Section 182-526-0102. Coordinated appeals process with the Washington health benefits exchange.

(1) The health care authority (HCA) coordinates with the Washington state health benefits exchange (HBE) to ensure a seamless appeal process for determinations related to eligibility for Washington apple health (WAH) when the modified adjusted gross income (MAGI) methodology is used as described in WAC 182-509-0305.

(2) An applicant, recipient, or an authorized representative of an applicant or recipient may request a WAH hearing:

(a) By telephone;

(b) By mail (which should be sent to Health Care Authority, P.O. Box 45504, Olympia, WA 98504-5504);

(c) In person;

(d) By facsimile transmission;

(e) By e-mail; or

(f) By any other commonly available electronic means.

(3) When an applicant or recipient appeals an HBE determination of eligibility for health insurance premium tax credits (HIPTC) or cost-sharing reductions with HBE and also requests a hearing with the health care authority related to WAH eligibility, the ALJ will not require the applicant or recipient to submit information to the ALJ that the applicant or recipient previously submitted to HBE.

(4) If an applicant or recipient submits to HBE a request for a hearing related to WAH eligibility, the ALJ will accept the date HBE received the request for the hearing as the date filed for the purposes of timeliness standards and will treat it as a valid hearing request.

(5) If the applicant or recipient appeals only the determination related to WAH eligibility, subsection (3) of this section does not apply.

[Statutory Authority: RCW 41.05.021, 42 C.F.R. § 431, 435, and 457, 45 C.F.R. § 155, and Patient Protection and Affordable Care Act (Public Law 111-148). WSR 13-22-094, § 182-526-0102, filed 11/6/13, effective 12/7/13.]

RCW 41.05.021, 42 C.F.R. § 431, 435, and 457, 45 C.F.R. § 155, and Patient Protection and Affordable Care Act (Public Law 111-148). WSR 13-22-094, § 182-526-0102, filed 11/6/13, effective 12/7/13.

Rules

182-509-0305,