State Hearing Decision - Hearing Decisions

OHIO DEPARTMENT OF JOB AND FAMILY SERVICES
BUREAU OF STATE HEARINGS
In the matter of:
Case Number: County:
5002147659 CLARK
Appeal: Program: Disposition:
1721158 MED OVERRULED
No Compliance Required
Decision Date:
Request Date:
Hearing Officer:
01/12/2012
10/12/2011
ANN SHANE
State Hearing Decision
ISSUE SECTION
Appeal number 1721158 Medicaid – Individual Options Waiver
The Appellant was on the waiting list for the Individual Options (IO) waiver in Warren County
but moved to Clark County prior to approval of the IO waiver in Warren County. The issue is
whether the denial of the IO waiver by the Warren County Board of Developmental Disabilities
is correct
After a review of the evidence and applicable regulations, the decision by Warren County Board
of Developmental Disabilities to deny enrollment on the IO waiver is found to be correct. It is
recommended the appeal be overruled.
PROCEDURAL MATTERS
The Appellant through her mother who is also her guardian requested a state hearing on October
12, 2011 because the Appellant was denied enrollment on the IO waiver. A state hearing was
scheduled and conducted on November 22, 2011. Participating and testifying under oath were
the Appellant’s mother/guardian Karen Kibby, Clark County CDJFS Supervisor Sheri Steinmetz,
Warren County BODD Business Services Manager Kristi Black and Warren County Business
Services Director Michelle Swearingen and Warren County JFS representative Arlene Byrd. An
appeal summary was received. The record was left open for the Appellant and Agencies to
submit additional documents. These documents were received and admitted as exhibits.
FINDINGS OF FACT
1. Appellant, age 20, is in receipt of a Level One waiver, applied for the IO waiver in 2004 and
was on the waiting list in Warren County.
2. Appellant was notified by Warren County BODD in July 2011 that an IO waiver slot was
available.
3. Appellant was in the approval process in Warren County when she moved to Clark County.
4. Warren County BODD denied the IO waiver because the Appellant was no longer a resident
of Warren County.
5. The Appellant is on the waiting list in Clark County.
JFS 04005 (Rev. 6/2002)
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STATE HEARING DECISION CONTINUATION
6. The Appellant’s mother (mother) argued that the Appellant had been approved by Warren
County BODD and papers were signed on July 20, 2011.
7. Mother reported in August 2011 the Appellant was moving to Clark County.
8. Warren BODD testified the state DODD must approve the IO waiver and the papers were
never sent to the state DODD because the Appellant moved out of the county.
9. Warren BODD testified the IO waiver process was stopped once they were notified the
Appellant was moving.
10. Warren BODD testified the Individualized Service Plan (ISP) that was sent to the Appellant
was a draft and not a finalized plan.
11. The Level One waiver eligibility was transferred from Warren BODD to Clark BODD.
CONCLUSIONS OF POLICY
Policy
The Individual Options (IO) Waiver is a Medicaid waiver program administered by the Ohio
Department of Developmental Disabilities (Ohio DODD) through the local county boards of DD.
ODJFS entered into a contract with Ohio DODD to allow Ohio DODD to administer the waiver
on behalf of ODJFS, the single state Medicaid Agency. Ohio Rev. Code § 5111.871 (2009)
The individual options waiver program provides necessary waiver services to individuals who
meet the level of care criteria for an intermediate care facility for individuals with mental
retardation and other developmental disabilities (ICF/MR) as set forth in rule 5101:3-3-07 of the
Administrative Code, as well as other eligibility requirements established by rule. Ohio Admin.
Code § 5101:3-40-01 (2008)
Ohio Revised Code 5126.055 (A) states a county board of developmental disabilities has
Medicaid local administrative authority to, and shall, do all of the following for an individual
with mental retardation or other developmental disability who resides in the county that the
county board serves (emphasis added) and seeks or receives home and community-based
services.
Ohio Administrative Code §5123-2-9-01 (E) states for each separate HCBS waiver, the
department (Ohio Department of Developmental Disabilities) may authorize enrollment by
allocating to county boards enrollment numbers. Paragraph( G)(1) states individuals determined
eligible for waiver services shall receive written notice from the department and waiver services
may be initiated on the date indicated by the department. The department shall also notify the
county board.
Analysis
The record developed at the hearing supports the Warren County BODD’s position that the
Appellant was in the approval process for placement on the IO waiver when she moved from
Warren County to Clark County. Enrollment in the IO waiver is dependent upon the waiting list
in the county in which the individual lives. In this case the Appellant was living in Warren
County at the time she was notified that a slot was available. Although an ISP was developed by
Warren BODD, an ISP is not an approval of the IO waiver. The approval of the waiver must be
issued by the Ohio Department of Developmental Disabilities. In this case, the ODODD did not
complete a final approval of the IO waiver prior to the mother signing the withdrawal/exit report.
The Appellant’s mother/guardian signed a withdrawal/exit report on September 8, 2011 because
the Appellant moved to Clark County. The withdrawal/exit report stopped the approval process
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STATE HEARING DECISION CONTINUATION
in Warren County. The Clark County BODD representative testified the Appellant will remain
on their waiting list for the IO waiver but the Level One waiver was transferred. Appellant
remains eligible for the Level One waiver in Clark County.
The denial of the IO waiver by the Warren County BODD is correct as the Appellant no longer
lived in Warren County prior to the approval determination by the Ohio Department of
Developmental Disabilities.
HEARING OFFICER’S RECOMMENDATION
Based on the record and policy before me I recommend appeal number 1721158 be overruled.
FINAL DECISION AND ADMINISTRATIVE ORDER
Finding the hearing officer’s decision to be supported by the evidence, the recommendation
above is adopted and the appeal is overruled.
Hearing Authority
January 12, 2012
Notice to Appellant
This is the official report of your hearing and is to inform you of the decision and order in your case. All papers and materials
introduced at the hearing or otherwise filed in the proceeding make up the hearing record. The hearing record will be maintained
by the Ohio Department of Job and Family Services. If you would like a copy of the official record, please telephone the hearing
supervisor at the TOLEDO District hearing section at 1-866-635-3748.
If you believe this state hearing decision is wrong, you may request an administrative appeal by writing to: Ohio Department of
Job and Family Services, Bureau of State Hearings, P.O.BOX 182825, Columbus, OH 43218-2825 or fax: (614) 728-9574.
Your request should include a copy of this hearing decision and an explanation of why you think it is wrong. Your written
request must be received by the Bureau of State Hearings within 15 calendar days from the date this decision is issued. (If the
15th day falls on a weekend or holiday, this deadline is extended to the next work day.) During the 15-day administrative appeal
period you may request a free copy of the tape recording of the hearing by contacting the district hearings section.
If you want information on free legal services but don't know the number of your local legal aid office, you can call the Ohio
State Legal Services Association, toll free, at 1-800-589-5888, for the local number.
Aviso a la Apelante
Esta es la decisión estatal administrativa de su caso. Todos los documentos y materiales presentados como prueba en la vista o de
otra manera radicados componen el récord administrativo. El récord administrativo será mantenido por el Ohio Department of
Job and Family Services.
Si usted cree que esta decisión estatal administrativa es erronea, usted puede solicitar una apelación administrativa escribiendo al:
Ohio Department of Job and Family Services, Bureau of State Hearings, P.O. Box 182825, Columbus, Ohio 43218-2825 o
facsímil (614) 728-9574. Su solicitud debe indicar por qué usted piensa que la decisión administrativa es erronea. Usted puede
completar la solicitud de apelación incluida con esta decisión. Su solicitud escrita o formulario de apelación tiene que ser
recibido por el Bureau of State Hearings dentro de los 15 días calendario desde la fecha en que esta decisión es expedida. (Si el
15to. día recae sobre un fin de semana o un día feriado, esta fecha límite es extendida al próximo día laborable). Durante el
período de 15 días de apelación administrativa, usted o su representante pueden solicitar una copia gratuita del récord
administrativo y de la grabación de la vista llamando al Bureau of State Hearings al 1-866-635-3748 (seleccione la opción 1 del
menú principal).
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STATE HEARING DECISION CONTINUATION
Si usted quiere información sobre servicios legales gratuitos pero no sabe el número de su oficina local de servicios legales, usted
puede llamar al Ohio State Legal Services Association, gratuitamente, al 1-800-589-5888, para el número local.
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STATE HEARING DECISION CONTINUATION
Appellant’s Exhibits
1. State hearing request
2. Individualized Services Plan (ISP), 4 pages
Appendix
Warren County BODD’s Exhibits
A. Appeal summary
B. OAC 5123-2-9-01 HCBS waivers – Enrollment and disenrollment, 6 pages
C. ODMR/DD Notification of Individual Change in Status
D. Warren County BODD Withdrawal/Exit Report
E. State hearing request
F. Individualized Services Plan (ISP), 7 pages
G. Personal Representative Designation Form
H. Individual Input form, 2 pages
I. Acknowledgement of Receipt of Notice of Privacy Practices
J. Self-Administration Assessment, 2 pages
K. Functional Assessment: Ages 16 and Above, 3 pages
L. Level of Care Review, 2 pages
M. Health Insurance Information and Authorization
N. Residential Needs Assessment, 6 pages
O. Cover Letter with Circle of Support and miscellaneous information, 49 pages
P. Warren County BODD Waiting List Questionnaire/Assessment
Q. Level One waiver information, 7 pages
R. Ohio Revised Code 5126.055 Services provided by board that has Medicaid local
administrative authority, 3 pages
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