ODM or the MCP;

(d) Where to get additional information regarding continued enrollment into the CSP, including the phone number for and availability of free legal services; and

(e) Hearing rights as described in division 5101:6 of the Administrative Code, including the individual's right to appeal the continuing enrollment through a state hearing.

(2) The individual requesting a timely hearing regarding continued enrollment into the CSP shall continue to be enrolled in the CSP until the hearing decision is rendered in accordance with rule 5101:6-4-01 of the Administrative Code.

(E) Denial of designated provider or pharmacy.

(1) ODM or the MCP shall provide written notice, or its electronic equivalent, to the individual when the individual's request for a designated provider or pharmacy change is denied. The notice shall contain clear and understandable information describing:

(a) The name of the denied designated provider or pharmacy;

(b) The reason why ODM or the MCP is denying the request for a change;

(c) The appropriate Administrative Code citation(s) supporting the decision of ODM or the MCP;

(d) Where to get additional information regarding the denial of the designated provider change, including the phone number for and availability of free legal services, and

(e) Hearing rights as described in division 5101:6 of the Administrative Code, including the right to appeal the denial through a state hearing.

(2) The individual requesting the hearing regarding the denial of designated provider or pharmacy change shall continue assignment with the current designated provider or pharmacy until the hearing decision is rendered in accordance with rule 5101:6-4-01 of the Administrative Code.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35 , 5164.02 , 5164.758
Rule Amplifies: 5101.35 , 5160.011 , 5164.02 , 5164.758 , 5167.03 , 5167.10 , 5167.12 , 5167.13
Prior Effective Dates: 9/1/76, 4/1/80, 10/1/81, 5/1/82, 7/1/82, 4/1/83, 9/24/83, 11/1/83 (Temp), 12/1/83, 1/1/84, 3/1/84 (Temp), 6/1/84, 10/3/84 (Emer), 12/22/84, 4/1/86, 4/1/87, 9/1/87, 7/1/88 (Emer), 9/25/88, 2/1/90, 6/1/93, 6/1/03, 9/1/08, 5/1/09, 8/1/10, 7/1/11 (Emer), 1/1/12

5101:6-2-50 State hearings: notice of determinations concerning spouses separated by institutionalization.

(A) At the time of the determination of eligibility of the institutionalized spouse for medicaid, both the institutionalized spouse, the community spouse, and authorized representative shall be provided with the following written notices, or their eligibility system equivalents, along with the notice of approval or denial. Notwithstanding rule 5101:6-2-03 of the Administrative Code, an JFS 07332, "Notice of Denial of Your Application for Medicaid: In Cases Involving Community Spouses" (rev. 10/2006) must be used in lieu of an JFS 07334, "Notice of Denial of Your Application for Assistance," (rev. 9/2011) to deny applications involving an institutionalized spouse with a community spouse.

(1) JFS 04076 "Resource Assessment Worksheet," (rev. 4/2012).

(2) JFS 04077 "Resource Transfer Worksheet," (rev. 10/2006).

(3) JFS 04078 "Monthly Income Allowance (MIA) Computation Worksheet," (rev. 10/2006).

(B) The notices shall demonstrate the method by which the respective determinations were made, inform the individual of the right to and the method of obtaining a county conference and a state hearing, and contain a telephone number to call about free legal services.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 12/29/92 (Emer), 3/22/90, 6/1/93, 1/1/96, 6/1/03, 9/1/08

5101:6-2-51 Notice of interim assistance reimbursement.

When, as the result of an interim assistance agreement, the local agency receives an individual's retroactive supplemental security income (SSI) payment for initial or initial post-eligibility SSI benefits, the individual and authorized representative shall be provided written notice.

(A) The notice shall be mailed or personally delivered no later than ten working days following the local agency's receipt of the SSI payment.

(B) The notice shall contain a clear and understandable statement of the apportionment of the SSI payment and the reasons for it, cite the applicable regulations, explain the individual's right to and the method of obtaining a county conference and a state hearing, and contain a telephone number to call about free legal services.

(C) "Notice of Interim Assistance Reimbursement," JFS 07107 (rev. 4/2001), or its computer-generated equivalent, shall be used.

R.C. 119.032 review dates: 11/18/2013 and 11/01/2018
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35
Prior Effective Dates: 10/1/90, 6/1/93, 6/1/03, 9/1/08