Ohio Administrative Code|Rule 5101:6-7-01 | State hearings: state hearing decisions.

                                                
(A) Hearing authority
(1) The bureau of state
			 hearings is responsible for preparing and issuing state hearing decisions under
			 the authority of the director of the Ohio department of job and family services
			 (ODJFS). For this purpose, the chief of the bureau of state hearings shall
			 designate hearing authorities in addition to the chief to review the findings,
			 conclusions, and recommendations of the hearing officers and to issue decisions
			 under the authority of the ODJFS director.
(2) No person designated
			 as hearing authority shall have previously participated in the agency decision
			 being appealed, nor shall the hearing authority and the hearing officer who
			 conducted the hearing be the same person.
(B) Timely issuance
(1) Hearing decisions
			 involving public assistance, social services, and child support services shall
			 be issued within seventy calendar days from the date of the hearing request. No
			 extension of the seventy-day requirement is permitted because the individual
			 requests a delay in the scheduling of the hearing.
(2) Hearing decisions
			 involving the prevention, retention and contingency (PRC) program shall be
			 issued within thirty calendar days from the date of the hearing
			 request.
(3) Hearing decisions
			 involving food assistance shall be issued within sixty calendar days from the
			 date of the hearing request, with the following exceptions:
(a) When the hearing has been postponed, as described in rule
				5101:6-5-02 of the Administrative Code, the sixty day time limit shall be
				extended by as many days as the hearing was postponed.
(b) Hearing decisions involving a denial of expedited food
				assistance shall be issued within thirty calendar days from the date of the
				hearing request.
(c) When the hearing has been requested in response to the
				simultaneous proposal of public assistance and food assistance adverse actions,
				the hearing decision shall be issued according to public assistance timeliness
				standards.
(4) Hearing decisions
			 involving the medicaid program shall be issued within seventy calendar days
			 from the date of the hearing request. This period shall be reduced to three
			 working days in the following instance:
(a) The hearing request is from an enrollee of a medicaid managed
				care plan or "MyCare Ohio" plan; and
(b) The enrollee, or the enrollee's authorized
				representative, claims that the request requires an expedited resolution
				because taking the time for a standard resolution could seriously jeopardize
				the enrollee's life or health or ability to attain, maintain, or regain
				maximum function; and
(c) The bureau of state hearings agrees that an expedited
				resolution is required.
(C) Basis
(1) The hearing
			 officer's findings of fact shall be based exclusively on the evidence
			 introduced at the hearing, or after the hearing and subject to examination and
			 rebuttal by both parties as described in rule 5101:6-6-02 of the Administrative
			 Code.
(a) The hearing officer may be guided, but shall not be bound, by
				the Ohio Rules of Evidence (as in effect on July 1, 2017) in conducting
				hearings and in making findings of fact. The hearing officer shall consider all
				relevant evidence offered at the hearing.
(b) Hearsay evidence may be considered by the hearing officer in
				arriving at the findings of fact. However, such evidence must be critically
				evaluated, since it is not given under oath and cannot be cross-examined to
				test the perception, memory, and veracity of the declarant.
Direct evidence shall normally be given more
				weight than hearsay evidence when the two are in conflict.
(c) It shall be the responsibility of the agency to show, by a
				preponderance of the evidence, that its action or inaction was in accordance
				with rules of the Administrative Code.
(d) The hearing officer's findings of fact shall be binding
				upon the hearing authority. However, the hearing authority may return the case
				to the hearing officer if it is determined that additional facts not already
				established by the hearing officer are essential to a correct decision or if
				the evidence relied upon was taken in violation of rule 5101:6-6-02 of the
				Administrative Code.
(2) The hearing
			 officer's conclusions of policy and recommendations shall be based solely
			 on rules of the Administrative Code, or local agency policy adopted pursuant to
			 options authorized in state law, except when these regulations and policies are
			 silent and reference to the Revised Code or other statutory source is necessary
			 to resolve the issue.
(a) When a hearing is regarding the prevention, retention and
				contingency (PRC) program, the hearing officer's conclusions of policy and
				recommendations shall be based on the PRC statement of policies if it was
				submitted at the hearing and if the submitted plan was effective as of the date
				of the action being appealed.
(b) The hearing authority shall review conclusions and
				recommendations by the hearing officer, and adopt them when they constitute a
				correct application of the appropriate regulations.
(c) The hearing authority shall amend conclusions and
				recommendations that do not correctly apply the appropriate regulations,
				clearly explaining the reason and basis for any such amendment.
(3) The hearing decision
			 shall address the issues raised in the request or otherwise included upon
			 agreement of all parties, subject to the conditions of rule 5101:6-3-01 of the
			 Administrative Code.
If it is discovered at the hearing that the
			 request or issue meets one of the denial criteria in rule 5101:6-5-03 of the
			 Administrative Code, the decision shall overrule the appeal on that
			 basis.
(4) When a hearing
			 request involves multiple issues, and when the appellant withdraws, in writing,
			 notice of dismissal of the withdrawn appeals, as required by rule 5101:6-5-03
			 of the Administrative Code, may be included in the hearing
			 decision.
(a) If the appellant withdraws some, but not all of the appeals,
				because there is no longer need for review by a higher authority on those
				appeals, the withdrawal is to be included in the decision, requiring no
				additional action on those appeals.
(b) If during the course of the hearing, the appellant withdraws
				some or all of the issues under appeal, contingent upon some corrective action
				agreed to by the agency, the hearing officer shall issue a state hearing
				decision, indicating that agreement and requiring the agency to comply with the
				action as agreed to during the hearing. This decision shall be issued via the
				JFS 04005 "State Hearing Decision" (rev. 1/2015).
(D) Content
The hearing decision shall separately set forth
		  the issue or issues to be decided, the hearing officer's findings of fact,
		  conclusions of policy and recommendations, and the decision and order.
(1) The issue section
			 shall fully describe the action or lack of action being appealed. It shall
			 include the date and specific nature of the action, including benefit amounts
			 where appropriate, as well as the specific eligibility factor on which the
			 action was based and shall include a summary of the hearing officer's
			 recommendations for resolution of the issue. When multiple issues are involved,
			 they shall be set forth separately and numbered for reference in the remainder
			 of the decision.
(2) The procedural
			 matters shall first address such preliminary matters as delays due to
			 postponement, resolution of disputes as to standing, and amendments or
			 additions to the issue or issues as stated on the agency's written notice
			 or in the hearing request, the dates the appeal summary was received by the
			 bureau of state hearings and the appellant, continuation of benefits (if
			 applicable), and status of subpoena request (if applicable).
(3)  The findings of fact
			 shall follow procedural matters. The findings of fact shall be clear and
			 orderly chronological discussion of the facts and events relevant to the
			 issue.
(4) The conclusions of policy shall cite
			 and summarize relevant portions of rules of the Administrative Code and other
			 applicable regulations as necessary, and shall clearly demonstrate how they
			 apply to the facts established. The decision shall clearly indicate the basis
			 for each such finding, to include discussion of the relative weight given to
			 conflicting evidence in arriving at the decision as to where the preponderance
			 of evidence lies.
Food assistance decisions shall also cite
			 applicable federal regulations.
Budget computations, where relevant, shall be
			 clearly set forth.
(5) The hearing officer's
			 recommendations shall separately indicate the outcome of the appeal on each
			 issue addressed, sustaining those in which the agency is found to have acted
			 incorrectly, overruling those in which the agency's action was correct,
			 and, if the provisions of paragraph (C)(4) of this rule apply, dismissing those
			 that have been withdrawn in writing. Clear instructions to the parties shall be
			 given when additional action is necessary to resolve the matter at
			 issue.
Compliance shall be required, via the JFS 04068
			 "Order of Compliance Notice" (rev. 1/2015), as necessary to assure
			 that the individual promptly receives all benefits ordered by a favorable
			 decision.
(6) The decision and order, signed by the
			 hearing authority, shall indicate adoption or amendment of the hearing
			 officer's recommendations, whether each issue is sustained or overruled,
			 and whether compliance is required.
(E) Notification
(1) The individual and
			 authorized representative shall be provided with the written state hearing
			 decision via the JFS 04005. The decision shall provide notice of the right to
			 and the method of obtaining an administrative appeal. A copy of the decision
			 shall also be sent to the local agency electronically, as an e-mail
			 attachment.
(2) When the hearing
			 involves one of the medical determination issues listed in paragraph (C)(1) of
			 rule 5101:6-6-01 of the Administrative Code, a copy of the decision shall also
			 be sent to the medical determination unit.
(3) When the hearing
			 involves a managed care plan or "MyCare Ohio" plan, copies of the
			 decision shall also be sent to the managed care plan or the "MyCare
			 Ohio" plan, and upon request to the Ohio department of
			 medicaid.
(F) Hearing record
The state hearing decision, together with
		  documents introduced at the hearing and all papers and requests filed in the
		  proceeding, shall constitute the exclusive record. The hearing record shall be
		  maintained by the bureau of state hearings in accordance with applicable record
		  retention requirements. It will be made available for review by the individual
		  and authorized representative upon request. The local agency shall be provided
		  a copy upon request as well.
(G) Library of decisions
The chief of the bureau of state hearings shall
		  maintain a library of all state hearing decisions. The decisions shall be
		  available for public inspection and copying, subject to applicable disclosure
		  safeguards.
(H) Binding effect
State hearing decisions shall be binding on the
		  agency or managed care plan or "MyCare Ohio" plan for the individual
		  case for which the decision was rendered.