WSR 15-09-136
(Washington Apple Health)
[Filed April 22, 2015, 9:34 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 14-17-123.
Title of Rule and Other Identifying Information: WAC 182-500-0010 Medical assistance definitionA and 182-503-0130 Washington apple healthAuthorized representative.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106B, 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 May 26, 2015, at 10:00 a.m.
Date of Intended Adoption: Not sooner than May 27, 2015.
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 May 26, 2015.
Assistance for Persons with Disabilities: Contact Kelly Richters by 5:00 p.m. on May 18, 2015, 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: The agency is creating a new rule regarding client authorized representatives, specifically how to designate, serve as, and terminate an authorized representative.
Reasons Supporting Proposal: See Purpose above.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Statute Being Implemented: RCW 41.05.021, 41.05.160.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Amy Emerson, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1348; Implementation and Enforcement: Mick Petersen, P.O. Box 42716, Olympia, WA 98504-45534 [98504-2716], (360) 725-0913.
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 business.
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.
April 22, 2015
Jason R. P. Crabbe
Rules Coordinator
AMENDATORY SECTION (Amending WSR 14-01-021, filed 12/9/13, effective 1/9/14)
WAC 182-500-0010 Medical assistance definition—A.
"Administrative renewal" means the agency uses verification from electronically available income data sources to verify and recertify a person's Washington apple health benefits for a subsequent certification period. A case is administratively renewed when the person's self-attested income is reasonably compatible (as defined in WAC 182-500-0095) with the information available to the agency from the electronic data sources and the person meets citizenship, immigration, Social Security number, and age requirements.
"Agency" means the Washington state health care authority (HCA), created ((pursuant to)) under chapter 41.05 RCW.
"Agency's designee" means the Washington state department of social and health services (DSHS), created ((pursuant to)) under chapter 43.20A RCW.
"Allowable costs" are the documented costs as reported after any cost adjustment, cost disallowances, reclassifications, or reclassifications to nonallowable costs which are necessary, ordinary and related to the outpatient care of medical care clients ((are)) or not expressly declared nonallowable by applicable statutes or regulations. Costs are ordinary if they are of the nature and magnitude which prudent and cost-conscious management would pay.
"Alternative benefits plan" means the range of health care services included within the scope of service categories described in WAC 182-501-0060 available to persons eligible to receive health care coverage under the Washington apple health modified adjusted gross income (MAGI)-based adult coverage described in WAC 182-505-0250.
"Ancillary services" means additional services ordered by the provider to support the core treatment provided to the patient. These services may include, but are not limited to, laboratory services, radiology services, drugs, physical therapy, occupational therapy, and speech therapy.
"Apple health for kids" is the umbrella term for health care coverage for certain groups of children that is funded by the state and federal governments under Title XIX medicaid programs or Title XXI Children's Health Insurance Program, or solely through state funds (including the program formerly known as the children's health program). Funding for any given child depends on the program for which the child is determined to be eligible. Apple health for kids programs are included in the array of health care programs available through Washington apple health (WAH).
"Attested income" means a self-declared statement of a person's income made under penalty of perjury to be true. (See also "self-attested income.")
"Authorization" means the agency's or the agency's designee's determination that criteria are met, as one of the preconditions to the agency's or the agency's designee's decision to provide payment for a specific service or device. (See also "expedited prior authorization" and "prior authorization.")
"Authorized representative" ((means a family member, friend, organization or someone acting responsibly on behalf of a person who is designated by the person to act on his or her behalf in all matters relating to an application or renewal of Washington apple health or other ongoing communications with agency or its designee. The authorization must be made in writing and signed by the person unless the person's medical condition prevents such written authorization. Authority to act on behalf of an applicant or beneficiary under state law can substitute for the person's authorization. The power to act as an authorized representative ends when the person or a court-appointed guardian of the person informs the agency or its designee that the representative is no longer authorized to act on his or her behalf, or when the agency learns of a change in the legal authority upon which the authorization is based)) is defined under WAC 182-503-0130.
WAC 182-503-0130 Authorized representative.
(1) Designating an authorized representative (AREP).
(a) A person may designate an AREP to act on his or her behalf in eligibility-related interactions with the medicaid agency by completing the agency's Authorized Representative Designation Form, or through any of the modalities described in 42 C.F.R. 435.907(a) and 42 C.F.R. 435.923.
(b) A court-appointed legal guardian with authority to make financial decisions on a person's behalf is that person's AREP.
(c) An agreement creating power of attorney (POA) that grants decision-making authority regarding the person's financial interactions with the agency establishes the POA as the AREP.
(d) If someone is unable to designate an AREP due to a medical condition, a person may designate himself or herself as the AREP by signing the agency's Authorized Representative Designation Form.
(2) Serving as an AREP. To serve as an AREP, a person or organization must:
(a) Have a good-faith belief that the information he or she provides to the agency is correct.
(b) Report any change in circumstance required under WAC 182-504-0105 unless doing so would exceed the scope of authorized representation or violate state or federal law.
(c) A provider, staff member, or volunteer of an organization must also comply with 42 C.F.R. 435.923(d-e).
(3) Terminating an AREP.
(a) The person or the AREP may terminate the authorized representation at any time for any reason by notifying the agency verbally or in writing.
(b) Authorized representation terminates automatically when the person dies.