reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0520 - Information which must be included in the ALJ's initial order

Current through Register Vol. 24-14, July 15, 2024
In an initial order, the administrative law judge (ALJ) must
				  :
(1) Identify the matter as a health
				care authority appeal;
(2) List the
				name and docket number of the case and the names of all parties and
				representatives;
(3) Make findings
				concerning the facts used to resolve the dispute based on the hearing
				record;
(4) Explain how the ALJ
				determined that evidence is credible or not credible when the facts or conduct
				of a witness is questioned;
(5)
				State the law that applies to the dispute;
(6) Apply the law to the facts of the case in
				the conclusions of law;
(7) Discuss
				the reasons for the decision based on the facts and the law;
(8) State the result and remedy
				ordered;
(9) Explain how to request
				corrections to the initial order or petition for review by the board of appeals
				(BOA) and provide the deadlines for such requests;
(10) State the date the initial order becomes
				final according to WAC
				182-526-0525; and
(11) Include any other information required
				by law or program rules.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0520, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0525 - When initial orders become final

Current through Register Vol. 24-14, July 15, 2024
An initial order becomes a final order at 5:00 p.m. on the
				  twenty-first calendar day after the office of administrative hearings (OAH)
				  serves the initial order, unless:
(1)
				Any party files a request for review of the initial order within twenty-one
				calendar days of the serving (mailing) of the initial order in accordance with
				WAC 182-526-0580(1);
(2) Any party files a request for extension
				of the deadline for filing a request for review which is granted by the review
				judge under WAC
				182-526-0580(2);
				or
(3) Any party files a late
				request for review which is accepted by a review judge in accordance with WAC
				182-526-0580(3);
(4) A managed care enrollee requests review
				by an independent review (IR) organization in accordance with
				RCW
				48.43.535 prior to the initial order becoming
				final or a final order being entered by a review judge. See WAC
				182-526-0200 for enrollee
				appeals.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0525, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0530 - How to correct or appeal an initial order

Current through Register Vol. 24-14, July 15, 2024
(1) If a party disagrees with an
				administrative law judge's (ALJ) initial order because of a clerical error, the
				party may ask for a corrected initial order from the ALJ as provided in WAC
				182-526-0540 through
				182-526-0555.
(2) If a party disagrees with an initial
				order for a reason other than a clerical error and wants the initial order
				changed, the party must request review by a review judge as provided in WAC
				182-526-0560 through
				182-526-0595.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0530, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0540 - Correction of clerical errors in an initial order

Current through Register Vol. 24-14, July 15, 2024
(1) A clerical error is a mistake that does
				not change the intent of the initial order.
(2) The administrative law judge (ALJ) may
				correct clerical errors in the initial order by entering a corrected initial
				order. The ALJ may correct clerical errors in response to a request by one of
				the parties.
(3) Some examples of
				clerical error are:
(a) Missing or incorrect
				words or numbers;
(b) Dates
				inconsistent with the decision or evidence in the record such as using May 3,
				2004, instead of May 3, 2014; or
(c) Math errors when adding the total of an
				overpayment.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0545 - How a party requests a corrected initial order

Current through Register Vol. 24-14, July 15, 2024
(1) A party may request that the
				administrative law judge (ALJ) issue a corrected initial order by calling or
				writing to the office of administrative hearings field office that held the
				hearing.
(2) When asking for a
				corrected initial order, the party must identify the clerical error that is
				claimed.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0545, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0550 - Deadline for a party to request a corrected initial order

Current through Register Vol. 24-14, July 15, 2024
(1) A party
				requesting a corrected initial order from the administrative law judge (ALJ)
				must make the request on or before the tenth calendar day after the order was
				served.
(2) The time period
				provided in subsection (1) of this section and the time it takes the ALJ to
				deny the request or make a decision regarding the request for a corrected
				initial order, do not count against any deadline for a review judge to enter a
				final order.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0550, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0555 - Process after a party requests a corrected initial order

Current through Register Vol. 24-14, July 15, 2024
(1) When a party
				requests a corrected initial order, the administrative law judge (ALJ) must
				either:
(a) Serve all parties a corrected
				order within ten calendar days; or
(b) Deny the request in writing within three
				business days of receiving it.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0560 - Review of an initial order by a review judge

Current through Register Vol. 24-14, July 15, 2024
(1) A party who disagrees with the initial
				order entered by an administrative law judge (ALJ) may request review by a
				review judge at the board of appeals (BOA).
(2) When a review judge reviews an initial
				order, the review judge does not hold another hearing . See WAC
				182-526-0595.
(3) Review judges may not review an initial
				order after the order becomes a final order, except as permitted by WAC
				182-526-0580.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0560, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0565 - Evidence a review judge considers in reviewing an initial order

Current through Register Vol. 24-14, July 15, 2024
(1) The review
				judge, in most cases, only considers evidence admitted in the record by the
				administrative law judge.
(2) The
				review judge considers the request, the initial order, and the record before
				deciding if the initial order should be changed.
(3) The review judge may allow the parties to
				make oral argument when reviewing initial orders.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0565, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0570 - Request for review of an initial order

Current through Register Vol. 24-14, July 15, 2024
(1) Any party may request a review judge to
				review the initial order.
(2) If
				more than one party requests review, each request must meet the deadlines in
				WAC 182-526-0580.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0570, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0575 - How to request review of an initial order

Current through Register Vol. 24-14, July 15, 2024
(1) A party must make the request for review
				of an initial order in writing and file the request with the board of appeals
				(BOA) at the address given in WAC
				182-526-0030 and within the
				deadlines set forth in WAC
				182-526-0580.
(2) The request for review should identify
				the parts of the initial order with which the party disagrees and should
				identify the evidence in the hearing record supporting the party's
				position.
(3) The party seeking
				review should also send a copy of the review request to the other
				parties.
(4) After receiving a
				request for review of an initial order, BOA serves a copy on the other parties,
				their representatives, and the office of administrative hearings. The other
				parties and their representatives may respond as described in WAC
				182-526-0590.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0575, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0580 - Deadline for requesting review of an initial order by a review judge

Current through Register Vol. 24-14, July 15, 2024
(1) The board of
				appeals (BOA) must receive the written review request of an initial order on or
				before 5:00 p.m. on the 21st calendar day after the initial order was served,
				unless an extension of the deadline is granted by the review judge.
(2) A party may file the written review
				request by physical mail, by facsimile transmission (fax), electronically by
				email, or in-person delivery. For the BOA contact information, see WAC
				182-526-0030.
(3) A review judge may extend the deadline to
				request review if a party:
(a) Asks for more
				time before the deadline expires; and
(b) Gives a good reason for more
				time.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0590 - Response to a request for review

Current through Register Vol. 24-14, July 15, 2024
(1)
				A party does not have to respond to the request for review. A response is
				optional.
(2) If a party decides to
				respond, that party must file the response so that the board of appeals (BOA)
				receives it on or before the seventh business day after the date the other
				party's review request was served to the party by the BOA.
(3) The party should send a copy of the
				response to all other parties or their representatives.
(4) A review judge may extend the deadline in
				subsection (2) of this section if a party asks for more time before the
				deadline to respond expires and gives a good reason.
(5) If a party asks for more time to respond,
				the time period provided by this section for responding to the review request,
				including any extensions, does not count against any deadline for a review
				judge to enter the final order.
(6)
				A review judge may accept and consider a party's response even if it is filed
				after the deadline.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0590, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0595 - Process after review response deadline

Current through Register Vol. 24-14, July 15, 2024
(1) After the response deadline, the record
				on review is closed unless the review judge finds there is a good reason to
				keep it open.
(2) A review judge is
				assigned to review the initial order after the record on review is closed. To
				find out which judge is assigned, call the board of appeals.
(3) After the record is closed, the assigned
				review judge:
(a) Reviews the record,
				including the initial order; and
(b) Enters a final order that affirms,
				modifies, dismisses or reverses the initial order; or
(c) Returns the case to the office of
				administrative hearings for further action.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0600 - Authority of the review judge

Current through Register Vol. 24-14, July 15, 2024
(1)
				In some cases, review judges review initial orders and enter final orders. The
				review judge has the same decision-making authority as the administrative law
				judge (ALJ). The review judge considers the entire record and decides the case
				de novo (anew). In reviewing findings of fact, the review judge must give due
				regard to the ALJ's opportunity to observe witnesses.
(2) Review judges may remand (return) cases
				to the office of administrative hearings for further action.
(3) In cases where there is a consolidated
				hearing under WAC
				182-526-0387, any party may
				request review of the initial order in accordance with the requirements
				contained in this chapter.
(4)
				Review judges may not review an ALJ order after the order becomes final, except
				as provided in WAC
				182-526-0580.
(5) A review judge conducts the hearing and
				enters the final order in cases where a contractor for the delivery of nursing
				facility services requests an administrative hearing under WAC
				388-96-904(5).
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0600, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0605 - Reconsideration of a final order entered by a review judge

Current through Register Vol. 24-14, July 15, 2024
(1) If a party does not agree with the final
				order and wants it reconsidered, the party may request the review judge to
				reconsider the decision.
(2) The
				party must make the request in writing and clearly state why the party wants
				the final order reconsidered. The party must file the written reconsideration
				request with BOA and it must be received by the deadline under WAC
				182-526-0620.
(3) The party should send a copy of the
				request to all other parties or their representatives.
(4) After receiving a reconsideration
				request, BOA serves a copy to the other parties and representatives and gives
				them time to respond.
(5) The final
				order or the reconsideration decision is the final HCA decision. If a party
				disagrees with that decision, the party must petition for judicial review to
				change it.
(6) If a party asks for
				reconsideration of the final order, the reconsideration process must be
				completed before a party requests judicial review. However, the party does not
				need to request reconsideration of a final order before requesting judicial
				review.
(7) The party may ask the
				court to stay or stop the HCA action after filing the petition for judicial
				review.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0605, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0620 - Deadline for requesting reconsideration

Current through Register Vol. 24-14, July 15, 2024
(1) To request reconsideration of a final
				order entered by a review judge, the BOA must receive a written reconsideration
				request on or before the tenth calendar day after the final order was
				served.
(2) The review judge may
				extend its deadline for filing a request for reconsideration if a party:
(a) Asks for more time before the deadline
				expires; and
(b) Gives a good
				reason for the extension.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0630 - Responding to a reconsideration request

Current through Register Vol. 24-14, July 15, 2024
(1) A party does not have to respond to a
				request for reconsideration of a final order. A response is optional.
(2) If a party responds, that party must file
				a response with the board of appeals (BOA) by or before the seventh business
				day after the date the review judge mailed the request to the party.
(3) A party should send a copy of the
				response to any other party or representative.
(4) If a party needs more time to respond,
				the review judge may extend its deadline if the party gives a good reason
				within the deadline in subsection (2) of this section.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0630, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0635 - Process after a party requests reconsideration

Current through Register Vol. 24-14, July 15, 2024
(1) After the review judge receives a
				reconsideration request, the review judge has twenty calendar days to enter and
				serve a reconsideration decision unless the review judge serves notice allowing
				more time.
(2) After the BOA
				receives a reconsideration request, the review judge must either:
(a) Write a reconsideration decision;
				or
(b) Serve all parties an order
				denying the request.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0640 - Judicial review of a final order

Current through Register Vol. 24-14, July 15, 2024
(1)
				Judicial review is the process of appealing a final order to a court.
(2) The party that requested the hearing may
				appeal a final order by filing a written petition for judicial review that
				meets the requirements of
				RCW
				34.05.546. HCA may not request judicial
				review.
(3) The party seeking
				judicial review must consult
				RCW
				34.05.510 to
				34.05.598 for further details of
				the judicial review process.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0640, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0645 - Deadline for petition for judicial review and filing requirements

Current through Register Vol. 24-14, July 15, 2024
A party must file a petition for judicial review with the
				  superior court within thirty calendar days after the final order is served to
				  the parties.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0645, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0647 - Exhaustion of administrative remedies required

Current through Register Vol. 24-14, July 15, 2024
Generally, a party may file a petition for judicial review
				  only after it has completed the administrative hearing process. See
				  RCW
				  34.05.534.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0647, filed 12/19/12,
					 effective 2/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0650 - Service of petition for judicial review

Current through Register Vol. 24-14, July 15, 2024
(1) The party requesting judicial review
				must:
(a) File a petition for judicial review
				with the court;
(b) File and serve
				the petition for judicial review of a final order within thirty days after the
				date it was mailed to the parties; and
(c) Serve copies of the petition on the
				health care authority (HCA), the office of the attorney general, and all other
				parties.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2700

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2700, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2700, filed 9/17/12,
				  effective 10/1/12. Statutory Authority: 2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2700, filed 8/14/06, effective 9/14/06.
				  Statutory Authority:
				  RCW
				  43.17.240, 43.20B.80 [43.20B.080], 74.08.090,
				  74.34.090, Section 1917(b) of the Social Security Act and 2001 2nd sp.s. c 7,
				  Part II. WSR 04-10-060, § 388-527-2700, filed 4/30/04, effective 6/1/04.
				  Statutory Authority:
				  RCW
				  43.20B.080,
				  74.08.090 and 74.34.010. WSR
				  99-11-076, § 388-527-2700, filed 5/18/99, effective 6/18/99. WSR
				  13-18-003, §
										182-527-2700, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2733

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2733, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2733, filed 9/17/12,
				  effective 10/1/12. Statutory Authority:
				  RCW
				  74.08.090 and 2008 Medicare Improvements for
				  Patient and Providers Act (which amended Section 1917(b)(1)(B)(ii) of the
				  Social Security Act); Deficit Reduction Act of 2005 (incorporating language
				  regarding LTC partnership agreements). WSR 10-08-110, § 388-527-2733,
				  filed 4/7/10, effective 5/8/10. Statutory Authority:
				  RCW
				  43.17.240, 43.20B.80 [43.20B.080], 74.08.090,
				  74.34.090, Section 1917(b) of the Social Security Act and 2001 2nd sp.s. c 7,
				  Part II. WSR 04-10-060, § 388-527-2733, filed 4/30/04, effective 6/1/04.
				  Statutory Authority:
				  RCW
				  43.20B.080,
				  74.08.090 and 74.34.010. WSR
				  99-11-076, § 388-527-2733, filed 5/18/99, effective 6/18/99. WSR
				  13-18-003, §
										182-527-2733, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2734 - Liens during a client's lifetime

Current through Register Vol. 24-14, July 15, 2024
For the purposes of this section, the term "agency" includes
				  the agency's designee.
(1)
When
				the agency may file.
(a) The agency may
				file a lien against the property of a Washington apple health client during the
				client's lifetime if:
(i) The client resides
				in a skilled nursing facility, intermediate care facility for individuals with
				an intellectual disability, or other medical institution under WAC
				182-500-0050;
(ii) The agency determines that a client
				cannot reasonably be expected to return home because:
(A) The agency receives a physician's
				verification that the client will not be able to return home; or
(B) The client has resided for six months or
				longer in an institution as defined in WAC
				182-500-0050; and
(iii) None of the following people
				lawfully reside in the client's home:
(A) The
				client's spouse or state-registered domestic partner;
(B) The client's child who is age twenty or
				younger, or is blind or permanently disabled as defined in WAC
				182-512-0050; or
(C) A client's sibling who has an equity
				interest in the home and who has been residing in the home for at least one
				year immediately before the client's admission to the medical
				institution.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2737

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2737, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2737, filed 9/17/12,
				  effective 10/1/12. Statutory Authority:
				  RCW
				  74.08.090 and 2008 Medicare Improvements for
				  Patient and Providers Act (which amended Section 1917(b)(1)(B)(ii) of the
				  Social Security Act); Deficit Reduction Act of 2005 (incorporating language
				  regarding LTC partnership agreements). WSR 10-08-110, § 388-527-2737,
				  filed 4/7/10, effective 5/8/10. Statutory Authority:
				  RCW
				  74.04.050,
				  74.04.057,
				  74.08.090, and
				  chapter
				  26.60 RCW. WSR 09-07-038,
				  § 388-527-2737, filed 3/10/09, effective 4/10/09. Statutory Authority:
				  2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2737, filed 8/14/06, effective 9/14/06.
				  Statutory Authority:
				  RCW
				  43.20B.080,
				  74.08.090 and 74.34.010. WSR
				  99-11-076, § 388-527-2737, filed 5/18/99, effective 6/18/99. WSR
				  13-18-003, §
										182-527-2737, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2738 - Estate recovery-General right to recover

Current through Register Vol. 24-14, July 15, 2024
For the purposes of this section, the term "agency" includes
				  the agency's designee.
(1)
When
				the agency may file.
After a Washington apple health client has died,
				the medicaid agency may file liens to recover the cost of services subject to
				recovery that were correctly paid on the client's behalf.
(2)
Notice requirement.
(a) Before the agency may file a lien under
				this section, it sends notice via first class mail as follows:
(i) If the estate has a personal
				representative, the agency sends notification to:
(A) The personal representative;
				and
(B) Any known title
				holder.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2740 - Estate recovery-Age-related limitations

Current through Register Vol. 24-14, July 15, 2024
For the purposes of this section, the term "agency" includes
				  the agency's desig-nee.
(1)
Liability for medicaid services.
(a) Beginning July 26, 1987, a client's
				estate is liable for medicaid services subject to recovery that were provided
				on or after the client's sixty-fifth birthday.
(b) Beginning July 1, 1994, a client's estate
				is liable for medicaid services subject to recovery that were provided on or
				after the client's fifty-fifth birthday.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2742 - Estate recovery-Service-related limitations

Current through Register Vol. 24-14, July 15, 2024
For the purposes of this section, the term "agency" includes
				  the agency's designee.
The agency's payment for the following services is subject to
				  recovery:
(1) State-only funded
				services, except:
(a) Adult protective
				services;
(b) Offender reentry
				community safety program services;
(c) Supplemental security payments (SSP)
				authorized by the developmental disabilities administration (DDA);
(d) Volunteer chore services; and
(e) Guardianship and conservatorship
				assistance program services.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2746 - Estate recovery-Asset-related limitations

Current through Register Vol. 24-14, July 15, 2024
For the purposes of this section, the term "agency" includes
				  the agency's designee.
(1)
Before July 25, 1993.
For services received before July 25, 1993,
				that are subject to recovery, the agency may exempt:
(a) The first fifty thousand dollars of the
				estate's value at the time of the client's death; and
(b) Sixty-five percent of the remaining value
				of the estate.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2750 - Estate recovery-Delay of recovery for undue hardship

Current through Register Vol. 24-14, July 15, 2024
For the purposes of this section, the term "agency" includes
				  the agency's designee.
(1) If an undue
				hardship exists at the time of the client's death, an heir may ask the agency
				to delay recovery.
(a) Undue hardship exists
				only when:
(i) The property subject to
				recovery is the sole income-producing asset of an heir;
(ii) Recovery would deprive an heir of
				shelter and the heir cannot afford alternative shelter; or
(iii) The client is survived by a
				state-registered domestic partner.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2753 - Hearings

Current through Register Vol. 24-14, July 15, 2024
For the purposes of this section, the term "agency" includes
				  the agency's designee.
(1) An
				administrative hearing to contest action under this chapter determines only:
(a) In the case of a lien filed during the
				client's lifetime under WAC 182-527-2734:
(i)
				Whether the client can reasonably be expected to return home from the medical
				institution;
(ii) Whether the
				client, or the client's estate, holds legal title to the identified property;
				and
(iii) Whether the client
				received services subject to recovery.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2754

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2754, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2754, filed 9/17/12,
				  effective 10/1/12. Statutory Authority:
				  RCW
				  74.08.090 and
				  74.09.520. WSR 12-18-010, §
				  388-527-2754, filed 8/23/12, effective 9/23/12. Statutory Authority:
				  RCW
				  74.08.090 and 2008 Medicare Improvements for
				  Patient and Providers Act (which amended Section 1917(b)(1)(B)(ii) of the
				  Social Security Act); Deficit Reduction Act of 2005 (incorporating language
				  regarding LTC partnership agreements). WSR 10-08-110, § 388-527-2754,
				  filed 4/7/10, effective 5/8/10. Statutory Authority:
				  RCW
				  43.17.240, 43.20B.80 [43.20B.080], 74.08.090,
				  74.34.090, Section 1917(b) of the Social Security Act and 2001 2nd sp.s. c 7,
				  Part II. WSR 04-10-060, § 388-527-2754, filed 4/30/04, effective 6/1/04.
				  Statutory Authority:
				  RCW
				  43.20B.080,
				  74.08.090 and 74.34.010. WSR
				  99-11-076, § 388-527-2754, filed 5/18/99, effective 6/18/99. Statutory
				  Authority: 1995 1st sp.s. c 18 and
				  RCW
				  74.08.090. WSR 95-19-001 and 95-24-037
				  (Orders 3893 and 3893A), § 388-527-2754, filed 9/6/95 and 11/29/95,
				  effective 10/7/95 and 12/30/95. WSR 13-18-003, §
										182-527-2754, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2790

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2790, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2790, filed 9/17/12,
				  effective 10/1/12. Statutory Authority:
				  RCW
				  74.08.090 and 2008 Medicare Improvements for
				  Patient and Providers Act (which amended Section 1917(b)(1)(B)(ii) of the
				  Social Security Act); Deficit Reduction Act of 2005 (incorporating language
				  regarding LTC partnership agreements). WSR 10-08-110, § 388-527-2790,
				  filed 4/7/10, effective 5/8/10. Statutory Authority: 2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2790, filed 8/14/06, effective 9/14/06.
				  Statutory Authority:
				  RCW
				  43.17.240, 43.20B.80 [43.20B.080], 74.08.090,
				  74.34.090, Section 1917(b) of the Social Security Act and 2001 2nd sp.s. c 7,
				  Part II. WSR 04-10-060, § 388-527-2790, filed 4/30/04, effective 6/1/04.
				  Statutory Authority:
				  RCW
				  74.08.090. WSR 01-02-076, §
				  388-527-2790, filed 12/29/00, effective 1/29/01. Statutory Authority:
				  RCW
				  43.20B.080,
				  74.08.090 and 74.34.010. WSR
				  99-11-076, § 388-527-2790, filed 5/18/99, effective 6/18/99. Statutory
				  Authority: 1995 1st sp.s. c 18 and
				  RCW
				  74.08.090. WSR 95-19-001 and 95-24-037
				  (Orders 3893 and 3893A), § 388-527-2790, filed 9/6/95 and 11/29/95,
				  effective 10/7/95 and 12/30/95. WSR 13-18-003, §
										182-527-2790, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2810

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2810, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2810, filed 9/17/12,
				  effective 10/1/12. Statutory Authority: 2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2810, filed 8/14/06, effective 9/14/06.
				  WSR 13-18-003, §
										182-527-2810, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2820

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2820, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2820, filed 9/17/12,
				  effective 10/1/12. Statutory Authority:
				  RCW
				  74.08.090 and 2008 Medicare Improvements for
				  Patient and Providers Act (which amended Section 1917(b)(1)(B)(ii) of the
				  Social Security Act); Deficit Reduction Act of 2005 (incorporating language
				  regarding LTC partnership agreements). WSR 10-08-110, § 388-527-2820,
				  filed 4/7/10, effective 5/8/10. Statutory Authority:
				  RCW
				  74.04.050,
				  74.04.057,
				  74.08.090, and
				  chapter
				  26.60 RCW. WSR 09-07-038,
				  § 388-527-2820, filed 3/10/09, effective 4/10/09. Statutory Authority:
				  2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2820, filed 8/14/06, effective 9/14/06.
				  WSR 13-18-003, §
										182-527-2820, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2830

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2830, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2830, filed 9/17/12,
				  effective 10/1/12. Statutory Authority: 2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2830, filed 8/14/06, effective 9/14/06.
				  WSR 13-18-003, §
										182-527-2830, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2840

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2840, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2840, filed 9/17/12,
				  effective 10/1/12. Statutory Authority: 2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2840, filed 8/14/06, effective 9/14/06.
				  WSR 13-18-003, §
										182-527-2840, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2850

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2850, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2850, filed 9/17/12,
				  effective 10/1/12. Statutory Authority: 2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2850, filed 8/14/06, effective 9/14/06.
				  WSR 13-18-003, §
										182-527-2850, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2860

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2860, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2860, filed 9/17/12,
				  effective 10/1/12. Statutory Authority: 2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2860, filed 8/14/06, effective 9/14/06.
				  WSR 13-18-003, §
										182-527-2860, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-527 - Estate recovery and pre death liens › Section 182-527-2870

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-19-038, §
										182-527-2870, filed 9/11/13,
				  effective 10/12/13. WSR 12-19-070, recodified as §
										182-527-2870, filed 9/17/12,
				  effective 10/1/12. Statutory Authority: 2005 c 292,
				  RCW
				  43.20B.080,
				  74.39A.170, 42 U.S.C. Section
				  1396p. WSR 06-17-075, § 388-527-2870, filed 8/14/06, effective 9/14/06.
				  WSR 13-18-003, §
										182-527-2870, filed 8/21/2013,
				  effective 9/21/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-530 - Prescription drugs (outpatient) › Section 182-530-1000 - Outpatient drug program-General

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of
				the outpatient drug program is to reimburse providers for outpatient drugs,
				vitamins, minerals, devices, and drug-related supplies according to medicaid
				agency rules and subject to the limitations and requirements in this
				chapter.
(2) The agency reimburses
				for outpatient drugs, vitamins, minerals, devices, and pharmaceutical supplies
				that are:
(a) Covered. Refer to WAC
				182-530-2000 for covered drugs,
				vitamins, minerals, devices, and drug-related supplies and to WAC
				182-530-2100 for noncovered drugs
				and drug-related supplies;
(b)
				Prescribed by a provider with prescriptive authority (see exceptions for family
				planning and emergency contraception for women 18 years of age and older in WAC
				182-530-2000(1)(b),
				and over-the-counter (OTC) drugs to promote smoking cessation in WAC
				182-530-2000
				(1)(g));
(c) Prescribed by:
(i) A provider with an approved core provider
				agreement;
(ii) A provider who is
				enrolled as a servicing provider on an approved core provider agreement;
				or
(iii) A provider who is enrolled
				as a nonbilling provider.
(d) Within the scope of an eligible client's
				medical assistance program;
(e)
				Medically necessary as defined in WAC
				182-500-0070 and determined
				according to the process found in WAC
				182-501-0165;
(f) Authorized, as required within this
				chapter;
(g) Billed according to
				WAC 182-502-0150 and
				182-502-0160; and
(h) Billed according to the requirements of
				this chapter.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-530 - Prescription drugs (outpatient) › Section 182-530-1075 - Requirements - Use of tamper-resistant prescription pads

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency requires providers to
				use tamper-resistant prescription pads or paper for written outpatient
				prescriptions, including over-the-counter drugs, for Washington apple health
				clients.
(2) This requirement
				applies to all outpatient prescription drugs, including:
(a) Prescriptions when medicaid is primary or
				secondary payer (including medicare Part D prescriptions).
(b) Signed hardcopy prescriptions given to a
				client, whether handwritten or computer-generated.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-530 - Prescription drugs (outpatient) › Section 182-530-1080 - Requirements for prescribing and dispensing controlled substances-Prescription monitoring program (PMP)

Current through Register Vol. 24-14, July 15, 2024
This section identifies the steps prescribers must take
				  before prescribing a controlled substance and the steps pharmacists must take
				  when dispensing a controlled substance from an outpatient pharmacy to check an
				  apple health client's prescription drug history in the prescription monitoring
				  program (PMP) described in chapter 246-470 WAC.
(1)
PMP review required.
Except
				as identified in subsection (4) of this section, a prescriber, before
				prescribing, and a pharmacist, when dispensing, must check all of a client's
				current prescriptions in the PMP, including any prescriptions not paid for by
				apple health.
(2)
Retrieval
				by delegates allowed.
A prescriber or pharmacist may delegate the
				retrieval of the client's PMP information to anyone in their practice setting
				with authorization to access the PMP, so long as the prescriber or pharmacist
				reviews all of the client's current prescriptions in the PMP before prescribing
				or when dispensing a controlled substance.
(3)
Documentation.
The
				prescriber and pharmacist must document in the client's record the date and
				time of the:
(a) Retrieval of information from
				the PMP; and
(b) Review of
				information from the PMP.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-530 - Prescription drugs (outpatient) › COVERAGE › Section 182-530-2000 - Covered-Outpatient drugs, devices, and drug-related supplies

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency covers:
(a) Outpatient drugs, including
				  over-the-counter (OTC) drugs, as defined in WAC
				  182-530-1050, subject to the
				  limitations and requirements in this chapter, when:
(i) The drug is approved by the Food and Drug
				  Administration (FDA);
(ii) The drug
				  is for a medically accepted indication as defined in WAC
				  182-530-1050;
(iii) The drug is not excluded from coverage
				  under WAC
				  182-530-2100;
(iv) The manufacturer has a signed drug
				  rebate agreement with the federal Department of Health and Human Services
				  (DHHS). Exceptions to the drug rebate requirement are described in WAC
				  182-530-7500; and
(v) The drug is prescribed by a provider with
				  prescriptive authority. Exceptions to the prescription requirement exist for
				  family planning and emergency contraception in (b) of this
				  subsection.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-530 - Prescription drugs (outpatient) › COVERAGE › Section 182-530-2100 - Noncovered-Outpatient drugs and pharmaceutical supplies

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency does not cover:
(a) A drug that is:
(i) Not approved by the Food and Drug
				  Administration (FDA); or
(ii)
				  Prescribed for a nonmedically accepted indication, including diagnosis, dose,
				  or dosage schedule that is not evidenced based.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-530 - Prescription drugs (outpatient) › AUTHORIZATION › Section 182-530-3000 - When the medicaid agency requires authorization

Current through Register Vol. 24-14, July 15, 2024
Covered drugs, devices, or drug-related supplies require
					 authorization for reimbursement when:
(1) The medicaid agency's pharmacists or
				  medical consultants:
(a) Have determined that
				  authorization for the drug, device, or drug-related supply is required, as
				  described in WAC
				  182-530-3100; or
(b) Have not yet reviewed the drug, device,
				  or drug-related supply as described in WAC
				  182-530-3100.