Ohio § 5101.35

§ 5101.35.

(A) As used in this section: (1)(a) “ Agency ” means the following entities that administer a family services program: (i) The department of job and family services; (ii) The department of children and youth; (iii) A county department of job and family services; (iv) A public children services agency; (v) A private or government entity administering, in whole or in part, a family services

program for or on behalf of the department of job and family services, the department

of children and youth, or a county department of job and family services or public

children services agency. (b) If the department of medicaid contracts with the department of job and family services

to hear appeals authorized by section 5160.31 of the Revised Code regarding medical assistance programs, “ agency ” includes the department of medicaid. (2) “ Appellant ” means an applicant, participant, former participant, recipient, or former recipient

of a family services program who is entitled by federal or state law to a hearing

regarding a decision or order of the agency that administers the program. (3)(a) “ Family services program ” means all of the following: (i) A Title IV-A program as defined in section 5101.80 of the Revised Code ; (ii) Programs that provide assistance under Chapter 5104. of the Revised Code; (iii) Programs that provide assistance under section 5101.461 , 5101.54 , 5119.41 , 5153.163 , 5153.165 , or 5180.42 of the Revised Code ; (iv) Title XX social services provided under section 5101.46 of the Revised Code , other than such services provided by the department of mental health and addiction

services, the department of developmental disabilities, a board of alcohol, drug addiction,

and mental health services, or a county board of developmental disabilities. (b) If the department of medicaid contracts with the department of job and family services

to hear appeals authorized by section 5160.31 of the Revised Code regarding medical assistance programs, “ family services program ” includes medical assistance programs. (4) “Medical assistance program” has the same meaning as in section 5160.01 of the Revised Code . (B) Except as provided by divisions (G) and (H) of this section, an appellant who appeals

under federal or state law a decision or order of an agency administering a family

services program shall, at the appellant's request, be granted a state hearing by

the department of job and family services or the department of children and youth,

as appropriate.  This state hearing shall be conducted in accordance with rules adopted under this

section.  The state hearing shall be recorded, but neither the recording nor a transcript

of the recording shall be part of the official record of the proceeding.  Except as provided in section 5160.31 of the Revised Code , a state hearing decision is binding upon the agency and department, unless it is

reversed or modified on appeal to the director of job and family services, director

of children and youth, or a court of common pleas. (C) Except as provided by division (G) of this section, an appellant who disagrees with

a state hearing decision may make an administrative appeal to the director of job

and family services or director of children and youth in accordance with rules adopted

under this section.  This administrative appeal does not require a hearing, but the director or the director's

designee shall review the state hearing decision and previous administrative action

and may affirm, modify, remand, or reverse the state hearing decision.  An administrative appeal decision is the final decision of the department and, except

as provided in section 5160.31 of the Revised Code , is binding upon the department and agency, unless it is reversed or modified on

appeal to the court of common pleas. (D) An agency shall comply with a decision issued pursuant to division (B) or (C) of

this section within the time limits established by rules adopted under this section.  If a county department of job and family services or a public children services

agency fails to comply within these time limits, the department may take action pursuant

to section 5101.24 of the Revised Code .  If another agency, other than the department of medicaid, fails to comply within

the time limits, the department may force compliance by withholding funds due the

agency or imposing another sanction established by rules adopted under this section. (E) An appellant who disagrees with an administrative appeal decision of the director

of job and family services, the director of children and youth, or either director's

designee issued under division (C) of this section may appeal from the decision to

the court of common pleas pursuant to section 119.12 of the Revised Code .  The appeal shall be governed by section 119.12 of the Revised Code except that: (1) The person may apply to the court for designation as an indigent and, if the court

grants this application, the appellant shall not be required to furnish the costs

of the appeal. (2) The appellant shall mail the notice of appeal to the department of job and family

services or director of children and youth, as appropriate, and file notice of appeal

with the court within thirty days after the department mails the administrative appeal

decision to the appellant.  For good cause shown, the court may extend the time for mailing and filing notice

of appeal, but such time shall not exceed six months from the date the department

mails the administrative appeal decision.  Filing notice of appeal with the court shall be the only act necessary to vest jurisdiction

in the court. (3) The department shall be required to file a transcript of the testimony of the state

hearing with the court only if the court orders the department to file the transcript.  The court shall make such an order only if it finds that the department and the

appellant are unable to stipulate to the facts of the case and that the transcript

is essential to a determination of the appeal.  The department shall file the transcript not later than thirty days after the day

such an order is issued. (F) The department of job and family service and department of children and youth, as

applicable, shall adopt rules in accordance with Chapter 119. of the Revised Code

to implement this section, including rules governing the following: (1) State hearings under division (B) of this section.  The rules shall include provisions regarding notice of eligibility termination and

the opportunity of an appellant appealing a decision or order of a county department

of job and family services to request a county conference with the county department

before the state hearing is held. (2) Administrative appeals under division (C) of this section; (3) Time limits for complying with a decision issued under division (B) or (C) of this

section; (4) Sanctions that may be applied against an agency under division (D) of this section. (G) The department of job and family services and the department of children and youth,

as applicable, may adopt rules in accordance with Chapter 119. of the Revised Code

establishing an appeals process for an appellant who appeals a decision or order regarding

a Title IV-A program identified under division (A)(4)(c), (d), (e), (f), (g), or (h)

of section 5101.80 of the Revised Code that is different from the appeals process

established by this section.  The different appeals process may include having a state agency that administers

the Title IV-A program pursuant to an interagency agreement entered into under section 5101.801 of the Revised Code administer the appeals process. (H) If an appellant receiving medicaid through a health insuring corporation that holds

a certificate of authority under Chapter 1751. of the Revised Code is appealing a

denial of medicaid services based on lack of medical necessity or other clinical issues

regarding coverage by the health insuring corporation, the person hearing the appeal

may order an independent medical review if that person determines that a review is

necessary.  The review shall be performed by a health care professional with appropriate clinical

expertise in treating the recipient's condition or disease.  The department shall pay the costs associated with the review. A review ordered under this division shall be part of the record of the hearing and

shall be given appropriate evidentiary consideration by the person hearing the appeal. (I) The requirements of Chapter 119. of the Revised Code apply to a state hearing or

administrative appeal under this section only to the extent, if any, specifically

provided by rules adopted under this section.