WSR 14-14-114
(Washington Apple Health)
[Filed July 1, 2014, 5:15 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 14-08-003.
Title of Rule and Other Identifying Information: WAC 182-504-0135 Washington apple healthReinstated coverage pending an appeal (new) and 182-506-0015 Medical assistance units for non-MAGI-based Washington apple health programs.
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 August 5, 2014, at 10:00 a.m.
Date of Intended Adoption: Not sooner than August 6, 2014.
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 August 5, 2014.
Assistance for Persons with Disabilities: Contact Kelly Richters by July 29, 2014, 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: WAC 182-504-0135 explains what a Washington apple health client's rights are in getting his or her health care coverage reinstated while pending an appeal with the agency; and adding clarifying information to WAC 182-506-0015 that was inadvertently left out of the last revision.
Statutory Authority for Adoption: RCW 41.05.021.
Statute Being Implemented: Patient Protection and Affordable Care Act (Public Law 111-148); 42 C.F.R. § 431, 435, and 457; and 45 C.F.R. § 155.
Rule is necessary because of federal law, Patient Protection and Affordable Care Act (Public Law 111-148); 42 C.F.R. § 431, 435, and 457; and 45 C.F.R. § 155.
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: Jessie Dean, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1501.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The joint administrative rules review committee (JARRC) has not requested the filing of a small business economic impact statement, and these rules do not impose a disproportionate cost impact on 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 JARRC or applied voluntarily.
July 1, 2014
Kevin M. Sullivan
Rules Coordinator
WAC 182-504-0135 Washington apple healthReinstated coverage pending an appeal.
(1) If you disagree with a Washington apple health (WAH) decision that we (the agency or its designee) made, you have the right to appeal under RCW 74.09.741. The appeal rules are found in chapter 182-526 WAC.
(2) If we end or change your WAH coverage without the advance notice required by WAC 182-518-0025(3) and you appeal on or before the tenth day after the date you receive the written notice of the WAH decision, WAH coverage will be reinstated and continue until the appeals process ends, unless otherwise specified in this section. This is called reinstated coverage.
(3) We will treat the fifth day after the date on the notice as the date you received the notice; however, if you show that you received the notice more than five days after the date on the notice, we will use the actual date you received the notice for counting the ten-day appeal period for the purpose of providing continued coverage. If the tenth day falls on a weekend or holiday, you have until the next business day to appeal and still be able to receive continued coverage.
(4) You receive reinstated coverage through the end of the month an administrative hearing decision is sent to you unless:
(a) An administrative law judge or our presiding officer serves an order ending reinstated coverage; or
(b) You:
(i) Tell us in writing that you do not want reinstated coverage; or
(ii) Withdraw your appeal in writing or at an administrative proceeding.
(5) You cannot receive reinstated coverage when a change in your WAH coverage is the result of a mass change. A mass change is when rules change that impact coverage for a class of applicants and recipients or due to a legislative or statutory change.
(6) A person receiving WAH medically needy coverage is not eligible for reinstated coverage beyond the end of the original certification period described in WAC 182-504-0020.
(7) If we end your WAH coverage because mail we sent to you was returned to us with no forwarding address, your WAH coverage will be reinstated if you continue to meet eligibility requirements and if we receive notification from you of your new address.
AMENDATORY SECTION (Amending WSR 14-01-021, filed 12/9/13, effective 1/9/14)
WAC 182-506-0015 Medical assistance units for non-MAGI-based Washington apple health programs.
This section explains how medical assistance units (MAUs) are constructed for programs not based on modified adjusted gross income (MAGI) methodologies. (MAGI-based programs are described in WAC 182-503-0510.)
(1) An MAU is a person or group of people who must be included together when determining eligibility. MAUs are established based on each person's relationship to other family members and the person's financial responsibility for the other family members. MAUs for non-MAGI-based programs include an applicant and persons financially responsible for the applicant as described in subsection (2) of this section (as limited by subsection (3) of this section).
(2) Financial responsibility applies only to spouses and to parents, as follows:
(a) Married persons, living together are financially responsible for each other;
(b) Natural, adoptive, or step-parents are financially responsible for their unmarried, minor children living in the same household;
(c) Minor children are not financially responsible for their parents or for their siblings;
(d) Married persons' financial responsibility for each other when not living together because one or both are residing in a medical institution is described in chapter 182-513 WAC.
(3) The number of persons in the MAU is increased by one for each verified unborn child for each pregnant woman already included in the MAU under this section.
(4) A separate SSI-related MAU is required for:
(a) SSI recipients;
(b) SSI-related persons;
(c) Institutionalized persons;
(d) The purpose of applying medical income standards for an:
(i) SSI-related applicant whose spouse is not relatable to SSI or is not applying for SSI-related medical; and
(ii) Ineligible spouse of an SSI recipient.
(5) When determining eligibility for an SSI-related medical program, the agency determines how household income is allocated and deemed to the SSI-related person according to the rules described in WAC 182-512-0820 and 182-512-0900 through 182-512-0960.