EMERGENCY RULES
SOCIAL AND HEALTH SERVICES
(Medicaid Program)
Effective Date of Rule: October 27, 2011.
Purpose: To establish hearing rules related to medicaid funded services to implement the requirements of 2E2SBH [2E2SHB] 1738, section 53, effective July 1, 2011, for the transition of the single state medicaid agency to the Washington health care authority.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-526-2610.
Statutory Authority for Adoption: RCW 41.05.021.
Other Authority: 2E2SHB 1738, section 53.
Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest; that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule; and that in order to implement the requirements or reductions in appropriations enacted in any budget for fiscal year 2009, 2010, 2011, 2012 or 2013, which necessitates the need for the immediate adoption, amendment, or repeal of a rule, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the fiscal needs or requirements of the agency.
Reasons for this Finding: 2E2SHB 1738, section 53(10) states that the authority "shall adopt any rules it deems necessary to implement this section" dealing with hearing rights. Further, in section 130, the bill states that "this act is necessary for the immediate preservation of the public peace, health, or safety of the state government and its existing public institution, and takes effect July 1, 2011." Delaying this adoption could jeopardize the agency's ability to provide general hearing rules and procedures that apply to the resolution of disputes between medical assistance clients and the various medical services programs established under chapter 74.09 RCW. This emergency rule is necessary to continue the current emergency rule adopted under WSR 11-14-040 while the permanent rule-making process is completed. The agency filed CR-101 preproposal statement of inquiry under WSR 11-19-004 on September 7, 2011, and is currently following the permanent rules process with internal drafting of the rules, conducting meetings in-house, and scheduling a discussion meeting with interested stakeholders.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, 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 137, Amended 0, Repealed 1.
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 137, Amended 0, Repealed 1.
Date Adopted: October 20, 2011.
Katherine I. Vasquez
Rules Coordinator
4305.3((MEDICAL FAIR HEARINGS)) ADMINISTRATIVE HEARING RULES FOR
MEDICAL SERVICES PROGRAMS
(1) This chapter:
(a) Establishes rules encouraging informal dispute resolution between the health care authority (HCA) or its authorized agents, and persons or entities who disagree with its actions; and
(b) Regulates all hearings involving medical services programs established under chapter 74.09 RCW.
(2) Nothing in this chapter is intended to affect the constitutional rights of any person or to limit or change additional requirements imposed by statute or other rule. Other laws or rules determine if you have a hearing right, including the APA and program rules or laws.
(3) Specific program hearing rules prevail over the rules in this chapter.
(4) The hearing rules in this chapter do not apply to the following programs:
(a) Public employees benefits program (see chapter 182-16 WAC);
(b) Basic health plan program (see chapter 182-22 WAC); and
(c) The Washington health program (see chapter 182-25 WAC).
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"Administrative law judge (ALJ)" means an impartial decision-maker who is an attorney and presides at an administrative hearing. The office of administrative hearings (OAH), which is a state agency, employs the ALJs. ALJs are not department or health care authority employees or representatives.
"Authorized agent" means a person or agency which may act on behalf of HCA pursuant to the agreement authorized by RCW 41.05.021. The authorized agent(s) may include employees of the department or its contractors.
"BOA" means the board of appeals which is physically located within the department of social and health services.
"Business days" means all days except Saturdays, Sundays, and legal holidays.
"Calendar days" means all days including Saturdays, Sundays, and legal holidays.
"Deliver" means giving a document to someone in person.
"Department" means the department of social and health services.
"Documents" means papers, letters, writings, or other printed or written items.
"Final order" means an order that is the final agency decision.
"HCA" means the health care authority.
"Health care authority (HCA) hearing representative" means an employee of HCA, an authorized agent of HCA, HCA contractor or a contractor of HCA's authorized agent, or an assistant attorney general authorized to represent HCA in an administrative hearing.
"Hearing" means a proceeding before an ALJ or review judge that gives a party an opportunity to be heard in disputes about medical services programs set forth in RCW 74.09. For purposes of this chapter, hearings include administrative hearings, adjudicative proceedings, and any other similar term referenced under chapter 34.05 RCW, the administrative procedure act, TITLE 182 WAC except as specifically excluded by WAC 388-526-0005(4), and TITLE 388 WAC, chapter 10-08 WAC, or other law.
"Initial order" is a hearing decision made by an ALJ that may be reviewed by a BOA review judge at either party's request.
"Judicial review" means a superior court's review of a final order.
"Mail" means placing a document in the mail with the proper postage.
"OAH" means the office of administrative hearings, a separate state agency from HCA or the department.
"Party" means:
(1) The health care authority (HCA); or
(2) A person or entity:
(a) Named in the action;
(b) To whom the action is directed; or
(c) Allowed to participate in a hearing to protect an interest as authorized by law or rule.
"Prehearing conference" means a proceeding scheduled and conducted by an ALJ or review judge in preparation for a hearing.
"Prehearing meeting" means an informal voluntary meeting that may be held before any prehearing conference or hearing.
"Program" means an organizational unit and the services that it provides, including services provided by HCA staff, its authorized agents, and through contracts with providers.
"Record" means the official documentation of the hearing process. The record includes recordings or transcripts, admitted exhibits, decisions, briefs, notices, orders, and other filed documents.
"Review" means a review judge evaluating initial orders entered by an ALJ and making the final agency decision as provided by RCW 34.05.464, or issuing final orders.
"Review judge" means a decision-maker with expertise in program rules who is an attorney and serves as the reviewing officer under RCW 34.05.464. In some cases, review judges conduct hearings and enter final orders. In other cases, they review initial orders and may make changes to correct any errors in an ALJ's initial order. After reviewing initial orders or conducting hearings, review judges enter final orders. Review judges are physically located at the DSHS board of appeals (BOA) and are not part of the program involved in the initial agency action.
"Rule" means a state regulation. Rules are found in the Washington Administrative Code (WAC).
"Should" means that an action is recommended but not required.
"Stay" means an order temporarily halting the HCA decision or action.
"You" means any individual or entity that has a right to be involved with the hearing process, which includes a party or a party's representative. "You" does not include HCA or HCA's representatives, or HCA's authorized agents.
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| Chapter 34.05 RCW | Chapter 388-526 WAC |
| Adjudicative proceeding | Different terms are used to refer to different stages of the hearing process and may include prehearing meeting, prehearing conference, hearing, review, reconsideration, and the entire hearing process |
| Application for adjudicative proceeding | Request a hearing |
| Enter | Make, send |
| Presiding officer | Administrative law judge or review judge |
| Reviewing officer | Review judge |
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(2) Good cause may include, but is not limited to, the following examples.
(a) You ignored a notice because you were in the hospital or were otherwise prevented from responding; or
(b) You could not respond to the notice because it was written in a language that you did not understand.
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Office of Administrative Hearings
2420 Bristol Court SW
PO Box 42488
Olympia, WA 98504-2488
(360) 664-8717
(360) 664-8721 (fax)
(b) The headquarters office is open from 8:00 a.m. to
5:00 p.m. Mondays through Friday, except legal holidays.
(2) OAH field offices are at the following locations:
Olympia
Office of Administrative Hearings
2420 Bristol Court SW
P.O. Box 42489
Olympia, WA 98504-2489
(360) 407-2768
1-800-583-8271
fax: (360) 586-6563
Seattle
Office of Administrative Hearings
One Union Square
600 University Street, Suite 1500
Mailstop: TS-07
Seattle, WA 98101-1129
(206) 389-3400
1-800-845-8830
fax: (206) 587-5135
Vancouver
Office of Administrative Hearings
5300 MacArthur Blvd., Suite 100
Vancouver, WA 98661
(360) 690-7189
1-800-243-3451
fax: (360) 696-6255
Spokane
Office of Administrative Hearings
Old City Hall Building, 5th Floor
221 N. Wall Street, Suite 540
Spokane, WA 99201
(509) 456-3975
1-800-366-0955
fax: (509) 456-3997
Yakima
Office of Administrative Hearings
32 N. 3rd Street, Suite 320
Yakima, WA 98901-2730
(509) 249-6090
1-800-843-3491
fax: (509) 454-7281
(3) You should contact the Olympia field office, under
subsection (2), if you do not know the correct field office.
(4) You can obtain further hearing information at the OAH web site: www.oah.wa.gov.
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| Department of Social and Health Services Board of Appeals |
|
| Location | Office Building 2 (OB-2) 2nd Floor 1115 Washington Street Olympia, Washington |
| Mailing address | P.O. Box 45803 Olympia, WA 98504-5803 |
| Telephone | (360) 664-6100 |
| Fax | (360) 664-6187 |
| Toll free | 1-877-351-0002 |
| Internet web site | www.dshs.wa.gov/boa |
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(a) Do not include the day of the action, notice, or order. For example, if a hearing decision is mailed on Tuesday and you have twenty-one days to request a review, start counting the days with Wednesday.
(b) If the last day of the period ends on a Saturday, Sunday, or legal holiday, the deadline is the next business day.
(c) For periods of seven days or less, count only business days. For example, if you have seven days to respond to a review request that was mailed to you on Friday, May 10, the response period ends on Tuesday, May 21.
(d) For periods over seven days, count every day, including Saturdays, Sundays, and legal holidays.
(2) The deadline ends at 5:00 p.m. on the last day.
(3) If you miss a deadline, you may lose your right to a hearing or appeal of a decision.
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(1) A rule requires the OAH to provide notice of a proceeding; and
(2) The OAH does not provide the amount of notice required.
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(2) When sending documents to the office of administrative hearings (OAH) or the board of appeals (BOA), you must mail or deliver the documents to one of the locations listed in WAC 388-526-0025(2) for OAH or in WAC 388-526-0030 for BOA.
(3) When sending documents to your assigned field office, you may use the address listed at the top of your notice of hearing. If a field office has not been assigned, all written communication about your hearing must be sent to the OAH Olympia field office which sends the communication to the correct office.
(4) Documents may be sent by giving them to someone in person, placing them in the mail with proper postage, or by fax or e-mail if the party mails a copy on the same day.
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(1) Personal service (hand delivery);
(2) First class, registered, or certified mail;
(3) Fax if the party mails a copy of the document the same day;
(4) Commercial delivery service; or
(5) Legal messenger service.
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(1) Personal service is made;
(2) Mail is properly stamped, addressed, and deposited in the United States mail;
(3) Fax produces proof of transmission;
(4) A parcel is delivered to a commercial delivery service with charges prepaid; or
(5) A parcel is delivered to a legal messenger service with charges prepaid.
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(1) A sworn statement;
(2) The certified mail receipt signed by the recipient;
(3) An affidavit or certificate of mailing;
(4) A signed receipt from the person who accepted the commercial delivery service or legal messenger service package; or
(5) Proof of fax transmission.
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(2) The date of filing is the date documents are received by OAH or BOA.
(3) Filing is complete when the documents are received by OAH or BOA during office hours.
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(a) Personal service (hand delivery);
(b) First class, registered, or certified mail;
(c) Fax transmission if the party mails a copy of the document the same day;
(d) Commercial delivery service; or
(e) Legal messenger service.
(2) A party cannot file documents by e-mail.
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(a) Any special prehearing alternative or administrative process offered by the program;
(b) Prehearing meeting;
(c) Prehearing conference; and
(d) Hearing.
(2) Because you have a limited time to request a hearing, you must request a hearing within the deadline on the notice of the agency action to preserve your hearing right.
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(2) Some programs may require you to go through an informal administrative process before you can request or have a hearing. The notice of the action sent to you should include information about this requirement if it applies.
(3) You have a limited time to request a hearing. The deadline for your request varies by the program involved. You should submit your request right away to protect your right to a hearing, even if you are also trying to resolve your dispute informally.
(4) If you request a hearing, one is scheduled.
(5) If the health care authority hearing representative or the administrative law judge (ALJ) questions your right to a hearing, the ALJ decides whether you have that right.
(6) If the ALJ decides you do not have a right to a hearing, your request is dismissed.
(7) If the ALJ decides you do have a right to a hearing, the hearing proceeds.
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(1) Contact the specific program involved, the office of administrative hearings, or the board of appeals;
(2) Review the notice sent to you of the action or decision; or
(3) Review the applicable law or program rule.
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(2) If you are allowed to make an oral request, you may do so to a health care authority (HCA) employee, HCA's authorized agent, or to an office of administrative hearings (OAH) employee in person, by telephone, or by voice mail.
(3) You may send a written request by mail, delivery service, personal service, or by fax if you mail a copy the same day. You should send written requests to the location on the notice or to OAH at the location specified in WAC 388-526-0025(2).
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(a) Your name, address, and telephone number;
(b) A brief explanation of why you disagree with the agency action;
(c) Your client identification or case number, contract number, or any other information that identifies your case or the program involved; and
(d) Any assistance you need, including a foreign or sign language interpreter or any other accommodation for a disability.
(2) You should also refer to a program's specific rules or the notice to see if additional information is required in your request.
(3) The office of administrative hearings (OAH) may not be able to process your hearing request if it cannot identify or locate you and determine the agency action involved.
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(2) Before your hearing is held:
(a) The health care authority (HCA) hearing representative may contact you and try to resolve your dispute; and
(b) You are encouraged to contact the HCA hearing representative and try to resolve your dispute.
(3) If you do not appear for your hearing, an administrative law judge may enter an order of default or an order dismissing your hearing according to WAC 388-526-0285.
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(2) If you withdraw your hearing request, you may only set aside the dismissal according to WAC 388-526-0290.
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"Hearing impaired person" means a person who, because of a hearing or speech impairment, cannot readily speak, understand, or communicate in spoken language.
"Intermediary interpreter" means an interpreter who:
(1) Is a certified deaf interpreter (CDI); and
(2) Is able to assist in providing an accurate interpretation between spoken and sign language or between types of sign language by acting as an intermediary between a hearing impaired person and a qualified interpreter.
"Limited English proficient (LEP)" includes limited English speaking persons or other persons unable to communicate in spoken English because of a hearing impairment.
"Limited English-speaking (LES) person" means a person who, because of non-English speaking cultural background or disability, cannot readily speak or understand the English language.
"Qualified interpreter" includes qualified interpreters for a limited English-speaking person or a person with a hearing impairment.
"Qualified interpreter for a limited English-speaking person" means a person who is readily able to interpret or translate spoken and written English communications to and from a limited English-speaking person. If an interpreter is court certified, the interpreter is considered qualified.
"Qualified interpreter for a person with a hearing impairment" means a visual language interpreter who is certified by the registry of interpreters for the deaf or National Association of the Deaf and is readily able to interpret or translate spoken communications to and from a hearing impaired person.
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(1) Be written in your primary language; or
(2) Include a statement in your primary language:
(a) Indicating the importance of the notice; and
(b) Telling you how to get help in understanding the notice and responding to it.
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(a) Has limited English proficiency; and
(b) Is a party or witness in a hearing.
(2) OAH may hire or contract with persons to interpret at hearings.
(3) The following persons may not be used as interpreters:
(a) A relative of any party;
(b) Health care authority (HCA) employees; or
(c) HCA authorized agents.
(4) The administrative law judge (ALJ) must determine, at the beginning of the hearing, if an interpreter can accurately interpret all communication for the person requesting the service. To do so, the ALJ considers the interpreter's:
(a) Ability to meet the needs of the hearing impaired person or limited English speaking person;
(b) Education, certification, and experience;
(c) Understanding of the basic vocabulary and procedures involved in the hearing; and
(d) Ability to be impartial.
(5) The parties or their representatives may question the interpreter's qualifications and ability to be impartial.
(6) If at any time before or during the hearing the interpreter does not provide accurate and effective communication, the ALJ must provide another interpreter.
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(2) You must make your request in writing or through a qualified interpreter on the record.
(3) The administrative law judge must determine if your waiver has been knowingly and voluntarily made.
(4) You may withdraw your waiver at any time before or during the hearing.
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(a) Use the interpretive mode that the parties, the hearing impaired person, the interpreter, and the administrative law judge (ALJ) consider the most accurate and effective;
(b) Interpret statements made by the parties and the ALJ;
(c) Not disclose information about the hearing without the written consent of the parties; and
(d) Not comment on the hearing or give legal advice.
(2) The ALJ must allow enough time for all interpretations to be made and understood.
(3) The ALJ may video tape a hearing and use it as the official transcript for hearings involving a hearing impaired person.
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(2) Interpreters must provide a telephone number where they can be reached. This number must be attached to any decision or order mailed to the parties.
(3) The office of administrative hearings or the board of appeals must mail a copy of a decision or order to the interpreter for use in oral translation.
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(2) Your representative may be a friend, relative, community advocate, attorney, or paralegal.
(3) You should inform the HCA hearing representative or the office of administrative hearings of your representative's name, address, and telephone number.
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(2) If you are represented, your representative should provide the ALJ and other parties with the representative's name, address, and telephone number.
(3) The presiding officer may require your representative to file a written notice of appearance or to provide documentation that you have authorized the representative to appear on your behalf. In cases involving confidential information, your representative must file a legally sufficient signed written consent or release of information document.
(4) If your representative is an attorney admitted to practice in Washington state, your attorney must file a written notice of appearance, and must file a notice of withdrawal upon withdrawal of representation.
(5) If you or your representative put in a written notice of appearance, the ALJ should call the telephone number on the notice of appearance if you, or your representative, do not appear by calling in with a telephone number before a hearing (including a prehearing).
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(1) Acting as a witness;
(2) Referring you to community legal resources;
(3) Helping you get nonconfidential information; or
(4) Informing you about or providing copies of the relevant laws or rules.
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(2) If you want an attorney to represent you and cannot afford one, community resources may be available to assist you. These legal services may be free or available at a reduced cost. HCA, HCA's authorized agent, or OAH can tell you who to contact for legal assistance.
(3) Information about legal assistance can also be found at www.oah.wa.gov.
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(2) An administrative law judge (ALJ) is independent and does not represent HCA or any other party.
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(2) An HCA hearing representative may contact you before the scheduled hearing to arrange a prehearing meeting. You may also contact the HCA hearing representative to request a prehearing meeting.
(3) A prehearing meeting is voluntary. You are not required to request one, and you are not required to participate in one.
(4) The prehearing meeting includes you and/or your representative, the HCA hearing representative, and any other party. An administrative law judge (ALJ) does not attend a prehearing meeting.
(5) The prehearing meeting gives the parties an opportunity to:
(a) Clarify issues;
(b) Exchange documents and witness statements;
(c) Resolve issues through agreement or withdrawal; and
(d) Ask questions about the hearing process and the laws and rules that apply.
(6) A prehearing meeting may be held or information exchanged:
(a) In person;
(b) By telephone conference call;
(c) Through correspondence; or
(d) Any combination of the above that is agreeable to the parties.
(7) If a prehearing conference is required by the program or rule, a prehearing meeting may not be an option available to you.
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(1) A health care authority (HCA) hearing representative:
(a) Explains the role of the HCA hearing representative in the hearing process;
(b) Explains how a hearing is conducted and the relevant laws and rules that apply;
(c) Explains your right to representation during the hearing;
(d) Responds to your questions about the hearing process;
(e) Identifies accommodation and safety issues;
(f) Distributes copies of the documents to be presented during the hearing;
(g) Provides, upon request, copies of relevant laws and rules;
(h) Identifies additional documents or evidence you may want or be required to present during the hearing;
(i) Tells you how to obtain documents from your file;
(j) Clarifies the issues; and
(k) Attempts to settle the dispute, if possible.
(2) You should explain your position and provide documents that relate to your case. You also have the right to consult legal resources.
(3) You and the HCA hearing representative may enter into written agreements or stipulations, including agreements that settle your dispute.
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(2) Any agreements or stipulations made at the prehearing meeting must be presented to an ALJ before or during the hearing, if you want the ALJ to consider the agreement.
(3) If all of your issues are not resolved in the prehearing meeting, you may request a prehearing conference before an ALJ or go to your scheduled hearing. The ALJ may also order a prehearing conference.
(4) You may withdraw your hearing request at any time if the HCA hearing representative agrees to some action that resolves your dispute, or for any other reason. If you withdraw your hearing request, the hearing is not held and the ALJ sends a written order of dismissal.
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(2) An ALJ may conduct the prehearing conference in person, by telephone conference call, or in any other manner acceptable to the parties. Your attendance is mandatory.
(3) You may lose the right to participate during the hearing if you do not attend the prehearing conference.
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(2) The ALJ must grant the first request for a prehearing conference if it is received by the office of administrative hearings (OAH) at least seven business days before the scheduled hearing date.
(3) The ALJ may grant untimely or additional requests for prehearing conferences.
(4) If the parties do not agree to a continuance, the OAH and/or the ALJ must set a prehearing conference to decide whether there is good cause to grant or deny the continuance.
(5) The OAH must schedule prehearing conferences for all cases which concern:
(a) The department's division of residential care services under Title XIX of the federal social security act; and
(b) Provider and vendor overpayment hearings.
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(1) Simplify or clarify the issues to be decided during the hearing;
(2) Agree to the date, time, and place of the hearing;
(3) Identify accommodation and safety issues;
(4) Agree to postpone the hearing;
(5) Allow the parties to make changes in their own documents, including the notice or the hearing request;
(6) Agree to facts and documents to be entered during the hearing;
(7) Set a deadline to exchange names and phone numbers of witnesses and documents before the hearing;
(8) Schedule additional prehearing conferences;
(9) Resolve the dispute;
(10) Consider granting a stay if authorized by law or program rule; or
(11) Determine any other procedural issues raised by the parties.
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(a) The actions taken;
(b) Any changes to the documents;
(c) Any agreements reached; and
(d) Any ruling of the ALJ.
(2) The ALJ must send the prehearing order to the parties at least fourteen calendar days before the scheduled hearing, except a hearing may still occur as allowed under WAC 388-526-0280(5). The parties and the ALJ may agree to a shorter time period.
(3) A party may object to the prehearing order by notifying the ALJ in writing within ten days after the mailing date of the order. The ALJ must issue a ruling on the objection.
(4) If no objection is made to the prehearing order, the order determines how the hearing is conducted, including whether the hearing will be in person or held by telephone conference or other means, unless the ALJ changes the order for good cause.
(5) The ALJ may take further appropriate actions to address other concerns.
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(2) If you do not attend, you may not be allowed to participate in the hearing. The administrative law judge may dismiss your hearing request or enter an order of default against you.
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(2) As needed, the ALJ may:
(a) Determine the order for presenting evidence;
(b) Issue subpoenas or orders directing witnesses to appear or bring documents;
(c) Rule on objections, motions, and other procedural matters;
(d) Rule on an offer of proof made to admit evidence;
(e) Admit relevant evidence;
(f) Impartially question witnesses to develop the record;
(g) Call additional witnesses and request exhibits to complete the record;
(h) Give the parties an opportunity to cross-examine witnesses or present more evidence against the witnesses or exhibits;
(i) Keep order during the hearing;
(j) Allow or require oral or written argument and set the deadlines for the parties to submit argument or evidence;
(k) Permit others to attend, photograph, or electronically record hearings, but may place conditions to preserve confidentiality or prevent disruption;
(l) Allow a party to waive rights given by chapters 34.05 RCW or 388-526 WAC, unless another law prevents it;
(m) Decide whether a party has a right to a hearing;
(n) Issue protective orders;
(o) Consider granting a stay if authorized by law or agency rule; and
(p) Take any other action necessary and authorized under these or other rules.
(3) The ALJ administers oaths or affirmations and takes testimony.
(4) The ALJ enters initial orders. Initial orders may become final orders pursuant to WAC 388-526-0525.
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(2) The review judge enters final agency decisions on all cases in the form of a final order.
(3) Following a review judge's decision, you, but not the health care authority or any of its authorized agents, may file a petition for judicial review as provided by this chapter.
(4) A review judge has the same authority as an administrative law judge, as described in WAC 388-526-0215, when conducting a hearing.
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(2) If no program rule applies, the ALJ or review judge must decide the issue according to the best legal authority and reasoning available, including federal and Washington state constitutions, statutes, regulations, and court decisions.
(3) When applying program rules regarding the substantive rights and responsibilities of the parties (such as eligibility for services, benefits, or a license), the ALJ and review judge must apply the program rules that were in effect on the date the agency notice was sent, unless otherwise required by other rule or law. If the health care authority (HCA) or HCA's authorized agents amends the notice, the ALJ and review judge must apply the rules that were in effect on the date the initial notice was sent, unless otherwise required by other rule or law.
(4) When applying program rules regarding the procedural rights and responsibilities of the parties, the ALJ and review judge must apply the rules that are in effect on the date the procedure is followed.
(5) Program rules determine the amount of time HCA or HCA's authorized agent has to process your application for services, benefits, or a license.
(6) The ALJ and review judge must apply the rules in this chapter beginning on the date each rule is effective.
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(2) The index of significant decisions is available to the public at www.dshs.wa.gov/boa. For information on how to obtain a copy of the index, see WAC 388-01-190.
(3) If a precedential published decision entered by the Court of Appeals or the Supreme Court reverses an indexed board of appeals final order, that order will be removed from the index of significant decisions.
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(2) If the validity of a rule is raised during the hearing, the ALJ or review judge may allow argument for court review.
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(2) Rulings that are not considered discretionary rulings for purposes of this section include but are not limited to those:
(a) Granting or denying a request for a continuance; and
(b) Granting or denying a request for a prehearing conference.
(3) A party must send the written motion of prejudice to the chief ALJ at the OAH headquarters identified in WAC 388-526-0025(1) and must send a copy to the OAH field office where the ALJ is assigned.
(4) A party may make an oral motion of prejudice at the beginning of the hearing before the ALJ rules on a discretionary issue in the case, admits evidence, or takes testimony if:
(a) The OAH did not assign an ALJ at least five business days before the date of the hearing; or
(b) The OAH changed the assigned ALJ within five business days of the date of the hearing.
(5) The first request for a different ALJ is automatically granted. The chief ALJ or a designee grants or denies any later requests.
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(2) Ex parte contact means a written or oral communication with the ALJ or review judge about something related to the hearing when the other parties are not present. Procedural questions are not considered an ex parte contact. Examples of procedural questions include clarifying the hearing date, time, or location or asking for directions to the hearing location.
(3) To ask to disqualify an ALJ or review judge, a party must send a written petition for disqualification. A petition for disqualification is a written explanation to request assignment of a different ALJ or review judge. A party must promptly make the petition upon discovery of possible bias, conflict of interest, or an ex parte contact.
(4) A party must send or deliver the petition to the ALJ or review judge assigned to the case. That ALJ or review judge must decide whether to grant or deny the petition and must state the facts and reasons for the decision.
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(2) The OAH must send a notice of hearing to all parties and their representatives at least fourteen calendar days before the hearing date.
(3) If the OAH schedules a prehearing conference, the OAH must send a notice of prehearing conference to the parties and their representatives at least seven business days before the date of the prehearing conference except:
(a) The OAH and/or an administrative law judge (ALJ) may convert a scheduled hearing into a prehearing conference and provide less than seven business days notice of the prehearing conference; and
(b) The OAH may give less than seven business days notice if the only purpose of the prehearing conference is to consider whether there is good cause to grant a continuance under WAC 388-526-0280 (3)(b).
(4) The OAH and/or the ALJ must reschedule the hearing if necessary to comply with the notice requirements in this section.
(5) If the ALJ denies a continuance after a prehearing conference, the hearing may proceed on the scheduled hearing date, but the ALJ must still issue a written order regarding the denial of the continuance.
(6) You may ask for a prehearing meeting even after you have requested a hearing.
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(a) The names of all parties who receive the notice and, if known, the names and addresses of their representatives;
(b) The name, mailing address, and telephone number of the administrative law judge (ALJ), if known;
(c) The date, time, place, and nature of the hearing;
(d) The legal authority and jurisdiction for the hearing; and
(e) The date of the hearing request.
(2) The office of administrative hearings (OAH) also sends you information with your notice of hearing telling you the following:
(a) If you fail to attend or participate in a prehearing conference or a hearing, you may lose your right to a hearing. Then the ALJ may send:
(i) An order of default against you; or
(ii) An order dismissing the hearing.
(b) If you need a qualified interpreter because you or any of your witnesses are persons with limited English proficiency, OAH will provide an interpreter at no cost to you.
(c) If the hearing is to be held by telephone or in person, and how to request a change in the way it is held.
(d) How to indicate any special needs for yourself or your witnesses, including the need for an interpreter in a primary language or for sensory impairments.
(e) How to contact OAH if a party has a safety concern.
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(2) HCA or HCA's authorized agent must put the change in writing and give a copy to the ALJ and all parties.
(3) The ALJ must offer to continue (postpone) the hearing to give the parties more time to prepare or present evidence or argument if there is a significant change from the earlier agency notice.
(4) If the ALJ grants a continuance, the office of administrative hearings must send a new hearing notice at least fourteen calendar days before the hearing date.
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(2) The ALJ must offer to continue (postpone) the hearing to give the other parties more time to prepare or present evidence or argument if there is a significant change in the hearing request.
(3) If the ALJ grants a continuance, the office of administrative hearings must send a new hearing notice at least fourteen calendar days before the hearing date.
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(2) If you do not notify the HCA hearing representative and OAH of a change in your mailing address and they continue to send notices and other important papers to your last known mailing address, the administrative law judge (ALJ) may assume that you received the documents.
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(2) Before contacting the administrative law judge (ALJ) to request a continuance, a party should contact the other parties, if possible, to find out if they will agree to a continuance. If you are unable to contact the parties, the office of administrative hearings (OAH) or the health care authority hearing representative must assist you in contacting them.
(3) The party making the request for a continuance must let the ALJ know whether the other parties agreed to the continuance.
(a) If the parties agree to a continuance, the ALJ must grant it unless the ALJ finds that good cause for a continuance does not exist.
(b) If the parties do not agree to a continuance, the ALJ must set a prehearing conference to decide whether there is good cause to grant or deny the continuance. The prehearing conference will be scheduled as required by WAC 388-526-0197 and 388-526-0250.
(4) If the ALJ grants a continuance, the OAH must send a new hearing notice at least fourteen calendar days before the new hearing date.
(5) If the ALJ denies the continuance, the ALJ will proceed with the hearing on the date the hearing is scheduled, but must still issue a written order regarding the denial of the continuance.
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(2) If your hearing is dismissed because you did not appear or refused to participate, the agency action stands.
(3) If the hearing is dismissed due to a written agreement between the parties, the parties must follow the agreement.
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(2) If the order of dismissal is vacated, your hearing is reinstated, which means you get another opportunity to have a hearing on your initial request for hearing.
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(2) You may make a late request to vacate the order of dismissal for up to one year after it was mailed but you must show good cause according to WAC 388-526-0020 for the late request to be accepted and the dismissal to be vacated.
(3) If you ask to vacate more than one year after the order was mailed, the administrative law judge may vacate the order of dismissal if the health care authority hearing representative and any other party agrees to waive (excuse) the deadline.
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(2) If your request was timely or you show good cause for missing the deadline, the ALJ will receive evidence and argument at a hearing from the parties on whether the order of dismissal should be vacated.
(3) The ALJ vacates an order of dismissal and reinstates the hearing if you show good cause or if the health care authority hearing representative agrees to waive the deadline. You will then be allowed to present your case about your original request for hearing, either at the same time or at a later date if a continuance is granted.
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(2) An ALJ may deny a request for a subpoena. For example, an ALJ may deny a request for a subpoena when the ALJ determines that a witness has no actual knowledge regarding the facts or that the documents are not relevant.
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(2) Service of a subpoena is complete when the server:
(a) Gives the witness a copy of the subpoena; or
(b) Leaves a copy at the residence of the witness with a person over the age of eighteen.
(3) To prove that a subpoena was served on a witness, the person serving the subpoena must sign a written, dated statement including:
(a) Who was served with the subpoena;
(b) When the subpoena was served;
(c) Where the subpoena was served; and
(d) The name, age, and address of the person who served the subpoena.
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(2) An ALJ may set aside or change a subpoena if it is unreasonable.
(3) Witnesses with safety or accommodation concerns should contact the office of administrative hearings (OAH).
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(1) Serving a subpoena;
(2) Complying with a subpoena; and
(3) Witness fees according to RCW 34.05.446(7).
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(2) A telephone conference hearing is where all parties appear by telephone.
(3) An in-person hearing is where you appear face-to-face with the administrative law judge (ALJ) and the other parties appear either in person or by telephone.
(4) Whether a hearing is held in person or by telephone conference, the parties have the right to see all documents, hear all testimony and question all witnesses.
(5) If a hearing is originally scheduled as an in-person hearing, you may request that the ALJ convert it to a telephone hearing. Once a telephone conference hearing begins, the ALJ may stop, reschedule, and convert the hearing to an in-person hearing if any party makes such a request.
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(2) If your hearing is scheduled as a telephone conference, an ALJ is present by telephone.
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(2) Witnesses may be excluded from the hearing if the administrative law judge (ALJ) finds good cause.
(3) The ALJ may also exclude other persons from all or part of the hearing.
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(a) A hearing format be converted (changed) from an in-person hearing to a telephone conference or from a telephone conference to an in-person hearing; or
(b) A witness appear in person or by telephone conference. The office of administrative hearings (OAH) must advise you of the right to request a change in how a witness appears.
(2) A party must show a compelling reason to change the way a witness appears (in-person or by telephone conference). Some examples of compelling reasons are:
(a) A party does not speak or understand English well.
(b) A party wants to present a significant number of documents during the hearing.
(c) A party does not believe that one of the witnesses or another party is credible, and wants the administrative law judge (ALJ) to have the opportunity to see the testimony.
(d) A party has a disability or communication barrier that affects their ability to present their case.
(e) A party believes that the personal safety of someone involved in the hearing process is at risk.
(3) A compelling reason to convert the way a witness appears at a hearing can be overcome by a compelling reason not to convert how a witness appears for a hearing.
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(2) The administrative law judge (ALJ) may schedule a prehearing conference to determine if the request should be granted.
(3) If the ALJ grants the request, the ALJ reschedules the hearing or changes how the witness or party appears.
(4) If the ALJ denies the request, the ALJ must issue a written order that includes findings of fact supporting why the request was denied.
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(2) The health care authority hearing representative may be able to help you copy and send your documents to the ALJ and any other parties.
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(1) The administrative law judge (ALJ):
(a) Explains your rights;
(b) Marks and admits or rejects exhibits;
(c) Ensures that a record is made;
(d) Explains that a decision is mailed after the hearing;
(e) Notifies the parties of appeal rights;
(f) May keep the record open for a time after the hearing if needed to receive more evidence or argument; and
(g) May take actions as authorized according to WAC 388-526-0215.
(2) The parties may:
(a) Make opening statements to explain the issues;
(b) Offer evidence to prove their positions, including oral or written statements of witnesses;
(c) Question the witnesses presented by the other parties; and
(d) Give closing arguments about what the evidence shows and what laws apply.
(3) At the end of the hearing if the ALJ does not allow more time to send in evidence, the record is closed.
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(2) Hearings may be combined at the request of the parties or the administrative law judge.
(3) All parties participating in a group hearing may have their own representative.
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(2) If a party asks to withdraw from a group hearing before the ALJ makes a discretionary ruling or the hearing begins, the ALJ must give the party a separate hearing.
(3) If a party later shows good cause, the ALJ may give the party a separate hearing at any time during the hearing process.
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(1) When you file a single application for an adjudicative proceeding seeking review of decisions by more than one agency, this review shall be conducted initially in one adjudicative proceeding. The administrative law judge (ALJ) may sever the proceeding into multiple proceedings on the motion of any of the parties, when:
(a) All parties consent to the severance; or
(b) Either party requests severance without another party's consent, and the ALJ finds there is good cause for severing the matter and that the proposed severance is not likely to prejudice the rights of an appellant who is a party to any of the severed proceedings.
(2) If there are multiple adjudicative proceedings involving common issues or parties where there is one appellant and both the health care authority and the department are parties, upon motion of any party or upon his or her own motion, the ALJ may consolidate the proceedings if he or she finds that the consolidation is not likely to prejudice the rights of the appellant who is a party to any of the consolidated proceedings.
(3) If the ALJ grants the motion to sever the hearing into multiple proceedings or consolidate multiple proceedings into a single proceeding, the ALJ will send out an order and a new notice of hearing to the appropriate parties in accordance with WAC 388-526-0250.
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(2) Evidence may be all or parts of original documents or copies of the originals.
(3) Parties may offer statements signed by a witness under oath or affirmation as evidence, if the witness cannot appear.
(4) Testimony given with the opportunity for cross-examination by the other parties may be given more weight by the administrative law judge.
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(2) The administrative law judge (ALJ) may set a deadline before the hearing for the parties to provide proposed exhibits and names of witnesses. If the parties miss the deadline, the ALJ may refuse to admit the evidence unless the parties show:
(a) They have good cause for missing the deadline; or
(b) That the other parties agree.
(3) If the ALJ gives the parties more time to submit evidence, the parties may send it in after the hearing. The ALJ may allow more time for the other parties to respond to the new evidence.
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(1) The other parties may object to the evidence and question the witnesses;
(2) The administrative law judge (ALJ) determines whether the evidence is admitted and what weight (importance) to give it;
(3) If the ALJ does not admit the evidence the parties may make an offer of proof to show why the ALJ should admit it;
(4) To make an offer of proof a party presents evidence and argument on the record to show why the ALJ should consider the evidence; and
(5) The offer of proof preserves the argument for appeal.
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(2) If an administrative law judge (ALJ) accepts a stipulation, the ALJ must enter it into the record.
(3) A stipulation may be made before or during the hearing.
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(2) To change or reject a stipulation, a party must show the administrative law judge that:
(a) The party did not intend to make the stipulation or was mistaken when making it; and
(b) Changing or rejecting the stipulation does not harm the other parties.
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(2) The administrative law judge (ALJ) may request that you mark and number your proposed exhibits before the hearing. You should bring enough copies of your proposed exhibits for all parties. If you do not bring enough copies, you must make your proposed exhibits available for copying.
(3) If you cannot afford to pay for copies of proposed exhibits, either the HCA hearing representative or the office of administrative hearings must make the copies for you.
(4) The ALJ may require proof that you are unable to pay.
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(2) The ALJ admits proposed exhibits into the record by marking, listing, identifying, and admitting the proposed exhibits.
(3) The ALJ may also exclude proposed exhibits from the record.
(4) The ALJ must make rulings on the record to admit or exclude exhibits.
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(2) Even if a party agrees that a proposed exhibit is a true and authentic copy of a document, the agreement does not mean that a party agrees with:
(a) Everything in the exhibit or agrees that it should apply to the hearing;
(b) What the exhibit says; or
(c) How the administrative law judge should use the exhibit to make a decision.
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(2) Sending the proposed exhibits to the ALJ before the telephone hearing allows all parties to use them during the hearing.
(3) For a telephone hearing, the health care authority hearing representative may help you send copies of your proposed exhibits to the ALJ and the other parties if you cannot afford to do so.
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(2) For example, an administrative law judge may take judicial notice of a calendar, a building code or a standard or practice.
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(2) If a party requests judicial notice, or if the ALJ intends to take judicial notice, the ALJ may ask the party to provide a copy of the document that contains the information.
(3) If judicial notice has been requested, or if the ALJ intends to take judicial notice, the ALJ must tell the parties before or during the hearing.
(4) The ALJ must give the parties time to object to judicial notice evidence.
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(2) One type of witness is an expert witness. An expert witness is qualified by knowledge, experience, and education to give opinions or evidence in a specialized area.
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(a) You or the health care authority (HCA) hearing representative; or
(b) Anyone you, the administrative law judge (ALJ), or the HCA hearing representative asks to be a witness.
(2) The ALJ decides who may testify as a witness.
(3) An expert witness may not be a former HCA employee, a former HCA authorized agent, or a former employee of the department in the proceeding against HCA or the department if that employee was actively involved in the agency action while working for HCA or the department, unless the HCA hearing representative agrees.
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(1) Must affirm or take an oath to testify truthfully during the hearing.
(2) May testify in person or by telephone.
(3) May request interpreters from OAH at no cost to you.
(4) May be subpoenaed and ordered to appear according to WAC 388-526-0315.
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(2) If a party has a representative, only the representative, and not the party, may question the witness.
(3) The administrative law judge may also question witnesses.
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(2) Admission of evidence is based upon the reasonable person standard. This standard means evidence that a reasonable person would rely on in making a decision.
(3) The ALJ may admit and consider hearsay evidence. Hearsay is a statement made outside of the hearing used to prove the truth of what is in the statement. The ALJ may only base a finding on hearsay evidence if the ALJ finds that the parties had the opportunity to question or contradict it.
(4) The ALJ may reject evidence, if it:
(a) Is not relevant;
(b) Repeats evidence already admitted; or
(c) Is from a privileged communication protected by law.
(5) The ALJ must reject evidence if required by law.
(6) The ALJ decides:
(a) What evidence is more credible if evidence conflicts; and
(b) The weight given to the evidence.
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(a) Provide evidence regarding disputed facts; and
(b) Persuade the administrative law judge (ALJ) that a position is correct.
(2) To persuade the ALJ, the party who has the burden of proof must provide the amount of evidence required by WAC 388-526-0485.
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(2) There are five elements of equitable estoppel. The standard of proof is clear and convincing evidence. You must prove all of the following:
(a) The agency made a statement or took an action or failed to take an action, which is inconsistent with a later claim or position by the agency. For example, the agency or one of its authorized agents gave you money based on your application, then later tells you that you received an overpayment and wants you to pay the money back based on the same information.
(b) You reasonably relied on the agency's original statement, action or failure to act. For example, you believed the agency acted correctly when you received money.
(c) You will be injured to your detriment if the agency is allowed to contradict the original statement, action or failure to act. For example, you did not seek nongovernmental assistance because you were receiving benefits from the agency, and you would have been eligible for these other benefits.
(d) Equitable estoppel is needed to prevent a manifest injustice. Factors to be considered in determining whether a manifest injustice would occur include, but are not limited to, whether:
(i) You cannot afford to repay the money to the agency;
(ii) You gave the agency timely and accurate information when required;
(iii) You did not know that the agency made a mistake;
(iv) You are free from fault; and
(v) The overpayment was caused solely by an agency mistake.
(e) The exercise of government functions is not impaired. For example, the use of equitable estoppel in your case will not result in circumstances that will impair agency functions.
(3) If the ALJ concludes that you have proven all of the elements of equitable estoppel in subsection (2) of this section with clear and convincing evidence, the agency is stopped or prevented from taking action or enforcing a claim against you.
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(1) Set another hearing date;
(2) Enter orders to address limited issues if needed before writing and mailing a hearing decision to resolve all issues in the proceeding; or
(3) Give the parties more time to send in exhibits or written argument.
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(1) At the end of the hearing if the administrative law judge does not allow more time to send in evidence or argument; or
(2) After the deadline for sending in evidence or argument is over.
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(2) The official record must include, if applicable:
(a) Notice of all proceedings;
(b) Any prehearing order;
(c) Any motions, pleadings, briefs, petitions requests, and intermediate rulings;
(d) Evidence received or considered;
(e) A statement of matters officially noticed;
(f) Offers of proof, objections, and any resulting rulings;
(g) Proposed findings, requested orders and exceptions;
(h) A complete audio recording of the entire hearing, together with any transcript of the hearing;
(i) Any final order, initial order, or order on reconsideration; and
(j) Matters placed on the record after an ex parte communication.
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(2) The maximum time an ALJ has to send a decision is ninety calendar days after the record is closed, but many programs have earlier deadlines. Specific program rules may set the deadlines.
(3) The office of administrative hearings must send the official record of the proceedings to the board of appeals. The record must be complete when it is sent, and include all parts required by WAC 388-526-0512.
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(1) Identify the hearing decision as a health care authority case;
(2) List the name and docket number of the case and the names of all parties and representatives;
(3) Find the facts used to resolve the dispute based on the hearing record;
(4) Explain why evidence is credible when the facts or conduct of a witness is in question;
(5) State the law that applies to the dispute;
(6) Apply the law to the facts of the case in the conclusions of law;
(7) Discuss the reasons for the decision based on the facts and the law;
(8) State the result and remedy ordered;
(9) Explain how to request changes in the decision and the deadlines for requesting them;
(10) State the date the decision becomes final according to WAC 388-526-0525; and
(11) Include any other information required by law or program rules.
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(2) If a party disagrees with an initial order and wants it changed, the party must request review by a review judge as provided in WAC 388-526-0560 through 388-526-0595.
If a party wants to stay the agency action until review of the initial order is completed, the party must request a stay from a review judge.
(3) Final orders entered by ALJs may not be reviewed by a review judge.
(4) If a party disagrees with an ALJ's final order, the party may request reconsideration as provided in WAC 388-526-0605 through 388-526-0635. You may also petition for judicial review of the final order as stated in WAC 388-526-0640 through 388-526-0650. You do not need to file a request for reconsideration of the final order before petitioning for judicial review. The health care authority may not request judicial review of an ALJ's or review judge's final order.
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(2) The administrative law judge corrects clerical errors in hearing decisions by issuing a second decision referred to as a corrected decision or corrected order. Corrections may be made to initial orders and final orders.
(3) Some examples of clerical error are:
(a) Missing or incorrect words or numbers;
(b) Dates inconsistent with the decision or evidence in the record such as using May 3, 1989, instead of May 3, 1998; or
(c) Math errors when adding the total of an overpayment.
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(2) When asking for a corrected decision, please identify the clerical error you found.
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(2) If you ask the ALJ to correct a decision, the time period provided by this section for requesting a corrected decision of an initial order, and the time it takes the ALJ to deny the request or make a decision regarding the request for a corrected initial order, do not count against any deadline, if any, for a review judge to enter a final order.
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(a) Send all parties a corrected order; or
(b) Deny the request within three business days of receiving it.
(2) If the ALJ corrects an initial order and a party does not request review, the corrected initial order becomes final twenty-one calendar days after the original initial order was mailed.
(3) If the ALJ denies a request for a corrected initial order and the party still wants the hearing decision changed, the party must request review by a review judge.
(4) Requesting an ALJ to correct the initial order does not automatically extend the deadline to request review of the initial order by a review judge. When a party needs more time to request review of an initial order, the party must ask for more time to request review as permitted by WAC 388-526-0580(2).
(5) If the ALJ denies a request for a corrected final order and you still want the hearing decision changed, you must request judicial review.
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(2) If a party wants the initial order changed, the party must request that a review judge review the initial order.
(3) If a request is made for a review judge to review an initial order, it does not mean there is another hearing conducted by a review judge.
(4) The review judge considers the request, the initial order, and the record, and may hear oral argument, before deciding if the initial order should be changed.
(5) Review judges may not review ALJ final orders.
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(2) The review judge may allow the parties to make oral argument when reviewing initial orders.
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(2) If more than one party requests review, each request must meet the deadlines in WAC 388-526-0580.
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(1) Parts of the initial order with which the party disagrees; and
(2) Evidence supporting the party's position.
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(2) A review judge may extend the deadline if a party:
(a) Asks for more time before the deadline expires; and
(b) Gives a good reason for more time.
(3) A review judge may accept a review request after the twenty-one calendar day deadline only if:
(a) The BOA receives the review request on or before the thirtieth calendar day after the deadline; and
(b) A party shows good cause for missing the deadline.
(4) If you ask a review judge to review an administrative law judge decision, the time period provided by this section for requesting review of an initial order, including any extensions, does not count against any deadline, if any, for a review judge to enter the final order.
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(2) After receiving a party's review request, BOA sends a copy to the other parties, their representatives, and the office of administrative hearings. The other parties and their representatives may respond as described in WAC 388-526-0590.
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(2) If a party decides to respond, that party must send the response so that the board of appeals (BOA) receives it on or before the seventh business day after the date the other party's review request was mailed to the party by the BOA.
(3) The party should send a copy of the response to all other parties or their representatives.
(4) A review judge may extend the deadline in subsection (2) of this section if a party asks for more time before the deadline to respond expires and gives a good reason.
(5) If you ask for more time to respond, the time period provided by this section for responding to the review request, including any extensions, does not count against any deadline, if any, for a review judge to enter the final order. A review judge may accept and consider a party's response even if it is received after the deadline.
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(2) A review judge is assigned to review the initial order after the record is closed. To find out which judge is assigned, call the board of appeals.
(3) After the record is closed, the assigned review judge:
(a) Reviews the initial order; and
(b) Enters a final order that affirms, changes, dismisses or reverses the initial order; or
(c) Returns the case to the office of administrative hearings for further action.
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(2) Review judges may return (remand) cases to the office of administrative hearings for further action.
(3) In cases where there is a consolidated hearing pursuant to WAC 388-526-0387, any party may request review of the initial order in accordance with the requirements contained in this chapter.
(4) A review judge conducts the hearing and enters the final order in cases covered by WAC 388-526-0218.
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(a) Ask the administrative law judge (ALJ) to reconsider the decision, if the final order was entered by an ALJ; or
(b) Ask the review judge to reconsider the decision, if the final order was entered by a review judge.
(2) The final order or the reconsideration decision is the final agency decision. If you disagree with that decision, you must petition for judicial review to change it.
(3) You may ask the court to stay or stop the agency action after filing the petition for judicial review.
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(a) Asking an administrative law judge (ALJ) to reconsider a final order entered by the ALJ because the party believes the ALJ made a mistake; or
(b) Asking a review judge to reconsider a final order entered by a review judge because the party believes the review judge made a mistake.
(2) If a party asks for reconsideration of the final order, the reconsideration process must be completed before you request judicial review. However, you do not need to request reconsideration of a final order before you request judicial review.
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(2) If the board of appeals (BOA) entered the final order, BOA must receive a written reconsideration request on or before the tenth calendar day after the final order was mailed.
(3) If a reconsideration request is received after the deadline, the final order will not be reconsidered and the deadline to ask for superior court review continues to run.
(4) OAH or BOA may extend its deadline if a party:
(a) Asks for more time before the deadline expires; and
(b) Gives a good reason for the extension.
(5) If a party does not request reconsideration or ask for an extension within the deadline, the final order may not be reconsidered and it becomes the final agency decision.
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(2) After receiving a reconsideration request, OAH or BOA sends a copy to the other parties and representatives and gives them time to respond.
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(2) If a party responds, that party must send a response to the office of administrative hearings (OAH) if OAH entered the final order, or to the board of appeals (BOA) if BOA entered the final order, by or before the seventh business day after the date OAH or BOA mailed the request to the party.
(3) A party must send a copy of the response to any other party or representative.
(4) If a party needs more time to respond, OAH or BOA may extend its deadline if the party gives a good reason within the deadline in subsection (2) of this section.
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(2) After OAH or BOA receives a reconsideration request, the ALJ or review judge must either:
(a) Write a reconsideration decision; or
(b) Send all parties an order denying the request.
(3) If the ALJ or review judge does not send an order or notice granting more time within twenty days of receipt of the reconsideration request, the request is denied.
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(2) You may appeal a final order by filing a written petition for judicial review that meets the requirements of RCW 34.05.546. HCA may not request judicial review.
(3) You must consult RCW 34.05.510 to 34.05.598 for further details of the judicial review process.
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(2) Generally, you may file a petition for judicial review only after you have completed the administrative hearing process. However, you do not need to file a request for reconsideration of a final order before requesting judicial review.
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(2) To serve HCA, you must deliver a copy of the petition to the director of HCA or to the board of appeals (BOA). You may hand deliver the petition or send it by mail that gives proof of receipt. The physical location of the director is:
Director
Health Care Authority
626 8th Avenue SE
Olympia, WA 98501
The mailing address of the director is:
Director
Health Care Authority
P.O. Box 45502
Olympia, WA 98504-5502
The physical and mailing addresses for BOA are in WAC 388-526-0030.
(3) To serve the office of the attorney general and other parties, you may send a copy of the petition for judicial review by regular mail. You may send a petition to the address for the attorney of record to serve a party. You may serve the office of the attorney general by hand delivery to:
Office of the Attorney General
7141 Cleanwater Drive S.W.
Tumwater, Washington 98501
The mailing address of the attorney general is:
Office of the Attorney General
P.O. Box 40124
Olympia, WA 98504-0124
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The following section of the Washington Administrative Code is repealed:
| WAC 388-526-2610 | Prehearing reviews for clients who request a fair hearing. |