Board of Appeals

Information about HCA 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.

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.
  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.
  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.

Review judges

  • Steve Dotson, enterprise risk manager/chief review judge
  • Clayton King, review judge
  • Diamanta Tornatore, review judge

Contact

For Medicaid-related appeals
Phone:
844-728-5212 or 360-725-0910
Fax: 360-507-9018

For general questions about BOA

Kristy Weber, legal assistant 4
Email:
Kristy.weber@hca.wa.gov
Phone: 360-725-0910

Steve Dotson, enterprise risk manager/chief review judge
Email: Steve.dotson@hca.wa.gov
Phone: 360-725-0444

Mailing address
Board of Appeals
P.O. Box 42700
Olympia, WA 98504-2700

Street address/personal service location
Board of Appeals
Cherry Street Plaza, 1st Floor Reception Desk
626 8th Ave SE
Olympia, WA 98501