WAC 182-526-0010 Definitions.
WAC 182-526-0010 Definitions.
Effective September 26, 2021
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 established under chapter 74.09 RCW.
"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 established under chapter 74.09 RCW. 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:
- Is a certified deaf interpreter (CDI); and
- 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.
- The health care authority (HCA);
- HCA-contracted managed care organization (MCO) (if applicable); and
- A person or entity:
- Named in the action;
- To whom the action is directed; or
- 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 established under chapter 74.09 RCW.
"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.