WSR 13-22-094 PERMANENT RULES HEALTH CARE AUTHORITY (Medicaid Program) [Filed November 6, 2013, 10:51 a.m., effective December 7, 2013] Effective Date of Rule: Thirty-one days after filing.
Purpose: This rule amendment is necessary for implementation of the Affordable Care Act on January 1, 2014. The health care authority is creating new WAC 182-526-0102 to address coordinating appeals with the Washington health benefits exchange.
Statutory Authority for Adoption: RCW 41.05.021; 42 C.F.R. § 431, 435, and 457; 45 C.F.R. § 155.
Other Authority: Patient Protection and Affordable Care Act (Public Law 111-148).
Adopted under notice filed as WSR 13-20-142 on October 2, 2013.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 1, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.
Date Adopted: November 6, 2013.
Kevin M. Sullivan
Rules Coordinator
NEW SECTION
WAC 182-526-0102 Coordinated appeals process with the Washington health benefits exchange.
(1) The health care authority (HCA) coordinates with the Washington state health benefits exchange (HBE) to ensure a seamless appeal process for determinations related to eligibility for Washington apple health (WAH) when the modified adjusted gross income (MAGI) methodology is used as described in WAC 182-509-0305. (2) An applicant, recipient, or an authorized representative of an applicant or recipient may request a WAH hearing: (a) By telephone; (b) By mail (which should be sent to Health Care Authority, P.O. Box 45504, Olympia, WA 98504-5504); (c) In person; (d) By facsimile transmission; (e) By e-mail; or (f) By any other commonly available electronic means. (3) When an applicant or recipient appeals an HBE determination of eligibility for health insurance premium tax credits (HIPTC) or cost-sharing reductions with HBE and also requests a hearing with the health care authority related to WAH eligibility, the ALJ will not require the applicant or recipient to submit information to the ALJ that the applicant or recipient previously submitted to HBE. (4) If an applicant or recipient submits to HBE a request for a hearing related to WAH eligibility, the ALJ will accept the date HBE received the request for the hearing as the date filed for the purposes of timeliness standards and will treat it as a valid hearing request. (5) If the applicant or recipient appeals only the determination related to WAH eligibility, subsection (3) of this section does not apply.
|