State Hearing Decision - Hearing Decisions

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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 Page 2 of 5
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). Page 3 of 5
Page 1: OHIO DEPARTMENT OF JOB AND FAMILY S
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State Hearing Decision - Hearing Decisions

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