HEALTH CARE AUTHORITY

(School Employees Benefits Board)

[Admin #2025-01.01—Filed April 17, 2025, 1:00 p.m.]

Preproposal statement of inquiry was filed as WSR 25-03-109.

Title of Rule and Other Identifying Information: Amending WAC 182-32-2040 How can a subscriber appeal a decision regarding the administration of wellness incentive program requirements?, 182-32-2070 What should a written request for administrative review and a request for brief adjudicative proceeding contain?, and 182-32-2090 Initial order.

Hearing Location(s): On May 27, 2025, at 10:00 a.m. The health care authority (HCA) holds public hearings virtually without a physical meeting place. To attend the virtual public hearing, you must register in advance at https://us02web.zoom.us/webinar/register/WN_tPBE4ot9T0eY4kiqA4mp4A. If the link above opens with an error message, please try using a different browser. After registering, you will receive a confirmation email containing information about joining the public hearing.

Date of Intended Adoption: Not sooner than May 28, 2025.

Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email arc@hca.wa.gov, fax 360-586-9727, beginning April 18, 2025, 8:00 a.m., by May 27, 2025, 11:59 p.m.

Assistance for Persons with Disabilities: Contact Johanna Larson, phone 360-725-1349, fax 360-586-9727, telecommunication relay service 711, email Johanna.Larson@hca.wa.gov, by May 9, 2025.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of this proposal is to make technical amendments in multiple sections within chapter 182-32 WAC to support the school employees benefits board (SEBB) program:

Reasons Supporting Proposal: See purpose.


•	Amend WAC 182-32-2040 to make a technical correction and clarify any subscriber aggrieved by a decision made by the PEBB [SEBB] wellness incentive program contracted vendor may appeal that decision to the PEBB [SEBB] program.
•	Amend WAC 182-32-2070 to include a statement that describes the appealing party or the appealing party's representative has read the notice of request and believes the contents of the brief adjudicative proceeding to be true and correct, and to add failure to provide documentation or reference to documentation of decisions previously rendered may result in a rejection of the item being appealed.
•	Amend WAC 182-32-2090 regarding a written initial order will be rendered within 10 days after the presiding officer receives the contents of the request for a brief adjudicative proceeding.

Statutory Authority for Adoption: RCW 41.05.021 and 41.05.160.

Statute Being Implemented: RCW 41.05.021 and 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: Stella Ng, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-0883; Implementation: Cade Walker, P.O. Box 42716, Olympia, WA 98504-2716, 360-643-7900; and Enforcement: Jean Bui, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1858.

A school district fiscal impact statement is not required under RCW 28A.305.135.

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.

This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:

Is exempt under RCW 19.85.025(4).

Explanation of exemptions: These rules pertain to school employees benefits and do not impose a more-than-minor cost on small businesses.

Scope of exemption for rule proposal:

AMENDATORY SECTION(Amending WSR 24-15-107, filed 7/22/24, effective 1/1/25)

WAC 182-32-2040How can a subscriber appeal a decision regarding the administration of wellness incentive program requirements?

(1) Any subscriber aggrieved by a decision made by the school employees benefits board (SEBB) wellness incentive program contracted vendor regarding the completion of the wellness incentive program requirements, or request for a reasonable alternative to a wellness incentive program requirement, may appeal that decision to the ((school employees benefits board (SEBB) wellness incentive program contracted vendor))SEBB program.

(2) Any subscriber who disagrees with a decision in response to an appeal filed with the SEBB ((wellness incentive)) program ((contracted vendor)) may appeal the decision by submitting a request for a brief adjudicative proceeding to the SEBB appeals unit.

(a) The request for a brief adjudicative proceeding from a current or former school employee must be received by the SEBB appeals unit no later than 30 days after the date of the denial notice. The contents of the request for a brief adjudicative proceeding are to be provided as described in WAC 182-32-2070.

(b) The request for a brief adjudicative proceeding from a continuation coverage enrollee or school board member must be received by the SEBB appeals unit no later than 60 days after the date of the denial notice. The contents of the request for a brief adjudicative proceeding are to be provided as described in WAC 182-32-2070.

(3) The SEBB appeals unit must notify the appellant in writing when the request for a brief adjudicative proceeding has been received.

(4) The brief adjudicative proceeding will be conducted by a presiding officer designated by the director.

(5) If a subscriber fails to timely request a brief adjudicative proceeding, the decision of the SEBB wellness incentive program contracted vendor becomes the authority's final order without further action.

AMENDATORY SECTION(Amending WSR 24-15-107, filed 7/22/24, effective 1/1/25)

WAC 182-32-2070What should a written request for administrative review and a request for brief adjudicative proceeding contain?

(1) A written request for administrative review of the school employees benefits board (SEBB) organization's or employer group's decision and a request for brief adjudicative proceeding should contain the following:

(((1)))(a) The name and mailing address of the party requesting an administrative review or the brief adjudicative proceeding;

(((2)))(b) The name and mailing address of the appealing party's representative, if any;

(((3)))(c) Documentation, or reference to documentation, of decisions previously rendered through the appeal process, if any;

(((4)))(d) A statement identifying the specific portion of the decision being appealed and clarifying what is believed to be unlawful or in error;

(((5)))(e) A statement of facts in support of the appealing party's position;

(((6)))(f) Any information or documentation that the appealing party would like considered;

(((7)))(g) The type of relief sought; ((and

(8)))(h) The signature of the appealing party or the appealing party's representative; and

(i) A statement that describes the appealing party or the appealing party's representative has read the notice of request for an appeal and believes the contents to be true and correct.

(2) Failing to provide documentation, or reference to documentation, of decisions previously rendered through the appeal process as described in subsection (1)(c) of this section, may result in rejection of the item being appealed.

AMENDATORY SECTION(Amending WSR 20-16-067, filed 7/28/20, effective 8/28/20)

WAC 182-32-2090Initial order.

Unless a continuance has been granted, ((within ten days after the school employees benefits board (SEBB) appeals unit receives a request for a brief adjudicative proceeding,)) the presiding officer ((must))will render a written initial order that addresses the issue or issues raised by the appellant in their appeal within 10 days after the presiding officer receives the contents of the request for a brief adjudicative proceeding. The presiding officer must serve a copy of the initial order on all parties and the initial order must contain information on how the appellant may request review of the initial order.