WSR 14-15-120
(Washington Apple Health)
[Filed July 22, 2014, 1:25 p.m., effective July 22, 2014, 1:25 p.m.]
Effective Date of Rule: Immediately upon filing.
Purpose: Medicaid expansion rule. WAC 182-504-0135 is a new rule to support the implementation of the federal Patient Protection and Affordable Care Act which began January 1, 2014. This new WAC provision 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.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Other Authority: Patient Protection and Affordable Care Act (Public Law 111-148); 42 C.F.R. § 431, 435, and 457; and 45 C.F.R. § 155.
Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest; and that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: See Purpose above. The agency worked with client advocates to craft this emergency rule and will continue working with them and other stakeholders in completing the permanent rule-making process.
Number of Sections Adopted in Order to Comply with Federal Statute: New 1, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.
Date Adopted: July 22, 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.