HEALTH CARE AUTHORITY

[Filed June 6, 2025, 6:52 a.m.]

Preproposal statement of inquiry was filed as WSR 25-09-018.

Title of Rule and Other Identifying Information: WAC 182-501-0100 Subrogation.

Hearing Location(s): On July 22, 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_VITsQt7BTjSW_XXGHQ5GqQ#/registration.

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 July 23, 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 June 5, 2025, 8:00 a.m., by July 22, 2025, 11:59 p.m.

Assistance for Persons with Disabilities: Contact HCA rules coordinator, phone 360-725-1349, fax 360-586-9727, telecommunication relay service 711, email arc@hca.wa.gov, by July 3, 2025.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HCA is amending WAC 182-501-0100 to reflect the 2011 change in authority for overseeing the medicaid program from the Washington state department of social and health services (DSHS) to HCA. Currently, the rule references only the DSHS lien statutes. This amendment will add reference to the HCA lien statutes. Both HCA and DSHS use liens for subrogation purposes.

Reasons Supporting Proposal: See purpose.

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: Brian Jensen, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-0815; Implementation and Enforcement: Trudi Glant, P.O. Box 45504, Olympia, WA 98504-5504, 360-725-2080.

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.

Scope of exemption for rule proposal from Regulatory Fairness Act requirements:

The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. This rule proposal imposes no compliance costs on businesses.

AMENDATORY SECTION(Amending WSR 15-15-053, filed 7/9/15, effective 8/9/15)

WAC 182-501-0100Subrogation.

(1) For the purpose of this section, "liable third party" means:

(a) The tort-feasor, or insurer of the tort-feasor, or both; and

(b) Any person, entity or program that is or may be liable to provide coverage for the illness or injuries for which the medicaid agency is providing assistance or residential care.

(2) As a condition of medical care eligibility, a client must assign to the state any right the client may have to receive payment from any liable third party for medical expenses, assistance, or residential care.

(3) To the extent authorized by a contract executed under RCW 74.09.522, a managed health care plan has the rights and remedies of the agency under RCW 41.05A.070, 43.20B.060, and 74.09.180.

(4) The agency is not responsible for medical care payment(s) for a client whose personal injuries are caused by the negligence or wrongdoing of another. However, the agency may provide the medical care required as a result of an injury or illness to the client if the client is otherwise eligible for medical care.

(5) The agency may pursue its right to recover the value of medical care provided to an eligible client from any liable third party or third-party settlement or judgment as a subrogee, assignee, or by enforcement of its public assistance lien under RCW 41.05A.050 through 41.05A.070, 43.20B.040 through 43.20B.070, 74.09.180, and 74.09.185.

(6) Notice to the agency and determining the reimbursement amount:

(a) The client or the client's legal representative must notify the agency in writing when filing any claim against a third party, commencing an action at law, negotiating a settlement, or accepting an offer from the liable third party. Send notices under this section to:

Health Care Authority

COB Casualty Unit

P.O. Box 45561

Olympia, WA 98504-5561

Fax: 360-753-3077

(b) The client or the client's legal representative must give the agency documentation proposing allocation of damages, if any, to be used for settlement or to be proven at trial.

(c) Where damages, including medical damages, have not been designated in the settlement or judgment, the client or the client's legal representative must contact the agency to determine the appropriate reimbursement amount for payments the agency made for the client's benefit.

(d) If the client and the agency cannot agree upon the appropriate reimbursement amount, any party may bring a motion in superior court for a hearing to determine the amount of reimbursement to the agency from settlement or judgment proceeds.

(7) The agency director or the director's designee must consent in writing to any discharge or compromise of any settlement or judgment of a lien created under RCW 41.05A.070 and 43.20B.060. The agency considers the compromise or discharge of a medical care lien only as authorized by federal regulation at 42 C.F.R. 433.139.

(8) The doctrine of equitable subrogation does not apply to defeat, reduce, or prorate any recovery made by the agency based on its assignment, lien, or subrogation rights.