WSR 97-01-092
PROPOSED RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Public Assistance)
[Filed December 18, 1996, 11:49 a.m.]
Original Notice.
Exempt from preproposal statement of inquiry under RCW 34.05.310(4).
Title of Rule: WAC 388-538-110 Client grievances.
Purpose: To amend the rule to correct the cross reference in subsection (2)(a) from (2)(c) to (3).
Statutory Authority for Adoption: RCW 74.08.090.
Summary: Amend WAC 388-38-110 (2)(a) to give the correct cross reference to (3).
Reasons Supporting Proposal: Prior cross reference was incorrect.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Bobbe Andersen, Medical Assistance Administration, 617 8th S.E., Olympia, WA, (360) 753-0529.
Name of Proponent: Department of Social and Health Services, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: This amendment will change an incorrect cross reference to a correct one.
Proposal Changes the Following Existing Rules: Changes the cross reference in subsection (2)(a) of WAC 388-538-110.
No small business economic impact statement has been prepared under chapter 19.85 RCW. No businesses are affected by this change.
Section 201, chapter 403, Laws of 1995, does not apply to this rule adoption. This section does not apply to the Department of Social and Health Services.
Hearing Location: Lacey Government Center, 1009 College Street S.E., Room 104-B (behind Tokyo Bento restaurant), Lacey, WA 98503, on January 22, 1997, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Merry Kogut, Manager by January 8, 1997, TTY (360) 902-8324, (360) 902-8317.
Submit Written Comments to: Merry Kogut, Manager, Rules and Policies Assistance Unit, P.O. Box 45800, Olympia, WA 98504, FAX (360) 902-8292, by January 22, 1997.
Date of Intended Adoption: January 23, 1997.
December 16, 1996
Merry A. Kogut, Manager
Rules and Policies Assistance Unit
AMENDATORY SECTION (Amending Order 3886, filed 8/29/95, effective 9/1/95)
WAC 388-538-110 Client grievances. (1) A client aggrieved by a decision of a managed care contractor or the department shall have the right to a fair hearing as required under WAC 388-81-040.
(2) A client enrolled in a plan:
(a) Shall exhaust a plan's grievance procedure before requesting a
fair hearing, except as provided in subsection (((2)(c))) (3) of this
section;
(b) Shall receive a written decision containing the following information:
(i) Action the plan intends to take;
(ii) Reasons for the intended action;
(iii) The specific information supporting the action;
(iv) Client's right to request a fair hearing;
(v) Full translation into the primary language of the limited English proficient recipient.
(c) May request a fair hearing when a:
(i) Grievance decision is adverse;
(ii) Plan does not respond in writing within thirty days from the date the client requests the grievance.
(3) The client may request a fair hearing at the same time a grievance is filed when:
(a) The plan denies medical care that a client indicates is urgently needed and the client requests a grievance in writing; or
(b) The subject matter of the grievance is one for which a client has a fair hearing right under chapters 34.05 RCW, 388-08 WAC, or this chapter.
(4) The managed care contractor shall advise a client of the
client's right to request a fair hearing at the time the contractor
notifies the client of the grievance decision.
[Statutory Authority: RCW 74.08.090 and 1995 2nd sp.s. c 18. 95-18-046 (Order 3886), 388-538-110, filed 8/29/95, effective 9/1/95. Statutory Authority: RCW 74.08.090. 94-04-038 (Order 3701), 388-538-110, filed 1/26/94, effective 2/26/94; 93-17-039 (Order 3621), 388-538-110, filed 8/11/93, effective 9/11/93.]