WSR 13-20-142
(Medicaid Program)
[Filed October 2, 2013, 10:35 a.m.]
Supplemental notice to WSR 13-14-089.
Preproposal statement of inquiry was filed as WSR 12-19-092.
Title of Rule and Other Identifying Information: Based on stakeholders' comments/suggestions, the agency has redrafted the proposal for WAC 182-526-0102 Coordinated appeals process with the Washington health benefits exchange.
The agency is also withdrawing the following proposals: WAC 182-526-0100 Expedited hearings and 182-526-0218 The authority of a review judge when conducting a hearing as a presiding officer.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106A, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at or directions can be obtained by calling (360) 725-1000), on November 5, 2013, at 10:00 a.m.
Date of Intended Adoption: Not sooner than November 6, 2013.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail, fax (360) 586-9727, by 5:00 p.m. on November 5, 2013.
Assistance for Persons with Disabilities: Contact Kelly Richters by October 28, 2013, TTY (800) 848-5429 or (360) 725-1307 or e-mail
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: This rule amendment is necessary for implementation of the Affordable Care Act on January 1, 2014. HCA is establishing a process for coordinating appeals with the Washington health benefits exchange (HBE).
Reasons Supporting Proposal: See Purpose statement.
Statutory Authority for Adoption: RCW 41.05.021; 42 C.F.R. § 431, 435, and 457; 45 C.F.R. § 155.
Statute Being Implemented: Patient Protection and Affordable Care Act (Public Law 111-148).
Rule is necessary because of federal law, Patient Protection and Affordable Care Act (Public Law 111-148).
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Kevin Sullivan, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1344; Implementation and Enforcement: Annette Schuffenhauer, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1254.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has analyzed the proposed rules and concludes they do not impose more than minor costs for affected small businesses.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules [review] committee or applied voluntarily.
October 1, 2013
Kevin M. Sullivan
Rules Coordinator
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.