This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and
universities.
| Rule |
Rule 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) The JFS 04059 "Explanation of
State Hearing Procedures" (rev. 1/2015), or its computer-generated
equivalent, shall be used to provide this notice. (C) If the assistance group making a
supplemental nutrition assistance program (SNAP) 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.
Last updated October 31, 2024 at 9:22 AM
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Rule 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) 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. (b) Citations of the applicable regulations. (c) An explanation of the assistance group's right to
and the method of obtaining a county conference and a state
hearing. (d) A telephone number to call about free legal
services. (2) The 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 supplemental nutrition assistance program
(SNAP) benefits, the assistance group shall be provided written notice of the
decision. (1) The ODJFS electronic
approval notices are the only notices that may be used for approval of
applications and reapplications for SNAP benefits. When the agency approves an
application or reapplication for SNAP 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) A clear and understandable statement of the action the
agency has taken. (b) Citations of the applicable regulations. (c) An explanation of the assistance group's right to
and the method of obtaining a county conference and a state
hearing. (d) The name and telephone number of the person to contact
for more information. (e) A telephone number to call about free legal
services. The notice shall also 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 shall provide the verification that
was previously 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) The JFS 07401 "Notice of Pending
Supplemental Nutrition Assistance Program (SNAP) Application" (rev.
11/2016), or its computer-generated equivalent, shall be used.
Last updated October 31, 2024 at 9:22 AM
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Rule 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) A clear and understandable statement of the action the
agency has taken and the reasons for it. (b) Citations of the applicable regulations. (c) An explanation of the individual's right to and
the method of obtaining a county conference and a state hearing. (d) A telephone number to call about free legal
services. (2) The JFS 07334
"Notice of Denial of Your Application for Assistance" (rev. 9/2011),
or its computer-generated equivalent, shall be used. (B) When the agency denies a supplemental
nutrition assistance program (SNAP) application, reapplication or requested
change in benefits, the assistance group shall be provided written notice of
the decision. (1) The ODJFS electronic
denial notices are the only notices that may be used for denial of applications
for SNAP 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) A clear and understandable statement of the action the
agency has taken and the reasons for it. (b) Citations of the applicable regulations. (c) An explanation of the assistance group's right to
and the method of obtaining a county conference and a state
hearing. (d) The name and telephone number of the person to contact
for more information. (e) 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: (a) What action the assistance group shall take to
reactivate the application. (b) 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. (c) That the assistance group shall 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, the agency may deny the case, but 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 shall accompany the
notice of denial for assistance groups with actual or potential categorical
eligibility.
Last updated October 31, 2024 at 9:22 AM
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Rule 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 supplemental
nutrition assistance program (SNAP) 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. An electronic notice may replace a written notice, as permitted by
federal law. (A) The written notice shall be sent
electronically, by regular U. S. mail, or hand delivered no less than fifteen
days prior to the effective date of the proposed action. (B) The notice shall
contain: (1) A clear and
understandable statement of the proposed action and the reasons for
it. (2) Citations of the
applicable regulations. (3) An explanation of the
assistance group's right to and the method of obtaining a county
conference and a state hearing. (4) An explanation of the
circumstances under which a timely hearing request shall result in continued
benefits. (5) A telephone number to
call about free legal services. (C) The 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 SNAP benefits, the agency shall issue a single notice for both
public assistance and SNAP actions.
Last updated October 31, 2024 at 9:22 AM
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Rule 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. The agency is 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 the
appellant understands that based on the information they provided, their
benefits will be reduced or terminated. 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
shall 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 shall 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) A clear and understandable statement of the action
being taken and the reasons for it. (b) Citations of the applicable regulations. (c) An explanation of the assistance group's right to
and the method of obtaining a county conference and a state
hearing. (d) An explanation of the circumstances under which a
timely hearing request shall result in reinstated benefits. (e) A telephone number to call about free legal
services. (3) The JFS 04085
"Prior Notice of Right to a State Hearing (Adequate Notice) (rev.
2/2014)," or its computer-generated equivalent, shall be
used. (B) Supplemental nutrition assistance
program (SNAP) 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 SNAP benefits, has been receiving
SNAP benefits pending the approval of the public assistance grant, and was
notified in writing at the time of certification that SNAP benefits would be
reduced upon approval of the public assistance grant. (5) An assistance group
member is disqualified for an 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 shall 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 SNAP 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.
Last updated October 31, 2024 at 9:22 AM
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Rule 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 supplemental nutrition assistance program (SNAP) recipients for
which federal law does not require notification. (1) The notice shall be
mailed or personally delivered no less than fifteen days prior to the
processing of the action. (2) The notice shall
contain: (a) A clear and understandable statement of the proposed
action and the reasons for it. (b) Citations of the applicable regulations. (c) An explanation of the assistance group's right to
and the method of obtaining a county conference and a state
hearing. (d) An explanation of the circumstances under which a
timely hearing request shall result in continued benefits. (e) 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 shall 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 SNAP, 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).
Last updated October 31, 2024 at 9:22 AM
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Rule 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 business days
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) The JFS 04059
"Explanation of State Hearing Procedures" (rev. 1/2015), shall be
used. (B) Notice of acceptance or
denial (1) Within twenty 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) The JFS 07647
"Notice of Case Status Application" (effective or revised effective
date as identified in rule 5101:12-10-99 of the Administrative Code), shall be
used. (C) Notice of a modification
denial (1) When the CSEA has
determined that a request for modification is not supported, the CSEA shall
notify the requesting party of that determination. (2) The notification shall include the
date and reason for the termination and shall be accompanied by the JFS
04059. (D) Notice of case closure (1) The CSEA shall notify
the recipient of child support services in writing at least sixty days prior to
taking administrative action to close the child support case when services are
proposed for termination pursuant to paragraph (D)(1) to (D)(7), (D)(11), or
(D)(12) of rule 5101:12-10-70 of the Administrative Code. (2) The JFS 07046,
"Pending Case Closure Notice" (effective or revised effective date as
identified in rule 5101:12-10-99 of the Administrative Code), shall be used to
provide notification of case closure.
Last updated October 31, 2024 at 9:22 AM
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Rule 5101:6-2-08 | State hearings: notice whenever disagreement with an action or inaction is expressed.
(A) Whenever an assistance group
disagrees with an agency action or lack of action, the agency shall remind the
assistance group of the right to request a state hearing via the JFS 04059
"Explanation of State Hearing Procedures" (rev. 1/2015). The
published hearing rules shall also be made available upon request. (B) When an assistance group disagrees
with a denial or termination of benefits, 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.
Last updated October 31, 2024 at 9:22 AM
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Rule 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) 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. (b) Citations of the applicable regulations. (c) An explanation of 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. (d) 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
supplemental nutrition assistance program (SNAP) 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) Citations of the applicable regulations. (b) An explanation of 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. (c) A clear and understandable statement of the
determination and the reasons for it, including the amount and period of the
overpayment. (d) A statement of how the claim was calculated, including
any offsetting done to reduce the overpayment. (e) A statement expressing the intent to collect from all
adults in the assistance group when the overpayment occurred. (f) A statement providing an opportunity to inspect and
copy records related to the claim. (g) An explanation of the available methods of
repayment. (h) A statement explaining that if the claim is not paid,
it will be sent to other collection agencies who will use various collection
methods. (i) A statement explaining that, if not paid, the claim
will be referred to the federal government for federal collection
action. (j) A statement explaining that if the claim becomes
delinquent the assistance group may be subject to additional processing
charges. (k) The name and telephone number of a person to contact
for more information. (l) A telephone number to call about free legal
services. (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) The JFS 07442
"Food Assistance Repayment Agreement" (rev. 11/2008), or its
computer-generated equivalent shall be used. (5) Notice is not
required when the overissuance involves possible fraud and has been referred to
the county prosecutor.
Last updated October 31, 2024 at 9:22 AM
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Rule 5101:6-2-25 | State hearings: notice of eligibility for lost supplemental nutrition assistance program (SNAP) benefits.
(A) If the agency determines that a loss
of SNAP 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: (1) A clear and
understandable statement of the amount and period of the underissuance, any
offsetting that was done and the method of restoration. (2) An explanation of the
assistance group's right to and the method of obtaining a county
conference and a state hearing. (3) The name and
telephone number of the person to contact for more information. (4) 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: (1) A clear and
understandable statement of the denial and the reasons for it. (2) Citations of the
applicable regulations. (3) An explanation of the
assistance group's right to and the method of obtaining a county
conference and a state hearing. (4) The name and
telephone number of the person to contact for more information. (5) A telephone number to
call about free legal services. (C) Approval and/or denial notices for
lost SNAP benefits are generated through the eligibility system.
Last updated October 31, 2024 at 9:22 AM
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Rule 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 SNAP 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 days from the date the loss was reported,
fifteen days if the issuance was made by certified or registered mail, or
within two business days after the agency receives the signed JFS 07222,
"Statement Requesting Replacement of Supplemental Nutrition Assistance
Program (SNAP) Benefits (rev. 10/2016)," whichever is later. If a notice of delay was issued, the agency shall
issue an approval or denial notice within two business days from the date it
receives the information which caused the delay. (B) The notice shall
contain: (1) A clear and
understandable statement of the decision and the reasons for it. (2) Citations of the
applicable regulations. (3) An explanation of the
assistance group's right to and the method of obtaining a county
conference and a state hearing. (4) A telephone number to
call about free legal services. (C) The JFS 07235 "Action Taken on
Your Request for Replacement of Food Assistance Benefits (rev. 12/2012),"
or its computer-generated equivalent, shall be used.
Last updated October 31, 2024 at 9:22 AM
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Rule 5101:6-2-30 | State hearings: notice of medical determination.
(A) The JFS 04022 "Notice of Medical
Determination and a 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: (1) A clear and
understandable statement of the decision and the reasons for it. (2) Citations of the
applicable regulations. (3) An explanation of the
individual's right to and the method of obtaining a state
hearing. (4) A telephone number to
call about free legal services.
Last updated October 31, 2024 at 9:22 AM
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Rule 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: (1) A clear and
understandable statement of the action taken and the reasons for
it. (2) Citations of the
applicable regulations. (3) An explanation of the
assistance group's right to and the method of obtaining a state
hearing. (4) 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.
Last updated October 31, 2024 at 9:22 AM
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Rule 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, 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) A clear and understandable statement of the
determination and the reasons for it. (b) Citations of the applicable regulations. (c) An outline of the implications of the decision for
admission to the facility. (d) An explanation of the individual's right to and
the method of obtaining a state hearing. (e) A telephone number to call about free legal
services. (3) Copies of the notice
shall be sent to: (a) The nursing facility. (b) The individual's attending physician. (c) The discharging hospital. (d) The Ohio department of medicaid (ODM) (or
designee). (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) A clear and understandable statement of the
determination and the reasons for it. (b) Citations of the applicable regulations. (c) An outline of the implications of the decision for
continued residence in the facility. (d) An explanation of the individual's right to and
the method of obtaining a state hearing. (e) A telephone number to call about free legal
services. (3) Copies of the notice
shall be sent to: (a) The nursing facility. (b) The individual's attending physician. (c) The discharging hospital. (d) The ODM (or designee).
Last updated October 31, 2024 at 9:22 AM
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Rule 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, shall send a notice to an
individual. (B) The notice shall
contain: (1) A clear and
understandable statement that the request was denied. (2) An explanation about
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. (3) Citations of the
applicable regulations. (4) An explanation of the
individual's right to and the method of obtaining a state
hearing. (5) A telephone number to
call about free legal services. (C) The JFS 01711 "Notice of Right
to Terminate Membership in Your Managed Care Plan for Just Cause," (rev.
8/2003), shall be used.
Last updated October 31, 2024 at 9:22 AM
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Rule 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) "Designated
pharmacy" has the same meaning as described in rule 5160-20-01 of the
Administrative Code. (4) "Designated
provider" has the same meaning as described in rule 5160-20-01 of the
Administrative Code. (5) "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. (C) Proposed enrollment into the
CSP. (1) ODM or the MCP shall
provide written notice, or its electronic equivalent, not less than fifteen
days before their 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. (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. (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. (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.
Last updated October 31, 2024 at 9:22 AM
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Rule 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.
Last updated April 3, 2023 at 8:29 AM
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