reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-035 - How can a subscriber appeal a decision regarding the administration of wellness incentive program requirements?

Current through Register Vol. 24-14, July 15, 2024
(1)
				  Any subscriber aggrieved by a decision regarding the completion of the wellness
				  incentive program requirements or request for a reasonable alternative to a
				  wellness incentive program requirement may appeal that decision to the PEBB
				  wellness incentive program contracted vendor.
(2) Any subscriber who disagrees with a
				  decision in response to an appeal filed with the public employee benefits board
				  (PEBB) wellness incentive program contracted vendor may appeal to the PEBB
				  appeals committee.
(a) The notice of appeal
				  from a current or former employee must be received by the PEBB appeals manager
				  no later than thirty days after the date of the denial notice. The contents of
				  the notice of appeal are to be provided in accordance with WAC
				  182-16-040.
(b) The notice of appeal from a retiree or
				  self-pay enrollee must be received by the PEBB appeals manager no later than
				  sixty days after the date of the denial notice. The contents of the notice of
				  appeal are to be provided in accordance with WAC
				  182-16-040.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-036 - How can an employee who is eligible to participate in the state's salary reduction plan appeal a decision regarding the administration of benefits offered under the state's salary reduction plan?

Current through Register Vol. 24-14, July 15, 2024
(1) Any employee who is eligible to
				  participate in the state's salary reduction plan who disagrees with a decision
				  that denies eligibility for or enrollment in a benefit offered under the
				  state's salary reduction plan may appeal that decision by submitting a written
				  request for review to his or her state agency. The state agency must receive
				  the request for review no later than thirty days after the date of the initial
				  denial notice. The contents of the request for review are to be provided as
				  described in WAC
				  182-16-040.
(a) Upon receiving the request for review,
				  the state agency shall make a complete review of the initial denial by one or
				  more staff who did not take part in the initial denial. As part of the review,
				  the state agency may hold a formal meeting or hearing, but is not required to
				  do so.
(b) The state agency shall
				  render a written decision within thirty days of receiving the request for
				  review. The written decision shall be sent to the employee.
(c) A copy of the state agency's written
				  decision shall be sent to the state agency's administrator or designee and to
				  the public employees benefits board (PEBB) appeals manager. The state agency's
				  written decision shall become the state agency's final decision effective
				  fifteen days after the date it is rendered.
(d) Any employee who disagrees with the state
				  agency's decision in response to a request for review, as described in
				  subsection (1) of this section, may appeal that decision by submitting a notice
				  of appeal to the PEBB appeals committee. The PEBB appeals manager must receive
				  the notice of appeal no later than thirty days after the date of the state
				  agency's written decision on the request for review.
The contents of the notice of appeal are to be provided in
					 accordance with WAC
					 182-16-040.
(e) The PEBB appeals manager shall notify the
				  appellant in writing when the notice of appeal has been received.
(f) The PEBB appeals committee shall render a
				  written decision to the appellant within thirty days of receiving the notice of
				  appeal. The committee may extend the thirty-day time requirement for rendering
				  a decision upon issuing a written finding of a good reason explaining the cause
				  for the delay.
(g) Any appellant
				  who disagrees with the decision of the PEBB appeals committee may request an
				  administrative hearing, as described in WAC
				  182-16-050.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-038 - How can an entity or organization appeal a decision of the health care authority to deny an employer group application?

Current through Register Vol. 24-14, July 15, 2024
An entity or organization whose employer group application
					 is denied by the authority may appeal the decision to the public employees
					 benefits board (PEBB) appeals committee. For rules regarding eligible entities,
					 see WAC 182-12-111. The PEBB appeals
					 manager must receive the notice of appeal no later than thirty days after the
					 date of the denial notice. The contents of the notice of appeal are to be
					 provided as described in WAC
					 182-16-040.
(1) The PEBB appeals manager shall notify the
				  appellant in writing when the notice of appeal has been received.
(2) The PEBB appeals committee shall render a
				  written decision to the appellant on the notice of appeal within thirty days of
				  receiving the notice of appeal. The committee may extend the thirty-day time
				  requirement for rendering a decision upon issuing a written finding of a good
				  reason explaining the cause for the delay.
(3) Any appellant aggrieved with the decision
				  of the PEBB appeals committee may request an administrative hearing, as
				  described in WAC
				  182-16-050.
Statutory Authority:
						RCW
						41.05.160. 12-20-022 (Order 2012-01), §
												182-16-038, filed 9/25/12,
						effective 11/1/12; 08-20-128 (Order 08-03), §
												182-16-038, filed 10/1/08,
						effective 1/1/09.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-040 - What should the request for review or notice of appeal contain?

Current through Register Vol. 24-14, July 15, 2024
A request for review or notice of appeal should contain
					 all of the following:
(1) The name and
				  mailing address of the party submitting the request for review or notice of
				  appeal;
(2) The name and mailing
				  address of the appealing party's representative, if any;
(3) Documentation, or reference to
				  documentation, of decisions previously rendered through the appeal process, if
				  any;
(4) A statement identifying
				  the specific portion of the decision being appealed and clarifying what is
				  believed to be unlawful or in error;
(5) A statement of facts in support of the
				  appealing party's position;
(6) Any
				  information or documentation that the appealing party would like considered and
				  substantiates why the decision should be reversed. Information or documentation
				  submitted at a later date, unless specifically requested by the PEBB appeals
				  manager, may not be considered in the appeal decision;
(7) The type of relief sought;
(8) A statement that the appealing party has
				  read the notice of appeal and believes the contents to be true and correct;
				  and
(9) The signature of the
				  appealing party or the appealing party's representative.
Statutory Authority:
						RCW
						41.05.160. 08-20-128 (Order 08-03), §
												182-16-040, filed 10/1/08,
						effective 1/1/09; 07-20-129 (Order 07-01), §
												182-16-040, filed 10/3/07,
						effective 11/3/07. Statutory Authority:
						RCW
						41.05.160,
						41.05.350, and
						41.05.165. 05-16-046 (Order
						05-01), §
												182-16-040, filed 7/27/05,
						effective 8/27/05. Statutory Authority:
						RCW
						41.05.160. 97-21-128, §
												182-16-040, filed 10/21/97,
						effective 11/21/97. Statutory Authority: RCW 41.05.010 and
						34.05.250. 91-14-025, §
												182-16-040, filed 6/25/91,
						effective 7/26/91.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-050 - How can an appellant aggrieved by a written decision made by the public employees benefits board (PEBB) appeals committee request an administrative hearing?

Current through Register Vol. 24-14, July 15, 2024
(1) Any appellant
				  aggrieved by a written decision of the public employees benefits board (PEBB)
				  appeals committee, may request an administrative hearing.
(2) The request must be made in writing to
				  the PEBB appeals manager. The PEBB appeals manager must receive the written
				  request for an administrative hearing no later than thirty calendar days after
				  the date of the written decision letter from the PEBB appeals
				  committee.
(3) The director, or his
				  or her designee, shall preside at all hearings resulting from the filings of
				  appeals under this section.
(4) All
				  hearings must be conducted in compliance with WAC
				  182-16-050 through
				  182-16-110,
				  chapter
				  34.05 RCW, and chapter
				  10-08 WAC, as described in WAC
				  182-16-010(2).
Statutory Authority:
						RCW
						41.05.160. 12-20-022 (Order 2012-01), §
												182-16-050, filed 9/25/12,
						effective 11/1/12. Statutory Authority:
						RCW
						41.05.160 and
						2011 c
						8 . 11-22-036 (Order 11-02), §
												182-16-050, filed 10/26/11,
						effective 1/1/12. Statutory Authority:
						RCW
						41.05.160. 10-20-147 (Order 10-02), §
												182-16-050, filed 10/6/10,
						effective 1/1/11; 08-20-128 (Order 08-03), §
												182-16-050, filed 10/1/08,
						effective 1/1/09; 07-20-129 (Order 07-01), §
												182-16-050, filed 10/3/07,
						effective 11/3/07. Statutory Authority:
						RCW
						41.05.160,
						41.05.350, and
						41.05.165. 05-16-046 (Order
						05-01), §
												182-16-050, filed 7/27/05,
						effective 8/27/05. Statutory Authority:
						RCW
						41.05.160. 97-21-128, §
												182-16-050, filed 10/21/97,
						effective 11/21/97. Statutory Authority: RCW 41.05.010 and
						34.05.250. 91-14-025, §
												182-16-050, filed 6/25/91,
						effective 7/26/91.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-052 - Requirements to appear and represent a party in the administrative hearing process

Current through Register Vol. 24-14, July 15, 2024
(1) All parties
				  must provide the presiding officer and all other parties with their name,
				  address, and telephone number.
(2)
				  The appellant may act as his or her own representative or have anyone represent
				  him or her, except employees of the health care authority (HCA) or HCA's
				  authorized agents.
(3) If the
				  appellant is represented by a person who is not an attorney admitted to
				  practice in Washington state, the representative must provide the presiding
				  officer and other parties with the representative's name, address, and
				  telephone number. In cases involving confidential information, the nonattorney
				  representative must provide the hearing representative with a signed, written
				  consent permitting release to the nonattorney representative of personal health
				  information protected by state or federal law.
(4) An attorney admitted to practice law in
				  Washington state, who wishes to represent the appellant, must file a written
				  notice of appearance containing the attorney's name, address, and telephone
				  number with the presiding officer's office and serve all parties with the
				  notice. The attorney must file a written notice of withdrawal of representation
				  with the presiding officer's office and serve all parties with the
				  notice.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-055 - Mailing address changes

Current through Register Vol. 24-14, July 15, 2024
(1) During
				  the appeal process if the appellant's mailing address changes, the appellant
				  must notify the public employees benefits board (PEBB) appeals unit as soon as
				  possible.
(2) If the appellant does
				  not notify the PEBB appeals unit of a change in the appellant's mailing address
				  and the PEBB appeals unit continues to serve notices and other important
				  documents to the appellant's last known mailing address, the documents will be
				  deemed served on the appellant.
(3)
				  This requirement to provide notice of an address change is in addition to WAC
				  182-08-191 that require a
				  subscriber to update their address.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-058 - Service or serve

Current through Register Vol. 24-14, July 15, 2024
(1) When the rules
				  in this chapter or in other public employees benefits board (PEBB) program
				  rules or statutes require a party to serve copies of documents on other
				  parties, a party must send copies of the documents to all other parties or
				  their representatives as described in this chapter. In this section,
				  requirements for service or delivery by a party apply also when service is
				  required by the presiding officer, reviewing officer or officers, or hearing
				  officer.
(2) Unless otherwise
				  stated in applicable law, documents may be sent only as identified in this
				  chapter to accomplish service. A party may serve someone by:
(a) Personal service (hand
				  delivery);
(b) First class,
				  registered, or certified mail sent via the United States Postal Service or
				  Washington state consolidated mail services;
(c) Fax;
(d) Commercial delivery service; or
(e) Legal messenger service.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-060 - Index of significant decisions [Repealed]

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						41.05.160. 12-20-022 (Order 2012-01), §
												182-16-060, filed 9/25/12,
						effective 11/1/12.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-064 - Applicable rules and laws

Current through Register Vol. 24-14, July 15, 2024
(1) An employing
				  agency must apply public employees benefits board (PEBB) program rules adopted
				  in the Washington Administrative Code (WAC) and follow instructions from the
				  authority.
(2) A presiding officer,
				  reviewing officer or officers, or hearing officer must first apply the
				  applicable PEBB program rules adopted in the WAC. If no PEBB program rule
				  applies, the presiding officer, reviewing officer or officers, or hearing
				  officer must decide the issue according to the best legal authority and
				  reasoning available, including federal and Washington state constitutions,
				  statutes, regulations, significant decisions indexed as described in WAC
				  182-16-130,
				  and court decisions.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-066 - Burden of proof, standard of proof, and presumptions

Current through Register Vol. 24-14, July 15, 2024
(1) The burden of
				  proof is a party's responsibility to provide evidence regarding disputed facts
				  and persuade the presiding officer, reviewing officer or officers, or hearing
				  officer that a position is correct based on the standard of proof. Unless
				  stated otherwise in rules or law, the appellant has the burden of proof in a
				  brief adjudicative proceeding or formal administrative hearing.
(2) Standard of proof refers to the amount of
				  evidence needed to prove a party's position. Unless stated otherwise in rules
				  or law, the standard of proof in a brief adjudicative proceeding or formal
				  administrative hearing is a preponderance of the evidence, meaning that
				  something is more likely to be true than not.
(3) Public officers and state agencies are
				  presumed to have properly performed their duties and acted as described in the
				  law, unless preponderance of the evidence to the contrary is presented. A party
				  challenging this presumption bears the burden of proof.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-120 - Computation of time

Current through Register Vol. 24-14, July 15, 2024
(1) In computing
				  any period of time prescribed by this chapter, the day of the event from which
				  the time begins to run is not included. (For example, if an initial order is
				  served on Friday and the party has twenty-one days to request a review, start
				  counting the days with Saturday.)
(2) As provided in subsection (3) of this
				  section, the last day of the period so computed is included unless it is a
				  Saturday, Sunday, or legal holiday as defined in
				  RCW
				  1.16.050, in which case the period extends to
				  the next business day.
(3) When the
				  period of time prescribed or allowed is ten days or less, intermediate
				  Saturdays, Sundays and state legal holidays must be excluded in the
				  computation.
(4) The deadline is
				  5:00 p.m. on the last day of the computed period.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-130 - Index of significant decisions

Current through Register Vol. 24-14, July 15, 2024
(1)
				  A final order may be relied upon, used, or cited as precedent by a party only
				  if the final order has been indexed in the authority's index of significant
				  decisions in accordance with
				  RCW
				  34.05.473(1)(b).
(2) An index of significant decisions is
				  available to the public on the health care authority's (HCA) website. As
				  decisions are indexed they will be available on the website.
(3) A final order published in the index of
				  significant decisions may be removed from the index when:
(a) A published decision entered by the court
				  of appeals or the supreme court reverses an indexed final order; or
(b) HCA determines that the indexed final
				  order is no longer precedential due to changes in statute, rule, or
				  policy.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2000 - Brief adjudicative proceedings

Current through Register Vol. 24-14, July 15, 2024
Pursuant to
					 RCW
					 34.05.482, the authority may use brief
					 adjudicative proceedings for issues identified in this chapter when doing so
					 would not violate law, or when protection of the public interest does not
					 require the authority to give notice and an opportunity to participate to
					 persons other than the parties, or the issue and interests involved in the
					 controversy do not warrant use of the procedures of
					 RCW
					 34.05.413 through
					 34.05.476 which
					 govern formal administrative hearings.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2005 - Record-Brief adjudicative proceeding

Current through Register Vol. 24-14, July 15, 2024
The record in a brief adjudicative proceeding consists of
					 any documents regarding the matter, considered or prepared by the presiding
					 officer for the brief adjudicative proceeding or by the reviewing officer or
					 officers for any review. The authority's record does not have to constitute the
					 exclusive basis for agency action, unless otherwise required by
					 law.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2010 - Appealing a decision regarding public employees benefits board (PEBB) eligibility, enrollment, premium payments, premium surcharges, a wellness incentive, or the administration of benefits

Current through Register Vol. 24-14, July 15, 2024
(1) Any current or former employee of a state
				  agency or their dependent aggrieved by a decision made by the state agency with
				  regard to public employees benefits board (PEBB) eligibility, enrollment, or
				  premium surcharges may appeal that decision to the state agency by the process
				  described in WAC
				  182-16-2020.
Note:
Eligibility decisions address whether a subscriber or
							 a subscriber's dependent is entitled to PEBB benefits, as described in PEBB
							 rules and policies. Enrollment decisions address the application for PEBB
							 benefits as described in PEBB rules and policies including, but not limited to,
							 the submission of proper documentation and meeting enrollment deadlines.
(2)
				  Any current or former employee of an employer group or their dependent who is
				  aggrieved by a decision made by an employer group with regard to PEBB
				  eligibility, enrollment, or premium surcharges may appeal that decision to the
				  employer group through the process established by the employer group.
Exception:
Any current or former employee of an employer group
							 aggrieved by a decision regarding life insurance, long-term disability (LTD)
							 insurance, eligibility to participate in the PEBB wellness incentive program,
							 or eligibility to receive a PEBB wellness incentive may appeal that decision to
							 the PEBB appeals unit by the process described in WAC
							 182-16-2030.
(3)
				  Any subscriber or dependent aggrieved by a decision made by the PEBB program
				  with regard to PEBB eligibility, enrollment, premium payments, premium
				  surcharges, eligibility to participate in the PEBB wellness incentive program,
				  or eligibility to receive a PEBB wellness incentive, may appeal that decision
				  to the PEBB appeals unit by the process described in WAC
				  182-16-2030.
(4) Any enrollee aggrieved by a decision
				  regarding the administration of PEBB medical and dental, life insurance,
				  accidental death and dismemberment (AD&D) insurance, or long-term
				  disability insurance may appeal that decision by following the appeal
				  provisions of those plans, with the exception of:
(a) Enrollment decisions;
(b) Premium payment decisions other than life
				  insurance or AD&D insurance premium payment decisions; and
(c) Eligibility decisions.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2020 - Appealing a decision made by a state agency about eligibility, premium surcharges, or enrollment in benefits

Current through Register Vol. 24-14, July 15, 2024
(1)
				  An eligibility, premium surcharges, or enrollment decision made by a state
				  agency may be appealed by submitting a written request for administrative
				  review to the state agency. The state agency must receive the request for
				  administrative review no later than thirty days after the date of the denial
				  notice. The contents of the request for administrative review are to be
				  provided as described in WAC
				  182-16-2070.
(a) Upon receiving the request for
				  administrative review, the state agency must perform a complete review of the
				  denial by one or more staff who did not take part in the decision resulting in
				  the denial.
(b) The state agency
				  must render a written decision within thirty days of receiving the written
				  request for administrative review. The written decision must be sent to the
				  employee or employee's dependent who submitted the request for administrative
				  review and must include a description of the appeal rights. The state agency
				  must also send a copy of the state agency's written decision to the state
				  agency's administrator (or designee) and to the public employees benefits board
				  (PEBB) appeals unit. If a state agency fails to render a written decision
				  within thirty days of receiving the written request for administrative review,
				  the request for administrative review may be considered denied as of the
				  thirty-first day and the original underlying state agency decision may be
				  appealed to the PEBB appeals unit by following the process in this
				  section.
(c) The state agency may
				  reverse eligibility, premium surcharges, or enrollment decisions as permitted
				  by WAC
				  182-08-187.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2030 - Appealing a public employees benefits board (PEBB) program decision regarding eligibility, enrollment, premium payments, premium surcharges, a PEBB wellness incentive, or certain decisions made by an employer group

Current through Register Vol. 24-14, July 15, 2024
(1) A decision made by the public employees
				  benefits board (PEBB) program regarding eligibility, enrollment, premium
				  payments, premium surcharges, or a PEBB wellness incentive, may be appealed by
				  submitting a request to the PEBB appeals unit for a brief adjudicative
				  proceeding to be conducted by the authority.
(2) A decision made by an employer group
				  regarding life insurance, LTD insurance, eligibility to participate in the PEBB
				  wellness incentive program, or eligibility to receive a PEBB wellness
				  incentive, may be appealed by submitting a request to the PEBB appeals unit for
				  a brief adjudicative proceeding to be conducted by the authority.
(3) The contents of the request for a brief
				  adjudicative proceeding are to be provided as described in WAC
				  182-16-2070.
(4) The request for a brief adjudicative
				  proceeding from a current or former employee or employee's dependent must be
				  received by the PEBB appeals unit no later than thirty days after the date of
				  the denial notice.
(5) The request
				  for a brief adjudicative proceeding from a retiree, self-pay enrollee, or
				  dependent of a retiree or self-pay enrollee must be received by the PEBB
				  appeals unit no later than sixty days after the date of the denial
				  notice.
(6) The PEBB appeals unit
				  must notify the appellant in writing when the request for a brief adjudicative
				  proceeding has been received.
(7)
				  The brief adjudicative proceeding will be conducted by a presiding officer
				  designated by the director.
(8)
				  Failing to timely request a brief adjudicative proceeding will result in the
				  prior PEBB program decision becoming the authority's final order without
				  further action.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2040 - How can a subscriber appeal a decision regarding the administration of wellness incentive program requirements?

Current through Register Vol. 24-14, July 15, 2024
(1)
				  Any subscriber aggrieved by a decision regarding the completion of the wellness
				  incentive program requirements, or request for a reasonable alternative to a
				  wellness incentive program requirement, may appeal that decision to the public
				  employees benefits board (PEBB) wellness incentive program contracted
				  vendor.
(2) Any subscriber who
				  disagrees with a decision in response to an appeal filed with the PEBB wellness
				  incentive program contracted vendor may appeal the decision by submitting a
				  request for a brief adjudicative proceeding to the PEBB appeals unit.
(a) The request for a brief adjudicative
				  proceeding from a current or former employee must be received by the PEBB
				  appeals unit no later than thirty days after the date of the denial notice. The
				  contents of the request for a brief adjudica-tive proceeding are to be provided
				  as described in WAC
				  182-16-2070.
(b) The request for a brief adjudicative
				  proceeding from a retiree or self-pay subscriber must be received by the PEBB
				  appeals unit no later than sixty days after the date of the denial notice. The
				  contents of the request for a brief adjudica-tive proceeding are to be provided
				  as described in WAC
				  182-16-2070.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2050 - How can an employee appeal a decision regarding the administration of benefits offered under the salary reduction plan?

Current through Register Vol. 24-14, July 15, 2024
(1) Any employee
				  who disagrees with a decision that denies eligibility for, or enrollment in, a
				  benefit offered under the salary reduction plan may appeal that decision by
				  submitting a written request for administrative review to their state agency.
				  The state agency must receive the written request for administrative review no
				  later than 30 days after the date of the denial. The contents of the written
				  request for administrative review are to be provided as described in WAC
				  182-16-2070.
(a) Upon receiving the written request for
				  administrative review, the state agency must perform a complete review of the
				  denial by one or more staff who did not take part in the decision resulting in
				  the denial.
(b) The state agency
				  must render a written decision within 30 days of receiving the written request
				  for administrative review. The written decision must be sent to the employee
				  who submitted the written request for review and must include a description of
				  appeal rights. The state agency must also send a copy of the state agency's
				  written decision to the state agency's administrator (or des-ignee) and to the
				  PEBB appeals unit. If a state agency fails to render a written decision within
				  30 days of receiving the written request for administrative review, the request
				  for administrative review may be considered denied as of the 31st day and the
				  original underlying state agency decision may be appealed to the PEBB appeals
				  unit by following the process in this section.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2060 - How can an entity or organization appeal a decision of the health care authority to deny an employer group application?

Current through Register Vol. 24-14, July 15, 2024
(1) An entity or organization whose employer
				  group application is denied by the authority may appeal the decision by
				  submitting a request for a brief adjudicative proceeding to the public
				  employees benefits board (PEBB) appeals unit. For rules regarding eligible
				  entities, see WAC
				  182-12-111.
(2) The PEBB appeals unit must receive the
				  request for a brief adjudicative proceeding no later than thirty days after the
				  date of the denial notice. The contents of the request for a brief adjudicative
				  proceeding are to be provided as described in WAC
				  182-16-2070.
(3) The PEBB appeals unit must notify the
				  appellant in writing when the request for a brief adjudicative proceeding has
				  been received.
(4) The brief
				  adjudicative proceeding will be conducted by a presiding officer designated by
				  the director.
(5) Failing to timely
				  request a brief adjudicative proceeding will result in the prior PEBB program
				  decision becoming the authority's final order without further action.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2070 - What should a written request for administrative review and a request for brief adjudicative proceeding contain?

Current through Register Vol. 24-14, July 15, 2024
A written request for administrative review of the
					 employing agency decision and a request for brief adjudicative proceeding
					 should contain:
(1) The name and
				  mailing address of the party requesting an administrative review or the brief
				  adjudicative proceeding;
(2) The
				  name and mailing address of the appealing party's representative, if
				  any;
(3) Documentation, or
				  reference to documentation, of decisions previously rendered through the appeal
				  process, if any;
(4) A statement
				  identifying the specific portion of the decision being appealed and clarifying
				  what is believed to be unlawful or in error;
(5) A statement of facts in support of the
				  appealing party's position;
(6) Any
				  information or documentation that the appealing party would like
				  considered;
(7) The type of relief
				  sought; and
(8) The signature of
				  the appealing party or the appealing party's representative.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2080 - Who can appeal or represent a party in a brief adjudicative proceeding?

Current through Register Vol. 24-14, July 15, 2024
(1) The appellant
				  may act as their own representative or may choose to be represented by another
				  person, except that employees of the health care authority (HCA) or HCA's
				  authorized agents may not represent an appellant, unless approved by a
				  presiding officer or reviewing officer.
(2) If the appellant is represented by a
				  person who is not an attorney admitted to practice in Washington state, the
				  representative must provide the presiding officer and other parties with the
				  representative's name, address, and telephone number. In cases involving
				  confidential information, the nonattorney representative must provide the PEBB
				  appeals unit and other parties with a signed, written consent permitting
				  release to the nonattorney representative of the appellant's health information
				  protected by state or federal law.
(3) An attorney admitted to practice law in
				  Washington state representing the appellant must file a written notice of
				  appearance containing the attorney's name, address, and telephone number with
				  the presiding officer's office and serve all parties with the notice. In cases
				  involving confidential information, the attorney must provide the PEBB appeals
				  unit and other parties with a signed, written consent permitting release to the
				  attorney of the appellant's health information protected by state or federal
				  law. If the appellant's attorney representative no longer represents the
				  appellant, then the attorney must file a written notice of withdrawal of
				  representation with the presiding officer or reviewing officer or officers'
				  office and serve all parties with the notice.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2085 - Continuances

Current through Register Vol. 24-14, July 15, 2024
The presiding officer or reviewing officer or officers may
					 grant, in their sole discretion, a request for a continuance on motion of the
					 appellant, the authority, or on their own. The continuance may be up to 30
					 calendar days.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2090 - Initial order

Current through Register Vol. 24-14, July 15, 2024
Unless a continuance has been granted, within ten days
					 after the public employees benefits board (PEBB) appeals unit receives a
					 request for a brief adjudicative proceeding, the presiding officer must render
					 a written initial order that addresses the issue or issues raised by the
					 appellant in their appeal. The presiding officer must serve a copy of the
					 initial order on all parties and the initial order must contain information on
					 how the appellant may request review of the initial order.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2100 - How to request a review of an initial order resulting from a brief adjudicative proceeding

Current through Register Vol. 24-14, July 15, 2024
(1) Both the
				  appellant and the authority may request review of an initial order. An
				  appellant who has received an initial order upholding an employing agency
				  decision, public employees benefits board (PEBB) program decision, or a
				  decision made by a PEBB program contracted vendor, may request review of the
				  initial order by the authority. The appellant may request review of the initial
				  order by filing a written request for review of the initial order or making an
				  oral request with the PEBB appeals unit within 21 days after service of the
				  initial order. The written or oral request for review of the initial order must
				  be made by using the contact information included in the initial order. If the
				  appellant fails to request review of the initial order within 21 days, the
				  initial order becomes the authority's final order without further
				  action.
(2) Upon timely request by
				  the appellant, a review of an initial order will be performed by one or more
				  reviewing officers designated by the director of the authority.
(3) If the appellant has not requested
				  review, the authority may review an order resulting from a brief adjudicative
				  proceeding on its own, and without notice to the parties, but it may not take
				  action on review less favorable to any party than the initial order without
				  giving that party notice and an opportunity to explain that party's view of the
				  matter.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2105 - Withdrawing the request for a brief adjudicative proceeding or review of an initial order

Current through Register Vol. 24-14, July 15, 2024
(1) The appellant
				  may withdraw the request for a brief adjudicative proceeding or review of an
				  initial order for any reason, and at any time, by contacting the public
				  employees benefits board (PEBB) appeals unit. The PEBB appeals unit will
				  present the withdrawal request to the presiding officer or reviewing officer or
				  officers.
(2) The request for
				  withdrawal must be made in writing.
(3) After a withdrawal request is received,
				  the presiding officer or reviewing officer or officers must enter and serve a
				  written order dismissing the brief adjudicative proceeding or review of an
				  initial order.
(4) If an appellant
				  withdraws a request for a brief adjudicative proceeding or review of an initial
				  order, the appellant may not reinstate the request for a brief adjudicative
				  proceeding or review of an initial order unless time remains on their original
				  appeal period.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2110 - Final order

Current through Register Vol. 24-14, July 15, 2024
(1) A final order
				  issued by the reviewing officer or officers will be in writing and include a
				  brief statement of the reasons for the decision.
(2) The final order must be served within 20
				  days of the date of the initial order or of the date the request for review of
				  the initial order was received by the PEBB appeals unit, whichever is
				  later.
(3) The final order will
				  include a notice that reconsideration and judicial review may be
				  available.
(4) A request for review
				  of the initial order is deemed denied if the authority does not issue a final
				  order within 20 days after the request for review of the initial order is
				  filed.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2120 - Request for reconsideration

Current through Register Vol. 24-14, July 15, 2024
(1) A request for
				  reconsideration asks the reviewing officer or officers to reconsider the final
				  order because the party believes the reviewing officer or officers made a
				  mistake of law, mistake of fact, or clerical error.
(2) A request for reconsideration must state
				  in writing why the party wants the final order to be reconsidered.
(3) Requests for reconsideration must be
				  filed with the reviewing officer or officers who entered the final
				  order.
(4) If a party files a
				  request for reconsideration:
(a) The reviewing
				  officer or officers must receive the request for reconsideration on or before
				  the tenth business day after the service date of the final order;
(b) The party filing the request must send
				  copies of the request to all other parties; and
(c) Within five business days of receiving a
				  request for reconsideration, the reviewing officer or officers must serve all
				  parties a notice that provides the date the request for reconsideration was
				  received.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2130 - Judicial review of 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 appellant may appeal a final order by
				  filing a written petition for judicial review that meets the requirements of
				  RCW
				  34.05.510 through
				  34.05.-598. Neither the public
				  employees benefits board (PEBB) program nor the employing agency may request
				  judicial review.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2135 - Petitions for judicial review-Service on the authority

Current through Register Vol. 24-14, July 15, 2024
Delivery pursuant to
					 RCW
					 34.05.542(4) shall be deemed
					 to have been made when a copy of the petition for judicial review has been
					 received by the public employees benefits board (PEBB) appeals unit at Cherry
					 Street Plaza, 626 8th Avenue S.E., Olympia, WA 98501 or received by mail at the
					 PEBB appeals unit, P.O. Box 45504, Olympia, WA 98504-5504.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2140 - Presiding officer-Designation and authority

Current through Register Vol. 24-14, July 15, 2024
The designation of a presiding officer must be consistent
					 with the requirements of
					 RCW
					 34.05.485 and the presiding officer must not
					 have personally participated in the decision made by the employing agency or
					 PEBB program.
(1) The presiding
				  officer will decide the issue based on the information provided by the parties
				  during the presiding officer's review of the appeal.
(2) A presiding officer is limited to those
				  powers granted by the state constitution, statutes, rules, or applicable case
				  law.
(3) A presiding officer may
				  not decide that a rule is invalid or unenforceable.
(4) In addition to the record, the presiding
				  officer may employ the authority's expertise as a basis for the
				  decision.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2150 - Reviewing officer or officers-Designation and authority

Current through Register Vol. 24-14, July 15, 2024
(1) The designation
				  of a reviewing officer or officers must be consistent with the requirements of
				  RCW
				  34.05.491 and the reviewing officer or
				  officers must not have personally participated in the decision made by the
				  employing agency or PEBB program.
(2) The reviewing officer or officers must
				  review the initial order and the record to determine if the initial order was
				  correctly decided and make any inquiries necessary to ascertain whether the
				  proceeding must be converted to a formal administrative hearing.
(3) The reviewing officer or officers will
				  issue a final order that will either:
(a)
				  Affirm the initial order in whole or in part; or
(b) Reverse the initial order in whole or in
				  part; or
(c) Remand to the
				  presiding officer in whole or in part.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-16-2160 - Conversion of a brief adjudicative proceeding to a formal administrative hearing

Current through Register Vol. 24-14, July 15, 2024
(1) The presiding
				  officer or the reviewing officer or officers, in their sole discretion, may
				  convert a brief adjudicative proceeding to a formal administrative hearing at
				  any time before the final order is issued on motion by:
(a) The appellant;
(b) The representative of the
				  appellant;
(c) The authority;
				  or
(d) The presiding officer or
				  reviewing officer or officers.