SOCIAL AND HEALTH SERVICES
[Filed January 24, 1997, 9:01 a.m.]
Date of Adoption: January 23, 1997.
Purpose: To adopt the rule to correct the reference in subsection (2)(a) from (2)(c) to (3).
Citation of Existing Rules Affected by this Order: Amending WAC 388-538-110.
Statutory Authority for Adoption: RCW 74.08.090.
Adopted under notice filed as WSR 97-01-092 on December 18, 1996.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, amended 1, repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 1, repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 1, repealed 0.
Effective Date of Rule: Thirty-one days after filing.
January 23, 1997
Merry 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
(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.]