WAC 182-526-0005 Purpose and scope

WAC 182-526-0005 Purpose and scope.

Effective February 7, 2025

1. This chapter:
   1. Describes the general hearing rules and procedures that apply to the resolution of disputes between an appellant and the health care authority (HCA), an agency designee, or an HCA-contracted managed care organization (MCO) or health plan, or a dispute involving an assessed overpayment by HCA against an HCA-contracted MCO or health plan, involving:
   2. Medical services programs established under chapter 74.09 RCW including, but not limited to, Washington apple health fee-for service, integrated managed care (see chapters 182-538 and 182-538B WAC), and crisis and noncrisis services in (see chapters 182-538C);
   3. Washington apple health expansion (see chapters 182-525, 182-525A, and 182-525B WAC); and
   4. The prescription drug pricing transparency program in chapter 182-51 WAC and the all payer health care claims database rules in chapter 182-70 WAC.
   5. Supplements the Administrative Procedure Act (APA), chapter 34.05 RCW, and the model rules, chapter 10-08 WAC, adopted by the office of administrative hearings (OAH).
   6. Establishes rules encouraging informal dispute resolution between the health care authority (HCA), its authorized agents, or an HCA-contracted MCO or health plan, and people or entities who disagree with its actions.
2. Unless specifically excluded by this chapter or program rules, this chapter regulates all hearings involving:
   1. Medical services programs established under chapter 74.09 RCW including, but not limited to, managed care in chapters 182-538, 182-538A, and 182-538B WAC, and crisis and noncrisis services in chapter 182-538C WAC;
   2. Apple health expansion eligibility or services as described in chapters 182-525, 182-525A, and 182-525B WAC; and
   3. Prescription drug pricing transparency program in chapter 182-51 WAC and the all payer health care claims database rules in chapter 182-70 WAC. 
3. Nothing in this chapter is intended to affect the constitutional rights of any person or to limit or change additional requirements imposed by statute or other rule. Other laws or rules determine if a hearing right exists, including the APA and program rules or laws.
4. If there is a conflict between this chapter and specific program rules, the specific program rules prevail. HCA's hearing rules and program rules prevail over the model hearing rules in chapter 10-08 WAC.
5. The hearing rules in this chapter do not apply to the public employees benefits board program (see chapter 182-16 WAC).