WSR 14-13-101
PERMANENT RULES
DEPARTMENT OF HEALTH
[Filed June 17, 2014, 1:49 p.m., effective July 18, 2014]
Effective Date of Rule: Thirty-one days after filing.
Purpose: Chapter 246-120 WAC creates a new chapter clarifying the secretary of health's authority to issue civil penalties against health carriers and third-party administrators. WAC 246-10-501, amending the application of brief adjudicative proceedings to allow adjudicative proceedings involving civil penalties against health carriers and third-party administrators to be conducted under brief adjudicative proceedings.
Citation of Existing Rules Affected by this Order: Amending WAC 246-10-501.
Statutory Authority for Adoption: RCW 70.290.060.
Other Authority: Chapter 70.290 RCW.
Adopted under notice filed as WSR 14-08-085 on April 1, 2014.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 5, Amended 1, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 5, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 5, Amended 1, Repealed 0.
Date Adopted: June 12, 2014.
Dennis Worsham
Deputy Secretary for
Public Health Operations
for John Wiesman, DrPH, MPH
Secretary
AMENDATORY SECTION (Amending WSR 13-19-087, filed 9/18/13, effective 10/19/13)
WAC 246-10-501 Application of brief adjudicative proceedings.
(1) If an adjudicative proceeding is requested, a brief adjudicative proceeding will be conducted where the matter involves one or more of the following:
(a) A determination whether an applicant for a professional, business, or facility license meets the minimum criteria for an unrestricted license and the department proposes to deny such a license or to issue a restricted license;
(b) An application to approve a water system plan under WAC 246-290-100;
(c) An application to approve a project report under WAC 246-290-110;
(d) An application for source approval under WAC 246-290-130;
(e) An application to approve construction documents under WAC 246-290-120;
(f) An application to approve an existing Group A water system under WAC 246-290-140;
(g) An application for source approval under WAC 246-291-100 or 246-291-110;
(h) An application to approve a design report under WAC 246-291-120;
(i) An application to approve an existing Group B water system under WAC 246-291-130;
(j) An application to approve a water system plan under WAC 246-291-140;
(k) A decision under WAC 246-293-190;
(l) A decision with respect to service area conflicts under WAC 246-293-430;
(m) An application for approval as a satellite management agency under WAC 246-295-040;
(n) A civil penalty imposed under RCW 70.119A.040 when the amount of the civil penalty does not exceed two thousand five hundred dollars;
(o) A request to bank nursing home beds under RCW 70.38.111(8) and 70.38.115(13);
(p) A determination as to whether a person is in compliance with the terms and conditions of a final order previously issued by the department;
(q) Any approval of a school or curriculum when such approval by the department is required or authorized by statute or rule;
(r) A determination whether a license holder requesting renewal has submitted all required information and meets minimum criteria for license renewal;
(s) A decision to deny, modify, or impose conditions upon an operating permit under WAC 246-294-050; ((or))
(t) A decision to deny or revoke certification as a home care aide when a long-term care worker is disqualified from working with vulnerable persons under chapter 74.39A RCW; or
(u) A civil penalty imposed against a health carrier or third-party administrator under RCW 70.290.060.
(2) If an adjudicative proceeding is requested, in a matter not listed in subsection (1) of this section, a brief adjudicative proceeding may be conducted in the discretion of the presiding officer when it appears that protection of the public interest does not require that the department provide notice and an opportunity to participate to persons other than the parties and:
(a) Only legal issues exist; or
(b) Both parties have agreed to a brief proceeding.
Chapter  246-120  WAC
CIVIL PENALTIES OF HEALTH CARRIERS AND THIRD-PARTY ADMINISTRATORS
NEW SECTION
WAC 246-120-010 Purpose.
The purpose of this chapter is to describe the procedures and conditions by which the secretary must issue civil penalties to health carriers and third-party administrators. This chapter is adopted under RCW 70.290.060.
NEW SECTION
WAC 246-120-020 Definitions.
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise:
(1) "Health carrier" has the same meaning as defined in RCW 70.290.010.
(2) "Secretary" means the secretary of the department of health.
(3) "Third-party administrator" has the same meaning as defined in RCW 70.290.010.
(4) "Washington vaccine association" or "association" means the association created under chapter 70.290 RCW. The association collects and remits adequate funds from health carriers and third-party administrators for the cost of vaccines provided to certain children in Washington state.
NEW SECTION
WAC 246-120-030 Penalty—Failure to reimburse audit costs.
(1) Following a compliance audit by Washington vaccine association pursuant to RCW 70.290.060 and upon certification of the audit costs, the Washington vaccine association shall notify the health carrier or third-party administrator in writing that there is an outstanding obligation to reimburse the Washington vaccine association for the cost of the audit.
(2) The health carrier or third-party administrator must reimburse the Washington vaccine association for the cost of the audit within forty-five days after receiving written notice of the obligation.
(3) The Washington vaccine association shall notify the secretary if the health carrier or third-party administrator fails to timely reimburse the Washington vaccine association for the cost of the audit. Upon receipt of such notice, the secretary shall assess a civil penalty of one hundred fifty percent of the amount of the costs of the audit against the health carrier or third-party administrator.
(4) The secretary shall serve notice of the civil penalty for failure to pay the audit costs in writing upon the health carrier or third-party administrator by personal service or by certified mail in a manner that shows proof of receipt. The civil penalty is due and payable twenty-eight days at the place specified in the notice after receipt by the health carrier or third-party administrator.
(5) A health carrier or third-party administrator who has received written notification of an assessed civil penalty according to this section may request a brief adjudicative proceeding pursuant to WAC 246-120-050. The sole issue at the brief adjudicative proceeding shall be whether the health carrier or third-party administrator paid the cost of the audit in the required time and manner.
NEW SECTION
WAC 246-120-040 Penalty—Failure to remit assessment.
(1) Following Washington vaccine association's notice of assessment pursuant to RCW 70.290.060 and the plan of operation, the health carrier or third-party administrator must remit the amount of the assessment to the Washington vaccine association within ninety days after receiving the written notice or timely pay in accordance with an approved payment plan with the Washington vaccine association.
(2) The Washington vaccine association shall notify the secretary if the health carrier or third-party administrator fails to pay the amount of the assessment or, after notification from the Washington vaccine association to the health carrier or third-party administrator of an outstanding obligation, the amount owed on the approved payment plan. The notice must provide the amount due to the Washington vaccine association. Upon receipt of such notice, the secretary shall assess a civil penalty of one hundred fifty percent of the assessment amount due against the health carrier or third-party administrator.
(3) The secretary shall serve notice of the civil penalty for failure to pay the assessment or amount owed on the approved payment plan in writing upon the health carrier or third-party administrator by personal service or by certified mail in a manner that shows proof of receipt. The civil penalty is due and payable twenty-eight days at the place specified in the notice after receipt by the health carrier or third-party administrator.
(4) A health carrier or third-party administrator who has received written notification of an assessed civil penalty according to this section may request a brief adjudicative proceeding pursuant to WAC 246-120-050. The sole issue at the brief adjudicative proceeding shall be whether the health carrier or third-party administrator failed to pay the annual assessment or the amount owed on the approved payment plan in the required time and manner.
NEW SECTION
WAC 246-120-050 Request for a brief adjudicative proceeding.
(1) A health carrier or third-party administrator who has received written notification of an assessed civil penalty according to this chapter may request a brief adjudicative proceeding pursuant to chapter 34.05 RCW.
(2) The application for a brief adjudicative proceeding must:
(a) Be in writing;
(b) State the basis for contesting the civil penalty;
(c) Include a copy of the adverse notice;
(d) Be served on and received by the department within twenty-eight days of the health carrier or third-party administrator receiving the notice of a civil penalty; and
(e) Be served in a manner which shows proof of receipt at the following address:
Adjudicative Clerk Office
310 Israel Rd. S.E.
Olympia, WA 98504-7879
(3) If a health carrier or third-party administrator files a timely and sufficient application for a brief adjudicative proceeding, the secretary shall not implement the action for the civil penalty until the final order is entered. The presiding or reviewing officer may permit the secretary to implement part or all of the action while the proceedings are pending, if the health carrier or third-party administrator causes an unreasonable delay in the proceedings or for other good cause.