WSR 15-24-114
(Washington Apple Health)
[Filed December 1, 2015, 2:23 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 15-07-047.
Title of Rule and Other Identifying Information: WAC 182-504-0135 Washington apple healthReinstated coverage pending an appeal and 182-518-0025 Washington apple healthNotice requirementsChanges in and terminations of coverage.
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 January 5, 2016, at 10:00 a.m.
Date of Intended Adoption: Not sooner than January 6, 2016.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, delivery 626 8th Avenue, Olympia, WA 98504, e-mail, fax (360) 586-9727, by January 5, 2016.
Assistance for Persons with Disabilities: Contact Amber Lougheed by December 29, 2015, e-mail, (360) 725-1349, or TTY (800) 848-5429 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: These rules are being amended to clarify that reinstated coverage is a remedy to the agency's failure to meet notice obligations. Content regarding reinstated coverage has moved to WAC 182-518-0025 with the intention of repealing WAC 182-504-0135. During the course of this review, WAC 182-518-0025 has also been amended to improve clarity.
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: Chantelle Diaz, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1842; Implementation and Enforcement: Mick Pettersen, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-0913.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The joint administrative [rules] review committee 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 the joint administrative rules review committee or applied voluntarily.
December 1, 2015
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 14-16-052, filed 7/29/14, effective 8/29/14)
WAC 182-518-0025 Washington apple healthNotice requirementsChanges in and terminations of coverage.
(((1) We send you written notice before your Washington apple health (WAH) coverage changes or ends. The notice includes:
(a) The change in coverage;
(b) The date your coverage will change or end;
(c) Specific facts and reason(s) for the decision;
(d) Specific rules the decision is based on; and
(e) Information found in WAC 182-518-0005(4).
(2) Before we send any notices to end your WAH coverage because your income is more than the modified adjusted gross income (MAGI) standard, we determine if you are eligible for other health care coverage (including non-MAGI-based coverage) based on information you have provided, as described in WAC 182-504-0125.
(3) We notify you at least ten days before we change or end your health care coverage. The ten days start on the day we send you the notice and end on the tenth day. We are not required to give ten days' notice if:
(a) You asked us to change or end your coverage;
(b) We are changing or ending your coverage due to a change in law;
(c) We are ending your coverage because everyone in your household either died or has been accepted to receive medicaid coverage somewhere else (another local jurisdiction, state, territory, or commonwealth);
(d) We are ending your coverage because mail we sent you was returned to us with no forwarding address and we do not have a more current address for you;
(e) You are incarcerated and it is expected to last more than thirty days; or
(f) We have facts indicating probable fraud by you, in which case we may notify you five days before we change or end your coverage.
(4) If we do not have to give ten days' advance notice, we send the notice right away after getting the information that caused the change, but no later than the date we took the action described in the notice.
(5) You may request an appeal if you disagree with our decision to change or end your health care coverage and get continued coverage as described in WAC 182-504-0130.)) (1) General rule. The agency sends written notice to the client at least ten days before terminating, suspending, or reducing the client's medicaid eligibility. The ten-day notice period starts on the day the agency sent the notice.
(2) Exceptions to ten-day notice period.
(a) If the agency has facts indicating fraud by the client or on the client's behalf, the agency sends written notice to the client at least five days before changing the client's coverage.
(b) The agency sends written notice to the client no later than the date the agency changed the client's eligibility if:
(i) The client requested the change;
(ii) A change in law caused the change;
(iii) The client is incarcerated and is expected to remain incarcerated at least thirty days;
(iv) Mail sent to the client has been returned without a forwarding address; or
(v) The agency is terminating the client's eligibility because everyone in the medical assistance unit under chapter 182-506 WAC either:
(A) Died; or
(B) Began receiving medicaid from a jurisdiction other than Washington state.
(3) Notice contents. Written notice under this section states:
(a) The nature of the change;
(b) The effective date of the change;
(c) The reason for the change;
(d) The regulation on which the change is based;
(e) The client's appeal rights, if any; and
(f) The client's right to continued coverage, if any.
(4) Reinstated coverage. If the agency fails to meet its notice obligations under this section, the agency reinstates the client's coverage back to the date of the change.
(5) Hearing rights. A person who does not agree with agency action under this section may request an administrative hearing under chapter 182-526 WAC, and may be entitled to continued coverage under WAC 182-504-0130.
The following section of the Washington Administrative Code is repealed:
WAC 182-504-0135
Washington apple healthReinstated coverage pending an appeal.