Board of Appeals

What is the Board of Appeals?

HCA Board of Appeals (BOA) reviews Apple Health (Medicaid)-related administrative hearing decisions. These are decisions issued by administrative law judges at the Office of Administrative Hearings (OAH).

These administrative hearing decisions are about:

• Eligibility for Apple Health services.
• Individual provider qualifications.
• Overpayments to Apple Health providers and clients.
• Nursing facility transfers and discharges.
• Provision of specific Apple Health benefits.
• Mental health grievances.
• Estate recovery.

After reviewing the OAH decisions that are appealed, BOA issues the final administrative order in each appealed case. BOA also conducts the hearings for nursing facility reimbursement rate cases and issues those final orders.

BOA review judges are attorneys who review hearing decisions for legal and factual errors, change the decisions as necessary, and preside over certain cases. They then issue final decisions on behalf of the HCA director. All BOA review judges are members of the Washington State Bar Association.

BOA review and hearings are conducted in accordance with the administrative hearing rules found in Chapter 182-526 WAC (Washington Administrative Code) and the Washington Administrative Procedure Act (APA) at Chapter 34.05 RCW.

• Hearing rules for the Public Employees Benefits Board (PEBB) Program can be found at Chapter 182-16 WAC. 
• Hearing rules for the School Employees Benefits Board (SEBB) Program can be found at Chapter 182-32 WAC.

BOA maintains our official record for each Apple Health-related adjudication, ensures that legal notices are prepared and processed to meet legal requirements for cases being reviewed or heard, receives petitions for judicial review, and files hearing records with superior court.

Decision process

BOA decision process consists of five steps:

1. Review: Once an administrative law judge at the Office of Administrative Hearings issues an initial order, either party may request review at the Board of Appeals.
   1. Complete and submit a petition for review of initial decision (appeal) (form 09-023).
2. Response time: Parties are given a short period of time to respond to another party’s petition for review.
3. Issuing of final order: After reviewing the record of the hearing or conducting the administrative hearing in some cases, the review judge or presiding officer issues a final order.
4. Reconsideration: After a review judge or presiding officer issues a final order, either party may request reconsideration of the final order.
   1. Complete and submit a petition for reconsideration of review decision (form 09-022).
5. Judicial review: Judicial review is the process of appealing the Health Care Authority's final order to a superior court. The agency cannot appeal BOA final orders to superior court. Please contact your local superior court clerk's office for additional information.

Significant decisions

BOA maintains an online index of significant decisions. A significant decision is a BOA final order that has an analysis or decision of substantial importance to HCA in carrying out its duties.

A significant decision is precedential, which means that future parties, administrative law judges, and review judges may rely on it in similar cases.