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 182-526-0205 - Appeals requested by a data supplier to the Washington all payer health care claims database (WA-APCD)

Current through Register Vol. 24-14, July 15, 2024
(1)
Appeal.
A data supplier may request an appeal of a denial of its
				administrative review conducted in accordance with WAC
				182-70-100.
(a) Request for an appeal must be submitted
				in writing to the health care authority (HCA) within fifteen calendar days
				after receipt of written notification of denial of its administrative
				review.
(b) An appeal request must
				contain:
(i) The requestor's name;
(ii) The requestor's mailing
				address;
(iii) The requestor's
				telephone number;
(iv) A
				description of HCA's action being contested;
(v) A brief explanation of why the person or
				entity disagrees with HCA's action; and
(vi) Any accommodation to help the requestor
				fully participate in the hearing, if applicable.
(c) Within ten business days of receipt of a
				written notice of appeal, HCA transmits the request to the office of
				administrative hearings (OAH).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0206 - Hearing and final order for penalties imposed under WAC 182-70-600

Current through Register Vol. 24-14, July 15, 2024
(1) For penalties
				imposed under WAC
				182-70-600,
				the Washington all payer health care claims database (WA-APCD) program director
				or the director's designee conducts a hearing and prepares a final
				order.
(2) The hearing must be
				conducted in accordance with this chapter and the Administrative Procedure Act,
				chapter 34.05 RCW.
(3) The WA-APCD
				program director, on behalf of the health care authority, must be the
				petitioner in the hearing, and the requestor must be the respondent.
(4) The WA-APCD program director has the
				burden of proving the basis for the finding of a violation and the penalty as
				set forth in the notice of violation and recommended penalty.
(5) The WA-APCD program director or the
				director's delegate issues a final written order that includes findings of
				fact, conclusions of law, and if appropriate, the penalty.
(6) If the order finds a violation and
				assesses monetary penalties, the order must include notice that payment must be
				made no later than forty-five days after service of the order or the period to
				appeal has expired, whichever is later.
(7) The WA-APCD program director must cause
				service of the final order on all parties.
(8) Any party to whom a violation is found
				may file a petition for review of the final order to superior court.
(9) If an appeal is not filed within the
				period set by
				RCW
				34.05.542, the WA-APCD program director's
				order is conclusive and binding on all parties.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0210 - Appeals requested by intermediate care facilities for individuals with intellectual disabilities (ICF/IID)

Current through Register Vol. 24-14, July 15, 2024
The hearing process described in this section applies to
				  requests for an appeal made by an intermediate care facility for individuals
				  with intellectual disabilities (ICF/IID), as defined in WAC
				  388-825-020.
(1)
Right to hearing.
An ICF/IID
				may request a hearing when it is dissatisfied with the medicaid agency's
				finding of noncompliance resulting in the termination of medicaid funding and
				any related provider agreements under
				42 C.F.R. Sec.
				431.151 through
				431.154.
(a) An agency review judge conducts the
				hearing and enters the agency's final order for cases held under this
				subsection.
(b) An ICF/IID cannot
				appeal:
(i) The choice of sanction or
				remedy;
(ii) The monitoring
				remedy;
(iii) The level of
				noncompliance found, except when a favorable review decision would affect the
				range of civil money penalty amounts the agency could collect; or
(iv) The decision about when to conduct an
				initial survey of a prospective provider.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0215 - Authority of the administrative law judge when conducting a hearing

Current through Register Vol. 24-14, July 15, 2024
(1) The
				administrative law judge (ALJ) must hear and decide the issues de novo (anew)
				based on the evidence presented and admitted into the record during the
				hearing.
(2) As needed, the ALJ
				may:
(a) Determine the order for presenting
				evidence;
(b) Issue subpoenas or
				orders directing witnesses to appear or bring documents;
(c) Rule on objections, motions, and
				procedural matters;
(d) Rule on an
				offer of proof made to admit evidence;
(e) Admit relevant evidence;
(f) Impartially question witnesses to develop
				the record;
(g) Call additional
				witnesses and request exhibits to complete the record;
(h) Give the parties an opportunity to
				cross-examine witnesses or present more evidence against the witnesses or
				exhibits;
(i) Keep order during the
				hearing;
(j) Allow or require oral
				or written argument and set the deadlines for the parties to submit argument or
				evidence;
(k) Permit others to
				attend, photograph, or electronically record hearings, but may place conditions
				to preserve confidentiality or prevent disruption;
(l) Allow a party to waive rights given by
				chapters 34.05 RCW or 182-526 WAC, unless another law prevents it;
(m) Decide whether a party has a right to a
				hearing;
(n) Issue protective
				orders;
(o) Consider granting a
				stay if authorized by law or HCA rule; and
(p) Take any other action necessary and
				authorized under these or other rules.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0216 - The authority of the administrative law judge and the review judge is limited

Current through Register Vol. 24-14, July 15, 2024
(1) The authority
				of the administrative law judge and the review judge is limited to those powers
				granted by statute or rule. The ALJ and the review judge do not have any
				inherent or common law powers.
(2)
				Neither an administrative law judge nor a review judge may decide that a rule
				is invalid or unenforceable. Only a court may decide this issue.
(3) If the validity of a rule is raised
				during the hearing, the ALJ or review judge may allow only argument for court
				review.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0216, 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 182-526-0218 - The authority of a review judge when conducting a hearing as a presiding officer

Current through Register Vol. 24-14, July 15, 2024
(1) A review judge
				has the same authority and responsibilities as an administrative law judge, as
				described in WAC
				182-526-0215, when conducting a
				hearing.
(2) 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).
(3) The review judge enters final HCA
				decisions on all cases in the form of a final order.
(4) Following a review judge's final order:
(a) Any party may request reconsideration of
				the final order as provided in this chapter and WAC
				388-96-904(12);
				and
(b) The party who requested the
				hearing, but not the health care authority or any of its authorized agents, may
				file a petition for judicial review as provided in this chapter.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0220 - Rules and laws an administrative law judge and review judge must apply when conducting a hearing and making a decision

Current through Register Vol. 24-14, July 15, 2024
(1) Administrative law judges (ALJs) and
				review judges must first apply the applicable program rules adopted in the
				Washington Administrative Code (WAC).
(2) If no program rule applies, the ALJ and
				review judge must decide the issue according to the best legal authority and
				reasoning available, including federal and Washington state constitutions,
				statutes, regulations, and court decisions.
(3) When applying program rules regarding the
				substantive rights and responsibilities of the parties (such as eligibility for
				services, benefits, or a license), the ALJ and review judge must apply the
				program rules in effect on the date of the health care authority (HCA) action,
				unless otherwise required by other rule or law. If HCA amends its notice of
				action, the ALJ or review judge must apply the rules in effect on the date the
				action was taken, unless otherwise required by other rule or law.
(4) When applying procedural rules, the ALJ
				and review judge must apply the rules that are in effect on the date the
				procedure is followed.
(5) Program
				rules determine the amount of time HCA or HCA's authorized agent has to process
				an application for services, benefits, or a license.
(6) The ALJ and review judge must apply the
				rules in this chapter beginning on the date each rule is effective.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0220, 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 182-526-0221 - HCA index of significant decisions

Current through Register Vol. 24-14, July 15, 2024
(1) A final order may be relied on, used, or
				cited as precedent by a party if the final order has been indexed in the index
				of significant decisions maintained by the health care authority
				(HCA).
(2) The index of significant
				decisions is available to the public at
http://www.hca.wa.gov/about-hca/significant-decisions
.
				For information on how to obtain a copy of the index, contact the HCA hearing
				representative.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0221, 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 182-526-0230 - Assigning an administrative law judge to a hearing

Current through Register Vol. 24-14, July 15, 2024
(1) The office of administrative hearings
				(OAH) assigns an administrative law judge (ALJ) at least five business days
				before the hearing, except when the hearing is expedited.
(2) A party may ask which ALJ is assigned to
				the hearing by calling or writing to the OAH field office listed on the notice
				of hearing.
(3) If requested by a
				party, OAH must send the name of the assigned ALJ to the party by email or in
				writing at least five business days before the party's scheduled hearing
				date.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0230, 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 182-526-0235

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0235, 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 182-526-0240 - Filing a motion of prejudice

Current through Register Vol. 24-14, July 15, 2024
(1)
				A party requesting a different administrative law judge (ALJ) may do so by
				filing a written motion of prejudice consistent with
				RCW
				34.12.050. A party must file the motion with
				the office of administrative hearings (OAH) before the ALJ rules on a
				discretionary issue in the case, admits evidence, or takes testimony. The
				motion must include an affidavit or sworn statement under penalty of perjury
				supporting the party's claim that the ALJ cannot hear the case
				fairly.
(2) Rulings that are not
				considered discretionary rulings for purposes of this section include, but are
				not limited to rulings that:
(a) Grant or deny
				a request for a continuance; or
(b)
				Grant or deny a request for a prehearing conference.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0245 - Disqualifying an administrative law judge or review judge

Current through Register Vol. 24-14, July 15, 2024
(1) An administrative law judge (ALJ) or
				review judge may be disqualified for bias, prejudice, or conflict of interest,
				or if one of the parties or a party's representative has ex parte contact with
				the ALJ or review judge.
(2) Ex
				parte contact means any written or oral communication with the ALJ or review
				judge about something related to the hearing when the other parties are not
				present. Procedural questions are not considered an ex parte contact. Examples
				of procedural questions include clarifying the hearing date, time, or location,
				or asking for directions to the hearing location.
(3) To request disqualification of an ALJ or
				review judge, a party must file a written petition for disqualification
				consistent with
				RCW
				34.05.425 explaining why the ALJ or review
				judge should be disqualified. A party must promptly file the petition upon
				discovery of possible bias, conflict of interest, or ex parte
				contact.
(4) A party must deliver
				the petition to the ALJ or review judge assigned to the case. That ALJ or
				review judge must decide whether to grant or deny the petition and must state
				the facts and reasons for the decision.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0245, 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 182-526-0250 - Time requirements for notices issued by the office of administrative hearings

Current through Register Vol. 24-14, July 15, 2024
(1) The office of
				administrative hearings (OAH) must serve a notice of hearing on all parties and
				their representatives at least fourteen calendar days before the hearing
				date.
(2) If OAH schedules a
				prehearing conference, OAH must serve a notice of prehearing conference to the
				parties and their representatives at least seven business days before the date
				of the prehearing conference except:
(a) OAH
				or an administrative law judge (ALJ) may change a scheduled hearing into a
				prehear-ing conference and provide less than seven business days' notice of the
				prehearing conference; and
(b) OAH
				may give less than seven business days' notice if the only purpose of the
				prehearing conference is to consider whether to grant a continuance under WAC
				182-526-0280 or 182-526-0282, as
				applicable.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0255 - Notice of hearing or notice of prehearing conference

Current through Register Vol. 24-14, July 15, 2024
(1)
(a) A
				notice of hearing or a notice of prehearing conference is a written notice
				issued by the office of administrative hearings (OAH) that must include the:
(i) Names of all parties to whom the notice
				is sent and, if known, the names and addresses of their
				representatives;
(ii) Name, mailing
				address, and telephone number of the administrative law judge (ALJ), if
				known;
(iii) Date, time, place, and
				nature of the hearing or pre-hearing conference;
(iv) Legal authority and jurisdiction for the
				hearing; and
(v) Date of the
				hearing request.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0260 - Amending the health care authority or managed care organization notice

Current through Register Vol. 24-14, July 15, 2024
(1) The
				administrative law judge (ALJ) must allow the health care authority (HCA),
				HCA's authorized agent, or a managed care organization (MCO) to amend (change)
				the notice of an action before or during the hearing to match the evidence and
				facts.
(2) HCA, HCA's authorized
				agent, or MCO must put the change in writing and deliver a copy to the ALJ and
				all parties.
(3) The ALJ must offer
				to continue (postpone) the hearing to give the parties more time to prepare or
				present evidence or argument if there is a substantive change from the earlier
				notice.
(4) If the ALJ grants a
				continuance, the office of administrative hearings must serve a new hearing
				notice at least fourteen calendar days before the hearing date.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0260, 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 182-526-0265 - Amending hearing requests

Current through Register Vol. 24-14, July 15, 2024
(1) The
				administrative law judge (ALJ) may allow the party that requested the hearing
				to amend its hearing request before or during the hearing.
(2) The ALJ must offer to continue (postpone)
				the hearing to give the other parties more time to prepare or present evidence
				or argument if there is a substantive change in the hearing request.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0265, 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 182-526-0270 - Mailing address changes

Current through Register Vol. 24-14, July 15, 2024
(1) The
				appellant must tell the health care authority (HCA) hearing representative and
				the office of administrative hearings (OAH) as soon as possible, when the
				party's mailing address changes.
(2) If a party does not notify the HCA
				hearing representative and OAH of a change of mailing address , OAH continues
				to send notices and other important papers to the last known mailing address.
				If this happens, the administrative law judge may find that the party received
				the documents or waived the right to receive those documents.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0270, 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 182-526-0280 - Continuing a hearing when an appellant is an applicant or recipient

Current through Register Vol. 24-14, July 15, 2024
(1) Any party may
				request a continuance under this section either orally or in writing.
(2) Before contacting the office of
				administrative hearings (OAH) to request a continuance, the party seeking the
				continuance must make a good faith effort to contact the other parties to find
				out if they agree to a continuance. The party making the request for a
				continuance must let OAH know whether the other parties agreed to the
				continuance.
(3)
Standard
				when less than sixty days.
When a continuance request is made less than
				sixty days from the date OAH received the hearing request:
(a) If all parties agree to the continuance,
				the ALJ must grant the request unless the ALJ holds a prehearing conference and
				finds that good cause for a continuance does not exist under WAC
				182-526-0020.
(b) If the parties do not agree to the
				continuance, the ALJ must schedule a prehearing conference and determine if
				good cause for a continuance exists under WAC
				182-526-0020 and under the
				following factors:
(i) Why the party is
				requesting a continuance;
(ii) Why
				the other party or parties are objecting to the request;
(iii) Whether a continuance in the case has
				previously been granted at the request of the same party who is now requesting
				the continuance and, if so, whether it was for the same reason;
(iv) The extent to which the requesting or
				objecting parties could have prevented the need for delay;
(v) The number and duration of previous
				continuances in the case and who requested them;
(vi) The legal or factual complexity of the
				case;
(vii) The relative harm to
				the parties if the continuance is granted or denied, including the risk of harm
				to the appellant if he or she is not receiving continued benefits;
(viii) The impact of a continuance on the
				parties' ability to adequately prepare and present their cases;
(ix) Any need to provide accommodation,
				translation, or interpreter services; and
(x) The impact of a continuance on the
				ability of OAH to issue a timely initial decision; or
(xi) Other relevant factors.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0282 - Continuance requests in provider hearing, estate recovery hearing, or nursing home rate hearing under WAC 388-96-904

Current through Register Vol. 24-14, July 15, 2024
This section applies to continuance requests made in
				  provider hearings, estate recovery hearings, or nursing home rate
				  hearings.
(1) A request for
				continuance under this section may be made either orally or in
				writing.
(2) Before contacting the
				office of administrative hearings (OAH) to request a continuance, the party
				seeking the continuance must make a good faith effort to contact the other
				parties to find out if they agree to a continuance.
(3) The party making the request for a
				continuance must let OAH know whether the other parties agreed to the
				continuance. If all parties agree to a continuance, the administrative law
				judge (ALJ) must grant the request unless the ALJ requires a showing of good
				cause for a continuance.
(4) If the
				parties do not agree to a continuance, the ALJ must schedule and hold a
				prehearing conference to decide whether there is good cause to grant the
				continuance.
(5) If the ALJ grants
				a continuance, OAH must serve a new notice of hearing on the parties at least
				fourteen calendar days before the new hearing date.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0284 - Orders of default

Current through Register Vol. 24-14, July 15, 2024
(1) An order of
				default may be entered when the appellant fails to attend a scheduled
				prehearing conference or hearing. The order of default will include a notice of
				inquiry as to whether the appellant wants to petition to reinstate the
				hearing.
(2) The appellant may file
				a petition to vacate an order of default under WAC
				182-526-0290.
(3) An order of default becomes a final order
				by operation of law, disposing of the appellant's request for a hearing under
				RCW 34.05.440
				if:
(a) The appellant does not file a
				petition to vacate within twenty-one calendar days of the order being served
				(mailed) on the parties under WAC
				182-526-0290(2)
				and (5)(b); or
(b) If the appellant fails to appear at a
				prehearing conference scheduled to address the petition to vacate under WAC
				182-526-0290(3)
				and (4)(a).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0285 - Orders of dismissal

Current through Register Vol. 24-14, July 15, 2024
(1) An order of
				dismissal may be entered when the appellant withdraws the request for hearing
				under WAC
				182-526-0115.
(2) An appellant may file a petition
				(request) to vacate an order of dismissal under WAC
				182-526-0290.
(3) An order of dismissal becomes a final
				order by operation of law, disposing of the appellant's request for a hearing
				under
				RCW 34.05.440
				if:
(a) The appellant does not file a
				petition to vacate the order within twenty-one calendar days of the order being
				served (mailed) on the parties under WAC
				182-526-0290(2)
				and (5)(b); or
(b) The appellant fails to appear at a
				prehearing conference scheduled to address the petition to vacate under WAC
				182-526-0290(3)
				and (4)(a).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0290 - Reinstating a hearing after an order of default or an order of dismissal

Current through Register Vol. 24-14, July 15, 2024
(1) If an order of
				default was entered under WAC
				182-526-0284, or an order of
				dismissal was entered under WAC
				182-526-0285, the appellant may
				file a petition (request) to vacate (set aside) the order.
(a) The petition to vacate must be filed with
				the office of administrative hearings (OAH) or the board of appeals (BOA) for
				nursing home rates cases.
(b) BOA
				forwards any petition to vacate to OAH except for nursing home rates
				cases.
(c) The appellant must
				specify in the petition to vacate the reason why the order should be
				vacated.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0300 - Order of dismissal based on subject matter

Current through Register Vol. 24-14, July 15, 2024
An order of dismissal issued based on lack of subject matter
				  jurisdiction must be entered as an initial order subject to the requirements of
				  WAC 182-526-0520.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0310 - Requesting a stay of the health care authority action

Current through Register Vol. 24-14, July 15, 2024
A party may request that an administrative law judge (ALJ) or
				  review judge stay (stop) a health care authority action until there is a
				  decision entered by the ALJ or review judge. The ALJ or review judge decides
				  whether to grant or deny the stay and enters a written order.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0310, 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 182-526-0315

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0315, 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 182-526-0320 - Subpoenas

Current through Register Vol. 24-14, July 15, 2024
(1) An
				administrative law judge (ALJ), the health care authority hearing
				representative, and an attorney for a party may issue subpoenas. If a party is
				not represented by an attorney, that party may ask the ALJ to issue a subpoena
				on the party's behalf. The ALJ may schedule a prehearing conference to decide
				whether to issue a subpoena.
(2) An
				ALJ may deny a party's request for a subpoena. For example, an ALJ may deny a
				request for a subpoena when the ALJ determines that a witness has no actual
				knowledge regarding the facts or that the documents are not relevant.
(3) There is no cost when OAH issues a
				subpoena on behalf of a party, but the party may have to pay for:
(a) Serving the subpoena;
(b) Complying with the subpoena;
				and
(c) Witness fees according to
				RCW
				34.05.446(7).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0340 - Hearing location

Current through Register Vol. 24-14, July 15, 2024
(1) The office of
				administrative hearings (OAH) may schedule a hearing to be conducted in-person,
				by telephone, or by video.
(2) A
				telephonic or video hearing is where the appellant appears by telephone, video,
				or other electronic means.
(3) An
				in-person hearing is where the appellant appears face-to-face with the ALJ. The
				other parties may choose to appear either in person, by telephone, or by
				video.
(4) Whether a hearing is
				held in-person, by video, or telephonically, each party has the right to see
				all documents, hear all testimony, and question all witnesses.
(5) If a hearing is originally scheduled as
				an in-person hearing, the appellant may ask that the ALJ change it to a
				telephonic or video hearing. Once a telephonic or video hearing begins, the ALJ
				may stop, reschedule, and change the hearing to an in-person hearing if any
				party makes such a request.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0340, 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 182-526-0345 - Administrative law judge present at the hearing

Current through Register Vol. 24-14, July 15, 2024
(1) If the hearing is scheduled as an
				in-person hearing, an administrative law judge (ALJ) is physically
				present.
(2) If the hearing is
				scheduled as a telephonic hearing, an ALJ is present by telephone.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0345, 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 182-526-0350 - Recording the hearing

Current through Register Vol. 24-14, July 15, 2024
The administrative law judge must make an audio record of
				  the entire hearing .
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0350, 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 182-526-0355 - People who may attend the hearing

Current through Register Vol. 24-14, July 15, 2024
(1)
				All parties and their representatives may attend a hearing under this
				chapter.
(2) Witnesses may be
				excluded from the hearing if the administrative law judge (ALJ) finds good
				cause to do so.
(3) The ALJ may
				also exclude other people from all or part of the hearing.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0355, 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 182-526-0360 - Changing how a hearing is held or how a witness appears at a hearing

Current through Register Vol. 24-14, July 15, 2024
(1) For cases in
				which the party who requested a hearing is an applicant or recipient of a
				medical services program established under chapter 74.09 RCW, the hearing must
				be held according to
				RCW
				74.09.741(5)(c).
(2) An applicant or recipient may agree to
				have one or more prehearing conferences conducted telephonically without
				waiving the right to have any subsequent prehearing conference or other
				hearings held in person.
(3) Any
				party to the hearing has the right to request that:
(a) The hearing be changed from an in-person
				hearing to a telephonic hearing or from a telephonic hearing to an in-person
				hearing; or
(b) A witness be
				allowed to appear telephonically even for an in-person hearing.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0370 - Submitting documents for a telephonic hearing

Current through Register Vol. 24-14, July 15, 2024
(1) When a hearing is conducted by telephone,
				an administrative law judge (ALJ) may order the parties to file and serve any
				documents or proposed exhibits at least five days before the hearing.
(2) The health care authority hearing
				representative may be able to help a party copy and file their documents with
				the office of administrative hearings (OAH) and send them to any other
				party.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0370, 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 182-526-0375 - Summary of the hearing process

Current through Register Vol. 24-14, July 15, 2024
At a hearing under this chapter:
(1) The administrative law judge (ALJ):
(a) Explains the hearing rights of the
				parties;
(b) Marks and admits or
				rejects exhibits;
(c) Ensures that
				a record is made;
(d) Explains that
				a decision is mailed after the hearing;
(e) Notifies the parties of appeal
				rights;
(f) May keep the record
				open for a time after the hearing if needed to receive more evidence or
				argument; and
(g) May take actions
				as authorized under this chapter.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0380 - Group hearing requests

Current through Register Vol. 24-14, July 15, 2024
(1) A group
				hearing may be held when two or more parties request a hearing about similar
				issues.
(2) Hearings may be
				combined at the request of the parties or the administrative law judge
				(ALJ).
(3) All parties
				participating in a group hearing may have their own representative
				present.
(4) A party may withdraw
				from a group hearing by asking the ALJ for a separate hearing.
(5) If a party asks to withdraw from a group
				hearing before the ALJ makes a discretionary ruling or the hearing begins, the
				ALJ must give the party a separate hearing.
(6) If a party later shows good cause, the
				ALJ may give the party a separate hearing at any time during the hearing
				process.
(7) The ALJ must grant a
				party's request to withdraw from a group hearing when participation in the
				group hearing could require the release of confidential or protected health
				care information and the party does not consent to the release of such
				information.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0380, 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 182-526-0387 - Requesting that a hearing be consolidated or severed when multiple agencies are parties to the proceeding

Current through Register Vol. 24-14, July 15, 2024
(1) The
				following requirements apply only to hearings in which an applicant or
				recipient of medical services programs set forth in chapter 74.09 RCW, seeks
				review of decisions made by more than one agency, as defined in
				RCW
				34.05.010. For example: A medical services
				program recipient appeals a termination of medical assistance by the health
				care authority and in the same request for hearing the recipient appeals a
				termination of cash assistance issued by the department of social and health
				services.
(2) When the applicant or
				recipient of a medical services program files a single request for hearing
				objecting to decisions made by more than one agency, as defined in
				RCW
				34.05.010, the office of administrative
				hearings (OAH) schedules one hearing. The administrative law judge (ALJ) may
				sever the proceeding into multiple hearings on the motion of any of the
				parties, when:
(a) All parties consent to the
				severance; or
(b) Any party
				requests severance without another party's consent, and the ALJ finds there is
				good cause for severing the hearing and that the proposed severance is not
				likely to prejudice the rights of the applicant or recipient in accordance with
				RCW
				74.09.741(5).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0390 - Evidence

Current through Register Vol. 24-14, July 15, 2024
(1) Evidence
				includes documents, objects, and testimony of witnesses that parties offer
				during the hearing to help prove their positions.
(2) Evidence may be all or parts of original
				documents and may be copies of the originals.
(3) Parties may offer statements signed by a
				witness under oath or affirmation as evidence, if the witness cannot
				appear.
(4) Testimony subject to
				cross examination by the other parties may be given more importance by the
				administrative law judge (ALJ).
(5)
				The parties may bring evidence to any prehearing meeting, prehearing
				conference, or hearing, or may file evidence before these events with the
				office of administrative hearings (OAH).
(6) The ALJ may set a deadline before the
				hearing for the parties to file proposed exhibits and the names of witnesses.
				If a party misses the deadline, the ALJ may refuse to admit the evidence unless
				:
(a) The ALJ finds that the offering party
				has good cause.
(b)The other
				parties agree that party has good cause for missing the deadline; or
(c) The other parties agree the ALJ may
				consider the evidence.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0405 - Stipulations

Current through Register Vol. 24-14, July 15, 2024
(1) A stipulation
				is an agreement among two or more parties that certain facts or evidence is
				correct or authentic.
(2) If an
				administrative law judge (ALJ) accepts a stipulation, the ALJ must enter it
				into the record.
(3) A stipulation
				may be made before or during the hearing.
(4) A party may change or reject a
				stipulation after it has been made.
(5) To change or reject a stipulation, a
				party must show the administrative law judge that:
(a) The party did not intend to make the
				stipulation or was mistaken when making it; and
(b) Changing or rejecting the stipulation
				does not harm the other parties.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0415 - Exhibits

Current through Register Vol. 24-14, July 15, 2024
(1) Proposed
				exhibits.
(a) Proposed exhibits are documents
				or other objects that a party wants the administrative law judge (ALJ) to
				consider when reaching a decision.
(b) After the document or object is accepted
				by the ALJ, it is admitted and becomes an exhibit.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0440 - Judicial notice

Current through Register Vol. 24-14, July 15, 2024
(1) The
				administrative law judge (ALJ) may consider and admit evidence by taking
				judicial notice.
(2) Judicial
				notice is evidence that includes facts or standards that are generally
				recognized and accepted by judges, government agencies, or national
				associations. For example, an administrative law judge may take judicial notice
				of a calendar, a building code, or a standard or practice.
(3) If a party requests judicial notice, or
				if the ALJ intends to take judicial notice, the ALJ may ask the party to
				provide a copy of the document that contains the information.
(4) If judicial notice has been requested, or
				if the ALJ intends to take judicial notice, the ALJ must tell the parties
				before or during the hearing.
(5)
				The ALJ must give the parties time to object to judicial notice
				evidence.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0440, 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 182-526-0450 - Witness

Current through Register Vol. 24-14, July 15, 2024
(1) The following
				persons may be witnesses in a hearing:
(a)
				The appellant or the health care authority (HCA) hearing representative;
				or
(b) Anyone the parties or the
				administrative law judge (ALJ) asks to be a witness.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0480 - Burden of proof

Current through Register Vol. 24-14, July 15, 2024
(1) Burden of proof
				is a party's responsibility to:
(a) Provide
				evidence regarding disputed facts; and
(b) Persuade the administrative law judge
				(ALJ) that a position is correct.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0485 - Standard of proof

Current through Register Vol. 24-14, July 15, 2024
Standard of proof refers to the amount of evidence needed to
				  prove a party's position. Unless the rules or law states otherwise, the
				  standard of proof in a hearing is a preponderance of the evidence. This
				  standard means that it is more likely than not that something happened or
				  exists.
Statutory Authority:
					 2011 1st sp.s. c
					 15§ 53, chapters 74.09,
					 34.05 RCW, and 10-08 WAC.
					 13-02-007, §
											182-526-0485, 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 182-526-0495 - Equitable estoppel

Current through Register Vol. 24-14, July 15, 2024
(1) Equitable
				estoppel is a legal doctrine that may be used only as an affirmative defense to
				prevent the health care authority (HCA) from collecting an overpayment.
				Equitable estoppel may not be used to require HCA to continue to provide
				something or to require HCA to take action contrary to a statute.
(2) There are five elements of equitable
				estoppel. A party asserting the doctrine of equitable estoppel must prove all
				of the following five elements by clear and convincing evidence:
(a) HCA made a statement or took an action or
				failed to take an action, which is inconsistent with a later claim or position
				by HCA.
(b) The party reasonably
				relied on HCA's original statement, action or failure to act.
(c) The party will be injured to its
				detriment if HCA is allowed to contradict the original statement, action or
				failure to act.
(d) Equitable
				estoppel is needed to prevent a manifest injustice. Factors to be considered in
				determining whether a manifest injustice would occur include, but are not
				limited to, whether:
(i) The party cannot
				afford to repay the money to HCA;
(ii) The party gave HCA timely and accurate
				information when required;
(iii)
				The party did not know that HCA made a mistake;
(iv) The party is free from fault;
				and
(v) The overpayment was caused
				solely by an HCA mistake.
(e) The exercise of government functions is
				not impaired.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0500 - Hearing record

Current through Register Vol. 24-14, July 15, 2024
(1) Before the
				record is closed, the administrative law judge (ALJ) may:
(a) Set another hearing date;
(b) If needed, enter orders addressing
				limited issues before issuing a hearing decision resolving all issues in the
				proceeding; or
(c) Give the parties
				more time to file exhibits or written argument.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-526 - Administrative hearing rules for medical services programs › Section 182-526-0512 - Contents of the hearing record

Current through Register Vol. 24-14, July 15, 2024
(1)
				The administrative law judge must produce a complete official record of the
				proceedings.
(2) The official
				record must include, if applicable:
(a) Notice
				of all proceedings;
(b) Any
				prehearing order;
(c) Any motions,
				pleadings, briefs, petitions requests, and intermediate rulings;
(d) Evidence received or
				considered;
(e) A statement of
				matters officially noticed;
(f)
				Offers of proof, objections, and any resulting rulings;
(g) Proposed findings, requested orders and
				exceptions;
(h) A complete audio
				recording of the entire hearing, together with any transcript of the
				hearing;
(i) Any final order,
				initial order, or order on reconsideration; and
(j) Matters placed on the record after an ex
				parte communication.