WAC 182-526-0355 People who may attend the hearing.

Effective March 16, 2017

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.

WAC 182-526-0320 Subpoenas.

Effective March 16, 2017

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:
   1. Serving the subpoena;
   2. Complying with the subpoena; and
   3. Witness fees according to RCW 34.05.446(7).
4. Any person who is at least eighteen years old and not a party to the hearing may serve a subpoena.
5. Service of a subpoena is complete when the server:
   1. Gives the witness a copy of the subpoena; or
   2. Leaves a copy at the residence of the witness with a person over the age of eighteen.
6. To prove that a subpoena was served on a witness, the person serving the subpoena must sign a written, dated statement including:
   1. Who was served with the subpoena;
   2. When the subpoena was served;
   3. The address where the subpoena was served; and
   4. The name, age, and address of the person who served the subpoena.
7. A party may request that an ALJ quash (set aside) or change the requirements of a subpoena at any time before the deadline given in the subpoena.
8. An ALJ may set aside or change a subpoena if it is unreasonable.
9. Witnesses with safety or accommodation concerns should contact the office of administrative hearings (OAH) upon receipt of a subpoena.

WAC 182-526-0255 Notice of hearing or notice of prehearing conference.

Effective March 16, 2017

1.  
   1. 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:
      1. Names of all parties to whom the notice is sent and, if known, the names and addresses of their representatives;
      2. Name, mailing address, and telephone number of the administrative law judge (ALJ), if known;
      3. Date, time, place, and nature of the hearing or prehearing conference;
      4. Legal authority and jurisdiction for the hearing; and
      5. Date of the hearing request.
   2. A notice of hearing or prehearing conference must include a statement that the appellant's failure to attend the prehearing conference or hearing may result in the loss of the right to a hearing.
   3. If the appellant fails to appear, the ALJ may enter an order of default.
2. Limited-English proficiency. The notice must include a statement that, if the appellant needs a qualified interpreter because they or any of their witnesses are people with limited-English proficiency, OAH will provide an interpreter at no cost to that party.
3. The notice must state whether the hearing or prehearing conference is to be held by telephone or in person, and how to request a change in the way it is held.
4. The notice of hearing or prehearing conference informs the appellant:
   1. How to indicate any special needs for the appellant or their witnesses, including the need for an interpreter in a primary language or for sensory impairments;
   2. How to contact OAH if a party has a safety concern; and
   3. That the appellant may request a qualified interpreter if the appellant or any of the appellant's witnesses are people with limited-English proficiency, and that OAH provides such interpreters at no cost to the appellant.

WAC 182-526-0218 The authority of a review judge when conducting a hearing as a presiding officer.

Effective February 1, 2013

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 judges 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:
   1. Any party may request reconsideration of the final order as provided in this chapter and WAC 388-96-904(12); and
   2. 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.

WAC 182-526-0175 Prehearing meetings.

Effective March 16, 2017

1. A prehearing meeting is an informal meeting with a health care authority (HCA) hearing representative that may be held before any prehearing conference or hearing.
2. The HCA hearing representative may contact the party who requested the hearing before the ((scheduled)) hearing date to arrange a prehearing meeting. Any party may also contact the HCA hearing representative to request a prehearing meeting.
3. A prehearing meeting is voluntary, but strongly encouraged. A party is not required to request a prehearing meeting and is not required to participate in one. A party's refusal to participate in a prehearing meeting does not affect the party's right to a hearing.
4. The prehearing meeting may include all or some of the parties, but does not include an administrative law judge (ALJ).
5. The prehearing meeting gives the parties an opportunity to:
   1. Clarify issues;
   2. Exchange documents and witness statements;
   3. Resolve issues through agreement or withdrawal; and
   4. Ask questions about the hearing process and the laws and rules that apply.
6. During a prehearing meeting:
   1. The HCA hearing representative may:
      1. Explain the role of the HCA hearing representative in the hearing process;
      2. Explain how a hearing is conducted and the relevant laws and rules that apply;
      3. Explain the right to representation during the hearing;
      4. Respond to questions about the hearing process;
      5. Identify accommodation and safety issues;
      6. Distribute copies of the documents to be presented during the hearing;
      7. Provide, upon request, copies of relevant laws and rules;
      8. Identify additional documents or evidence a party may want or be required to present during the hearing;
      9. Provide information about how to obtain relevant documents;
      10. Clarify the issues; and
      11. Attempt to settle the dispute, if possible.
   2. Parties should explain their position and provide documents that relate to the case. Parties may consult legal resources.
   3. Parties may enter into written agreements or stipulations, including agreements that settle the dispute.
7. A prehearing meeting may be held or information exchanged:
   1. In person;
   2. By telephone conference call;
   3. Through correspondence; or
   4. Any combination of the above that is agreeable to the parties.

WAC 182-526-0130 Limited-English-proficient parties--Notice requirements.

Effective February 1, 2013

If the office of administrative hearings is notified that the party who has requested the hearing is a limited-English-proficient (LEP) person, all hearing notices, decisions and orders must:

1. Be written in that party's primary language; or
2. Include a statement in the party's primary language:
   1. Indicating the importance of the notice; and
   2. Providing information about how to get help in understanding the notice and responding to it.

WAC 182-526-0085 Determining if a hearing right exists.

Effective March 16, 2017

1. A person or entity has a right to a hearing only if a law or program rule gives that right.
2. Some programs may require a person or entity to go through an informal administrative process before requesting or having a hearing. The notice of the agency's action includes information about this requirement if it applies.
3. Program rules and statutes may limit the time a person or entity has to request a hearing. The deadline for filing the request for hearing varies by the program involved. Hearing requests should be submitted right away to protect the right to a hearing, even if the parties are also trying to resolve the dispute informally. The notice of the agency's action contains information about this requirement.
4. If the health care authority (HCA) hearing representative or the administrative law judge (ALJ) questions the person's or entity's right to a hearing, the ALJ or review judge (RJ) must address whether the hearing right exists.
5. If on appeal of the initial order the HCA hearing representative or the review judge questions the right to a hearing, the review judge decides whether the hearing right exists.
6. If the ALJ or RJ decides that the person or entity does not have a right to a hearing, the ALJ or RJ enters an order dismissing the hearing.
7. If the ALJ or RJ decides that a person or entity has a right to a hearing, the hearing proceeds.

WAC 182-518-0010 Washington apple health -- Notice requirements approval and denial notices.

Effective August 29, 2014.

1. We send written notice when we approve, reopen, reinstate, or deny coverage for any Washington apple health (WAH) program. The notice includes the information described in WAC 182-518-0005(4) and all of the following:
   1. The WAH coverage for each person approved, reopened or reinstated;
   2. The date that each person's coverage begins (the effective date); and
   3. The dates for which we approved each person's coverage (certification period).
2. Denial and withdrawal notices include:
   1. The date of denial;
   2. Specific facts and reason(s) supporting the decision;
   3. Specific rules or statutes that support or require the decision; and
   4. Information to get help applying for nonmodified adjusted gross income (MAGI)-based WAH.
3. If we deny your request for health care coverage or consider it withdrawn because you failed to give us requested information, the denial notice also includes:
   1. A list of the information you did not give us;
   2. The date we asked you for the information and the date it was due;
   3. Notice that we will reconsider your eligibility if we receive any information related to determining your eligibility, including any changes to information we have, within thirty days of the date of the notice;
   4. Information described in subsection (1) of this section; and
   5. Notice of administrative hearing rights.

WAC 182-516-0001 Definitions

Effective February 2, 2018

"Acquire" means, in the context of trusts, to gain title to, or to gain ownership interest in an asset in a trust. Receiving payment or benefit from an asset in a trust is not acquiring the asset.

"Annuitant" means a person or entity that receives the stream of payments from an annuity.

"Annuity" means a policy, certificate or contract that is an agreement between two parties in which one party pays a lump sum to the other, and the other party agrees to guarantee payment of a set amount of money over a set amount of time.

"Beneficiary" means, in the context of a trust, a person or entity that is entitled to benefit from a trust.

"Grantor" means the person or entity who owned the asset immediately before establishing a trust with that asset.

"Immediate" means, in the context of annuities, an annuity that is fully funded at purchase with no accumulation or deferral to allow accumulation.

"Income" means, in the context of a trust, the undistributed proceeds that a trust principal generates over a period including, but not limited to, interest, dividends, rents and realized gains on the sale or exchange. Any income not disbursed in one period is principal the next period.

"Irrevocable":
     a. For a trust, "irrevocable" means the grantor or someone act­ ing on behalf of the grantor cannot reacquire any portion of the as­ sets in the trust for the benefit of the grantor or unilaterally change the terms of the trust; and the beneficiary or someone acting on behalf of the beneficiary cannot acquire any portion of the assets in the trust for the benefit of the beneficiary or unilaterally change the terms of the trust. A legal instrument that is called irrevocable, but permits acquisition or reacquisition of any portion of the assets if some action is taken by or on behalf of the grantor or the benefi­ciary, is revocable for the purposes of this chapter.

     b. A trust or annuity that is not irrevocable is revocable.

     c. A trust is still irrevocable if it meets the definition under (a) of this definition, but allows modifications to the trust to conform with changes in trust law, which occur after the establishment of the trust.

     d. For an annuity, "irrevocable" means the contract cannot be canceled and the terms of the contract cannot be changed.

"Principal" means the assets, other than income, that make up the trust, promissory note, or loan.

"Revocable" means the instrument is not irrevocable. See the def­inition of "irrevocable."

"Self-settled trust" means any trust established with assets that were originally owned by the beneficiary, or would have been owned by the beneficiary if they had not been diverted into the trust by the beneficiary, the court, or someone acting on the beneficiary's behalf. Depending on the date a trust is established, a trust may be self-set­tled if the assets were originally owned by the beneficiary's spouse, or would have been owned by the beneficiary's spouse if they had not been diverted into the trust by the beneficiary's spouse, the court, or someone acting on the beneficiary's spouse's behalf.

Trustee" means a person or entity that manages and administers a trust for the beneficiary.

"Uncompensated asset transfer" means the entirety of the fair market value of the asset transferred was uncompensated, regardless of any consideration received in return for the asset.

WAC 182-514-0250 Program for adults age nineteen and older.

Effective February 29, 2016.

1. To qualify for coverage under the modified adjusted gross income (MAGI)-based long-term care (LTC) program under this section, a person ((twenty-one years of)) age nineteen or older must be eligible for one of the following Washington apple health (WAH) programs:
   1. WAC 182-505-0240 Washington apple health—Parents and caretaker relatives;
   2. WAC 182-523-0100 Washington apple health—Medical extension;
   3. WAC 182-505-0250 Washington apple health—MAGI-based adult medical;
   4. WAC 182-505-0115 Washington apple health—Eligibility for pregnant women; or
   5. WAC 182-507-0110 Washington apple health—Alien medical programs.
2. The categorically needy (CN) income level for health care coverage under this section is the applicable standard for the program the person receives after the standard five percentage point income disregard. See WAC 182-505-0100 for standards based on the federal poverty level.
3. The medicaid agency determines countable income for CN coverage under this section using MAGI methodology under chapter 182-509 WAC.
4. The agency approves CN coverage under this section for twelve calendar months.
5. A person is ineligible for medically needy (MN) coverage under this section if the person's income exceeds CN eligibility standards, unless the person is age nineteen, twenty, or pregnant.
6. If a person who is age nineteen, twenty, or pregnant is not eligible for CN coverage under this section, the agency determines eligibility for MN coverage under WAC 182-514-0263.
7. A person who applies for or receives MAGI-based LTC coverage at Eastern or Western State Hospital in the month of his or her twenty-first birthday and who receives active inpatient psychiatric treatment that will likely continue through the person's twenty-first birthday is eligible for CN coverage until:(a) The facility discharges the person; or(b) The end of the month in which the person turns age twenty-two, whichever occurs first.
8. Except for a person described in subsection (7) of this section, a person who is admitted to Eastern or Western State Hospital who is older than age twenty but younger than age sixty-five is not eligible for WAH coverage.