Ohio Administrative Code|Rule 5101:6-7-03 | State hearings: implementation of the hearing decision.

                                                
(A) Responsibility
(1) When the hearing
			 decision orders action to be taken by the agency, the agency that is ordered to
			 take the action is responsible for promptly and fully implementing the
			 decision.
(2)  State hearings is responsible for
			 monitoring timely compliance with decisions.
(3) When the hearing decision orders
			 action to be taken by a managed care plan or "MyCare Ohio" plan, the
			 managed care plan or "MyCare Ohio" plan is responsible for promptly
			 and fully implementing the decision.
The , Ohio department of medicaid (ODM) is
			 responsible for timely compliance with decisions involving compliance by a
			 managed care plan or "MyCare Ohio" plan.
(B) Promptness
(1) Decisions that order
			 action favorable to the individual
(a) For decisions involving public assistance, social services or
				child support services, compliance shall be achieved within fifteen calendar
				days from the date the decision is issued, but in no event later than ninety
				calendar days from the date of the hearing request.
(b) For decisions involving food assistance, any increase in
				benefits must be reflected in the food assistance allotment within ten calendar
				days of receipt of the decision, even if the local agency must provide a
				supplement, outside the normal issuance cycle.
The local agency may take longer than ten
				days if it elects to make the decision effective in the assistance group's
				normal issuance cycle, provided that issuance will occur within sixty calendar
				days of the date of the hearing request. If the local agency elects to follow
				this procedure, the benefit increase may be reflected in the normal issuance
				cycle or with a supplementary issuance.
(c) Compliance shall be promptly reported to the bureau of
				state hearings, via a notice certifying the agency's compliance with the
				state hearing decision, and accompanied by appropriate documentation
				substantiating compliance is met.
When the hearing decision orders action to be
				taken by a managed care plan or a "MyCare Ohio" plan, each shall also
				send a copy of the notice certifying the agency's compliance with the
				state hearing decision, to ODM.
(2) Decisions that
			 authorize action adverse to the individual
(a) The agency shall implement the decision promptly, if still
				appropriate.
(b) When the adverse action results in a decrease in the
				assistance group's food assistance benefits, the decrease shall be
				reflected in the next issuance cycle following receipt of the hearing
				decision.
(C) Date compliance is
		  achieved
(1) For decisions
			 involving public assistance, social services or child support services,
			 compliance shall be considered achieved on the date eligibility, payment, or
			 services are authorized or other action ordered by the hearing decision is
			 taken.
(2) For decisions
			 involving food assistance, compliance shall be considered achieved on the date
			 the action is reflected in the assistance group's food assistance
			 allotment.
(D) Underpayments/underissuances
(1) When the decision
			 determines that the individual has been improperly denied benefits or has
			 received fewer benefits than were due, any underpayments must be corrected in
			 accordance with rules 5101:1-23-60, 5101:1-5-50 and/or 5101:4-8-03 of the
			 Administrative Code.
(2) The local agency
			 shall restore food assistance benefits to assistance groups that are leaving
			 the county before the departure whenever possible. If benefits are not restored
			 prior to departure, the local agency shall forward an authorization of the
			 benefits to the assistance group or to the new county if this information is
			 known.
The new county shall accept an authorization
			 and issue the appropriate benefits whether the notice is presented by the
			 assistance group or received directly from another county.
(E) Overpayments/overissuances
(1) Overpayments related
			 to the appeal are subject to collection in accordance with rule 5101:1-23-70 of
			 the Administrative Code.
(2) When the appeal
			 involves food assistance, a claim against the assistance group for any
			 overissuance related to the appeal must be prepared in accordance with rule
			 5101:4-8-15 of the Administrative Code.
(F) Prior authorization
		  issues
(1) When a hearing
			 decision reverses a denial of prior authorization for medical service and
			 authorizes the service, the approval unit shall approve the prior
			 authorization, using the normal prior authorization procedure. The approval
			 notification sent to the provider shall be accompanied by a copy of the hearing
			 decision.
(2) When a hearing
			 decision reverses a denial of prior authorization for additional therapeutic
			 leave days for a medicaid recipient with a developmental disabilities (DD)
			 level of care in a long-term care facility, the bureau of state hearings shall
			 send a copy of the decision to the long-term care facility. The hearing
			 decision constitutes authorization for the additional leave days.
(G) Precertification issues
When a hearing decision changes a review
		  agency's decision on a request for precertification of a hospital
		  admission or medical procedure, the bureau of state hearings shall send a copy
		  of the decision and a notice certifying the agency's compliance with the
		  state hearing decision to the review agency.
The review agency shall certify those hospital
		  days or medical procedures authorized by the decision using the normal
		  precertification procedure, complete the notice certifying the agency's
		  compliance with the state hearing decision, and send it to state
		  hearings.
(H) Coordinated services program (CSP)
		  issues
When a hearing decision changes a decision by the
		  recipient monitoring and review section concerning proposed or continued
		  enrollment in the CSP or denial of a request for a change of designated
		  provider, the bureau of state hearings shall send a copy of the decision to the
		  recipient monitoring and review section. The recipient monitoring and review
		  section shall take the actions ordered by the decision, complete the notice
		  certifying the agency's compliance with the state hearing decision, and
		  send it to state hearings.
(I) Preadmission screening resident
		  review (PASRR) issues
When a hearing decision changes a preadmission
		  screening (PAS) or resident review (RR) determination made by the Ohio
		  department of mental health and addiction services or the Ohio department of
		  developmental disabilities, the hearing decision shall constitute the revised
		  PAS or RR determination.