WAC 182-526-0095 Requesting a hearing.

Effective March 16, 2017

1. A hearing request may be made orally or in writing, unless a rule requires otherwise. If an oral request is allowed by rule, an oral request for hearing can be made to a health care authority (HCA) employee, HCA's authorized agent, or to the office of administrative hearings (OAH) employee in person, by telephone, or by voicemail.
2. Program rules may require a specific method and location for sending a written request for hearing. A written request for hearing should be sent to the location specified in the notice.
3. A hearing request should contain:
   1. The requestor's name;
   2. The requestor's address;
   3. The requestor's telephone number;
   4. The applicant's, recipient's, or provider's identification number;
   5. A description of each agency action being contested;
   6. A brief explanation of why the person or entity disagrees with HCA's action; and
   7. Any accommodation to help the requestor fully participate in the hearing, including a foreign or sign language interpreter or any other accommodation for an individual with a disability.

WAC 182-526-0080 Resolving a dispute with the health care authority.

Effective March 16, 2017

1. If a person or entity disagrees with a decision or action of the health care authority (HCA) or one of its authorized agents, the person or entity may request a hearing.
2. A notice of an action or decision by HCA or its authorized agent sent to a person's or entity's correct address is presumed to be received by the person or entity on the fourth business day after it was sent by first class mail. This presumption does not apply to certified or registered mail.
3. A hearing must be requested in the manner and within the deadlines established in statute or rule.
4. After a person or entity requests a hearing the dispute may be resolved through:
   1. Any prehearing alternative or administrative process offered by the program, HCA's authorized agent, or the HCA hearing representative;
   2. A prehearing meeting;
   3. A prehearing conference; or
   4. A hearing.

WAC 182-526-0070 Filing documents.

Effective September 26, 2021

1. Filing is the act of delivering documents to the office of administrative hearings (OAH) or the board of appeals (BOA).
2. The date of filing is the date documents are received by OAH or BOA.
3. Filing is complete when the documents are received by OAH or BOA during business days between 8:00 a.m. to 5:00 p.m. If the documents are received after 5:00 p.m. on a business day, the filing is effective the next business day.
4. A party may file documents by delivering them to OAH or BOA by:
   1. Personal service (e.g., hand delivery);
   2. First class, registered, or certified mail;
   3. Fax transmission;
   4. Electronic service;
   5. Other secure electronic means established by the agency or OAH;
   6. Electronic cloud sharing service approved by the agency;
   7. Commercial delivery service; or
   8. Legal messenger service.
5. A party may obtain confirmation of receipt of the filing from the OAH or BOA staff to prove that the documents were successfully filed electronically.

WAC 182-526-0040 Service of documents on another party.

Effective April 4, 2024

1. When the rules in this chapter or in other program rules or statutes require a party to serve copies of documents on other parties, the party must send copies of the documents to all other parties or their representatives.
2. When sending documents to the office of administrative hearings (OAH) or the board of appeals (BOA), the party must file the documents at one of the locations listed in WAC 182-526-0025(2) for OAH or in WAC 182-526-0030 for BOA.
3. When sending documents to the assigned OAH field office, the parties should use the address of the assigned OAH listed on the notice of hearing. If a field office has not been assigned, all written communication about the hearing must be sent to the OAH Olympia field office, which sends the communication to the correct office. Documents may be sent only as described in this section to accomplish service.
4. Unless otherwise stated in law, a party may serve someone by:
   1. Personal service (hand delivery);
   2. First class, registered, or certified mail;
   3. Fax;
   4. Electronic service;
   5. Commercial delivery service;
   6. Legal messenger service; or
   7. Department of enterprise services consolidated mail services if the servicing party is a state agency, including the agency and OAH. See RCW 43.19.710.
5. A party must serve all other parties or their representatives whenever the party files a pleading, brief, or other document with OAH or BOA, or when required by law.
6. Service is complete when:
   1. Personal service is made;
   2. Mail is properly stamped, addressed, and deposited in the United States mail;
   3. Mail is placed in consolidated mail services to be mailed by United States mail first class, postage prepaid, by a state agency for outgoing mail delivery;
   4. A fax produces proof of transmission;
   5. Electronic service is sent;
   6. A parcel is delivered to a commercial delivery service with charges prepaid; or
   7. A parcel is delivered to a legal messenger service with charges prepaid.
7. A party may prove service by providing any of the following:
   1. A sworn statement;
   2. The certified mail receipt signed by the person who received the envelope;
   3. An affidavit or certificate or mailing;
   4. A signed receipt from the person who accepted the commercial delivery service or legal messenger service package; or
   5. Proof of fax or electronic service transmission.
8. The OAH or BOA may serve documents, by email only if the other parties have agreed to accept electronically served documents.

WAC 182-526-0035 Calculating when a hearing deadline ends.

Effective March 16, 2017

1. When counting days to calculate when a hearing deadline ends under program rules or statutes:
   1. Do not include the day of the action, notice, or order. For example, if a hearing decision is mailed on Tuesday and the party has twenty-one days to request a review, start counting the days with Wednesday.
   2. If the last day of the period is a Saturday, Sunday, or a designated holiday under WAC 357-31-005, the deadline is the next business day.
   3. For periods of seven days or less, count only business days. For example, if the party has seven days to respond to a review request that was mailed on Friday, May 10th, the response period ends on Tuesday, May 21st.
   4. For periods over seven days, count every calendar day, including Saturdays, Sundays, and designated holidays under WAC 357-31-005.
2. The deadline is 5:00 p.m. on the last day.
3. If the party who requested the hearing misses a deadline, that party may lose the right to a hearing or appeal of a decision.

WAC 182-526-0030 Contacting the board of appeals.

Effective September 26, 2021

The information included in this section is current at the time of rule adoption, but may change. Current information and additional contact information are available on the health care authority's internet site, in person at the board of appeals (BOA) office, or by a telephone call to the BOA's main public number.

Board of Appeals

WAC 182-526-0025 Use and location of the office of administrative hearings

Effective March 16, 2017

1. The health care authority (HCA) may use administrative law judges employed by the office of administrative hearings (OAH) to conduct administrative hearings and issue initial orders in accordance with RCW 34.05.425 (1)(c).
2. In some situations, HCA may use presiding officers employed by HCA to conduct administrative hearings and issue final orders in accordance with RCW 34.05.425 (1)(a) and (b). When HCA uses HCA-employed presiding officers to conduct administrative hearings, HCA's presiding officer has all the duties and responsibilities set forth in this chapter relating to administrative law judges and the office of administrative hearings. The notice of hearing will identify whether the case is to be heard by OAH or an HCA-employed presiding officer.
3.  
   1. OAH headquarters location is:
      Office of Administrative Hearings
      2420 Bristol Court S.W.
      P.O. Box 42488
      Olympia, WA 98504-2488
      360-664-8717
      fax: 360-664-8721
   2. The headquarters office is open from 8:00 a.m. to 5:00 p.m. Monday through Friday, except legal holidays.
4. OAH field offices are at the following locations:

   Olympia
   Office of Administrative Hearings
   2420 Bristol Court S.W.
   P.O. Box 42489
   Olympia, WA 98504-2489
   360-407-2700
   1-800-583-8271
   fax: 360-586-6563
   ​
   Seattle
   Office of Administrative Hearings
   One Union Square
   600 University Street, Suite 1500
   Mailstop: TS-07
   Seattle, WA 98101-1129
   206-389-3400
   1-800-845-8830
   fax: 206-587-5135

   Tacoma
   Office of Administrative Hearings
   949 Market Street, Suite 500
   Tacoma, WA 98402
   253-476-6888
   fax: 253-593-2200

   Spokane
   Office of Administrative Hearings
   16201 E. Indiana Avenue, Suite 5600
   Spokane Valley, WA 99216
   509-456-3975
   1-800-366-0955
   fax: 509-456-3997

5. Contact the Olympia field office, under subsection (2) of this section, if unable to identify the correct field office.
6. Further hearing information can be obtained at the OAH web site: www.oah.wa.gov.

WAC 182-526-0020 Good cause.

Effective November 9, 2024

1. Good cause is a substantial reason or legal justification allowing the administrative law judge (ALJ) to grant a party's request or to excuse their action or inaction, including granting a continuance or excusing a failure to appear at an administrative proceeding.
2. To determine if there is good cause, the administrative law judge may consider the provisions of Superior Court Civil Rule 60 as a guideline. Good cause may include, but is not limited to, the following examples:
   1. The party who requested the hearing ignored a notice because the party was in the hospital or was otherwise prevented from responding; or
   2. The party who requested the hearing could not respond to the notice because it was written in a language that the party did not understand.
3. For applicants and recipients with rights to adjudicative proceedings, good cause for failing to meet a hearing deadline is further addressed in RCW 74.09.741.
4. The requestor bears the burden to show why a request should be granted or an action excused.

WAC 182-526-0015 Terms in the Administrative Procedure Act compared to this chapter

Effective February 1, 2013

To improve clarity and understanding, the rules in this chapter may use different words than the Administrative Procedures Act (APA) or the model rules. Following is a list of terms used in those laws and the terms as used in these rules:

WAC 182-526-0010 Definitions.

Effective February 23, 2025

The following definitions and those found in RCW 34.05.010 apply to this chapter:

"Administrative law judge (ALJ)" - An impartial decision-maker who is an attorney and presides at an administrative hearing. ALJs are employed by the office of administrative hearings (OAH), which is a separate state agency, as defined in RCW 34.05.010. ALJs are not department of social and health services or health care authority (HCA) employees or representatives.
"Agency" – See WAC 182-500-0010.
"Appellant" – A person or entity who requests a hearing about an action of HCA or its designee.
"Applicant" - Any person who has made a request, or on whose behalf a request has been made, to HCA, or HCA's authorized agent on HCA's behalf, for assistance through a medical service program administered by HCA.
"Authorized agent" - A person or agency, as defined in RCW 34.05.010, acting on HCA's behalf under an agreement authorized by RCW 41.05.021 to act as an HCA hearing representative. An authorized agent may be an employee of the department of social and health services or its contractors but may not be an employee of an HCA-contracted managed care organization.
"Board of appeals" or "BOA" - The HCA's board of appeals.
"Business days" - All days except Saturdays, Sundays, and designated holidays under WAC 357-31-005.
"Calendar days" - All days including Saturdays, Sundays, and designated holidays under WAC 357-31-005.
"Continuance" - A change in the date or time of a prehearing conference, hearing, or the deadline for other action.
"Date of the health care authority (HCA) action" - The date when the HCA's decision is effective.
"Deliver" - Giving a document to a person or entity in person or placing the document into the person or entity's possession as authorized by the rules in this chapter or chapter 34.05 RCW.
"Department" - The department of social and health services.
"Documents" - Papers, letters, writings, or other printed or written items.
"Electronic service" - The service of documents sent or received through electronic communications, cloud services, or other electronic means established by the agency. For the purpose of effectuating service, as defined below, on HCA or OAH (but not BOA), service via OAH's PRISM participant portal is an acceptable method of "electronic service."

"Filing" – The act of delivering documents to the office of administrative hearings (OAH) or the board of appeals (BOA).
"Final order" - An order that is the final HCA decision.
"HCA" - The health care authority.
"Health care authority (HCA) hearing representative" - An employee of HCA, an authorized agent of HCA, HCA contractor or a contractor of HCA's authorized agent, or an assistant attorney general authorized to represent HCA in an administrative hearing. The HCA hearing representative may or may not be an attorney. An employee of an HCA contracted managed care organization is not an HCA hearing representative.
"Hearing" - Unless context clearly requires a different meaning, a proceeding before an ALJ, HCA-employed presiding officer, or a review judge that gives a party an opportunity to be heard in disputes about medical services programs administered by HCA. For purposes of this chapter, hearings include administrative hearings, adjudicative proceedings, and any other similar term referenced under chapter 34.05 RCW, the Administrative Procedure Act, Titles 182 and 388 WAC, chapter 10-08 WAC, or other law.
"Initial order" - A hearing decision entered (made) by an ALJ that may be reviewed by a review judge at any party's request.
"Intermediary interpreter" - An interpreter who:

1. Is a certified deaf interpreter (CDI); and
2. Is able to assist in providing an accurate interpretation between spoken and sign language or between types of sign language by acting as an intermediary between a person with hearing loss and a qualified interpreter. "Judicial review" - ((A superior court's)) Review of a final order as provided under RCW 34.05.510 through 34.05.598.

"Limited-English-proficient (LEP)" - Includes limited-English-speaking persons or other persons unable to communicate in spoken English because of hearing loss.
"Limited-English-speaking (LES) person" - A person who, because of non-English-speaking cultural background or disability, cannot readily speak or understand the English language.
"Mail" - Placing a document in the United States Postal system, or commercial delivery service, properly addressed and with the proper postage.
"Managed care organization" or "MCO" - An organization having a certificate of authority or certificate of registration from the office of insurance commissioner that contracts with HCA under a comprehensive risk contract to provide prepaid health care services to eligible recipients under HCA's managed care programs.
"OAH" - The office of administrative hearings.
"Order of default" - An order entered by an administrative law judge (ALJ) or review judge when the appellant fails to appear in a prehearing conference or a hearing. Once the order of default becomes a final order, it terminates the appellant's request for a hearing and ends the hearing process.
"Order of dismissal" – An order from the administrative law judge (ALJ) or review judge ending the hearing process.
"Party":

1. The health care authority (HCA);
2. HCA-contracted managed care organization (MCO) (if applicable); and
3. A person or entity:
   1. Named in the action;
   2. To whom the action is directed; or
   3. Is allowed to participate in a hearing to protect an interest as authorized by law or rule.

​"Person with hearing loss" - A person who, because of a loss of hearing, cannot readily speak, understand, or communicate in spoken language.
"Prehearing conference" - A formal proceeding scheduled and conducted by an ALJ or other reviewing officer on the record for the purposes identified in WAC 182-526-0195.
"Prehearing meeting" - An informal, voluntary meeting that may be held before any prehearing conference or hearing.
"Program" - An organizational unit and the services that it provides, including services provided by HCA staff, its authorized agents, and through contracts with providers and HCA-contracted managed care organizations.
"Qualified interpreter" - Includes qualified interpreters for a limited-English-speaking person or a person with hearing loss.
"Qualified interpreter for a limited-English-speaking person" - A person who is readily able to interpret or translate spoken and written English communications to and from a limited-English-speaking person effectively, accurately, and impartially. If an interpreter is court certified, the interpreter is considered qualified.
"Qualified interpreter for a person with hearing loss" - A visual language interpreter who is certified by the Registry of Interpreters for the Deaf (RID) or National Association of the Deaf (NAD) and is readily able to interpret or translate spoken communications to and from a person with hearing loss effectively, accurately, and impartially.
"Recipient" - Any person receiving assistance through a medical service program administered by HCA.
"Reconsideration" - Asking a review judge to reconsider a final order entered because the party believes the review judge made a mistake.
"Record" - The official documentation of the hearing process. The record includes recordings or transcripts, admitted exhibits, decisions, briefs, notices, orders, and other filed documents.
"Review" - A review judge evaluating initial orders entered by an ALJ and making the final HCA decision as provided by RCW 34.05.464, or issuing final orders.
"Review judge" - A decision maker with expertise in program rules who serves as the reviewing officer under RCW 34.05.464. The review judge reviews initial orders and the hearing record exercising decision-making power as if hearing the case as a presiding officer. In some cases, review judges conduct hearings under RCW 34.05.425 as a presiding officer. After reviewing initial orders or conducting hearings, review judges enter final orders. Review judges are employed by HCA but may be physically located at the board of appeals (BOA). The review judge must not have been involved in the initial HCA action.
"Rule" - A regulation adopted by a state agency. Rules are found in the Washington Administrative Code (WAC).
"Service" – The delivery of documents as explained in WAC 182-526-0040.
"Should" - That an action is recommended but not required.
"Stay" - An order temporarily halting the HCA decision or action.
"Witness" - For the purposes of this chapter, means any person who makes statements or gives testimony that becomes evidence in a hearing. One type of witness is an expert witness. An expert witness is qualified by knowledge, skill, experience, training, and education to give opinions or evidence in a specialized area.