Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0010 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The following definitions and those found in
				  RCW
				  34.05.010 apply to this chapter:
"Administrative law judge (ALJ)"
- An impartial
				  decision-maker who is an attorney and presides at an administrative hearing.
				  ALJs are employed by the office of administrative hearings (OAH), which is a
				  separate state agency, as defined in
				  RCW
				  34.05.010. ALJs are not department of social
				  and health services or health care authority (HCA) employees or
				  representatives.
"Agency"
- See WAC
				  182-500-0010.
"Appellant"
- A person or entity who requests a
				  hearing about an action of HCA or its designee.
"Applicant"
- Any person who has made a request,
				  or on whose behalf a request has been made, to HCA, or HCA's authorized agent
				  on HCA's behalf, for assistance through a medical service program established
				  under chapter 74.09 RCW.
"Authorized agent"
- A person or agency, as
				  defined in
				  RCW
				  34.05.010, acting on HCA's behalf under an
				  agreement authorized by
				  RCW
				  41.05.021 to act as an HCA hearing
				  representative. An authorized agent may be an employee of the department of
				  social and health services or its contractors but may not be an employee of an
				  HCA-contracted managed care organization.
"Board of appeals"
or
"BOA"
- The
				  HCA's board of appeals.
"Business days"
- All days except Saturdays,
				  Sundays, and designated holidays under WAC
				  357-31-005.
"Calendar days"
- All days including Saturdays,
				  Sundays, and designated holidays under WAC
				  357-31-005.
"Continuance"
- A change in the date or time of
				  a pre-hearing conference, hearing, or the deadline for other action.
"Date of the health care authority (HCA) action"
-The date when the HCA's decision is effective.
"Deliver"
- Giving a document to a person or
				  entity in person or placing the document into the person or entity's possession
				  as authorized by the rules in this chapter or chapter 34.05 RCW.
"Department"
- The department of social and
				  health services.
"Documents"
- Papers, letters, writings, emails,
				  or other printed or written items.
"Electronic service"
- The service of documents
				  sent or received through electronic communications, cloud services, or other
				  electronic means established by the agency. For the purpose of effectuating
				  service, as defined below, on HCA or OAH (but not BOA), service via OAH's PRISM
				  participant portal is an acceptable method of "electronic service."
"Filing"
- The act of delivering documents to
				  the office of administrative hearings (OAH) or the board of appeals
				  (BOA).
"Final order"
- An order that is the final HCA
				  decision.
"HCA"
- The health care authority.
"Health care authority (HCA) hearing
				  representative"
- An employee of HCA, an authorized agent of HCA, HCA
				  contractor or a contractor of HCA's authorized agent, or an assistant attorney
				  general authorized to represent HCA in an administrative hearing. The HCA
				  hearing representative may or may not be an attorney. An employee of an HCA
				  contracted managed care organization is not an HCA hearing
				  representative.
"Hearing"
- Unless context clearly requires a
				  different meaning, a proceeding before an ALJ, HCA-employed presiding officer,
				  or a review judge that gives a party an opportunity to be heard in disputes
				  about medical services programs established under chapter 74.09 RCW. For
				  purposes of this chapter, hearings include administrative hearings,
				  adjudicative proceedings, and any other similar term referenced under chapter
				  34.05 RCW, the Administrative Procedure Act, Titles 182 and 388 WAC, chapter
				  10-08 WAC, or other law.
"Initial order"
- A hearing decision entered
				  (made) by an ALJ that may be reviewed by a review judge at any party's
				  request.
"Intermediary interpreter"
- An interpreter
				  who:
(1) Is a certified deaf interpreter (CDI); and
(2) Is able to assist in providing an accurate interpretation
				  between spoken and sign language or between types of sign language by acting as
				  an intermediary between a person with hearing loss and a qualified
				  interpreter.
"Judicial review"
- Review of a final order as
				  provided under
				  RCW
				  34.05.510 through
				  34.05.598.
"Limited-English proficient (LEP)"
- Includes
				  limited-English-speaking persons or other persons unable to communicate in
				  spoken English because of hearing loss.
"Limited-English-speaking (LES) person"
- A
				  person who, because of non-English-speaking cultural background or disability,
				  cannot readily speak or understand the English language.
"Mail"
- Placing a document in the United States
				  Postal system, or commercial delivery service, properly addressed and with the
				  proper postage.
"Managed care organization"
or
"MCO"
- An organization having a certificate of authority or
				  certificate of registration from the office of insurance commissioner that
				  contracts with HCA under a comprehensive risk contract to provide prepaid
				  health care services to eligible recipients under HCA's managed care
				  programs.
"OAH"
- The office of administrative
				  hearings.
"Order of default"
- An order entered by an
				  administrative law judge (ALJ) or review judge when the appellant fails to
				  appear in a prehearing conference or a hearing. Once the order of default
				  becomes a final order, it terminates the appellant's request for a hearing and
				  ends the hearing process.
"Order of dismissal"
- An order from the
				  administrative law judge (ALJ) or review judge ending the hearing
				  process.
"Party":
(1) The health care authority (HCA);
(2) HCA-contracted managed care organization (MCO) (if
				  applicable); and
(3) A person or entity:
(a) Named in the action;
(b) To whom the action is directed; or
(c) Is allowed to participate in a hearing to protect an
				  interest as authorized by law or rule.
"Person with hearing loss"
- A person who,
				  because of a loss of hearing, cannot readily speak, understand, or communicate
				  in spoken language.
"Prehearing conference"
- A formal proceeding
				  scheduled and conducted by an ALJ or other reviewing officer on the record for
				  the purposes identified in WAC
				  182-526-0195.
"Prehearing meeting"
- An informal, voluntary
				  meeting that may be held before any prehearing conference or hearing.
"Program"
- An organizational unit and the
				  services that it provides, including services provided by HCA staff, its
				  authorized agents, and through contracts with providers and HCA-contracted
				  managed care organizations.
"Qualified interpreter"
- Includes qualified
				  interpreters for a limited-English-speaking person or a person with hearing
				  loss.
"Qualified interpreter for a limited-English-speaking
				  person"
- A person who is readily able to interpret or translate spoken
				  and written English communications to and from a limited-English-speaking
				  person effectively, accurately, and impartially. If an interpreter is court
				  certified, the interpreter is considered qualified.
"Qualified interpreter for a person with hearing
				  loss"
- A visual language interpreter who is certified by the Registry
				  of Interpreters for the Deaf (RID) or National Association of the Deaf (NAD)
				  and is readily able to interpret or translate spoken communications to and from
				  a person with hearing loss effectively, accurately, and impartially.
"Recipient"
- Any person receiving assistance
				  through a medical service program established under chapter 74.09 RCW.
"Reconsideration"
- Asking a review judge to
				  reconsider a final order entered because the party believes the review judge
				  made a mistake.
"Record"
- The official documentation of the
				  hearing process. The record includes recordings or transcripts, admitted
				  exhibits, decisions, briefs, notices, orders, and other filed documents.
"Review"
- A review judge evaluating initial
				  orders entered by an ALJ and making the final HCA decision as provided by
				  RCW
				  34.05.464, or issuing final orders.
"Review judge"
- A decision-maker with expertise
				  in program rules who serves as the reviewing officer under
				  RCW
				  34.05.464. The review judge reviews initial
				  orders and the hearing record exercising decision-making power as if hearing
				  the case as a presiding officer. In some cases, review judges conduct hearings
				  under
				  RCW
				  34.05.425 as a presiding officer. After
				  reviewing initial orders or conducting hearings, review judges enter final
				  orders. Review judges are employed by HCA but may be physically located at the
				  board of appeals (BOA). The review judge must not have been involved in the
				  initial HCA action.
"Rule"
- A regulation adopted by a state agency.
				  Rules are found in the Washington Administrative Code (WAC).
"Service"
- The delivery of documents as
				  explained in WAC
				  182-526-0040.
"Should"
- That an action is recommended but not
				  required.
"Stay"
- An order temporarily halting the HCA
				  decision or action.
"Witness"
- For the purposes of this chapter,
				  means any person who makes statements or gives testimony that becomes evidence
				  in a hearing. One type of witness is an expert witness. An expert witness is
				  qualified by knowledge, skill, experience, training, and education to give
				  opinions or evidence in a specialized area.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0010, filed 12/19/12,
					 effective 2/1/13.