Administrative Hearing decision

WAC 182-526-0195 Prehearing conferences.

Effective September 27, 2021

1. Unlike a prehearing meeting, a prehearing conference is a formal proceeding conducted on the record by an administrative law judge (ALJ) to address issues and prepare for a hearing.
   1. The ALJ must make an audio record of the prehearing conference.
   2. An ALJ may conduct the prehearing conference in person, by telephone, or in any other manner acceptable to the parties.
2. All parties must attend the prehearing conference. If the party who requested the hearing does not attend the prehearing conference, the ALJ may enter an order of default and an order dismissing the hearing.
3. The ALJ may require a prehearing conference. Any party may request a prehearing conference.
4. The ALJ must grant the appellant's, and may grant the managed care organization's or the agency representative's, first request for a prehearing conference if it is filed with the office of administrative hearings (OAH) at least seven business days before the scheduled hearing date.
5. When the ALJ grants a party's request for a prehearing conference, the ALJ must continue the previously scheduled hearing when necessary to comply with notice requirements in this section.
6. The ALJ may grant additional requests for prehearing conferences.
7. The office of administrative hearings (OAH) must schedule prehearing conferences for all cases which concern:
   1. The department's division of residential care services under Title XIX of the federal Social Security Act.
   2. Provider and vendor overpayment hearings.
   3. Estate recovery and predeath liens.
8. During a prehearing conference the parties and the ALJ may:
   1. Simplify or clarify the issues to be decided during the hearing;
   2. Agree to the date, time, and place of the hearing;
   3. Identify any accommodation or safety issues;
   4. Agree to postpone the hearing;
   5. Allow the parties to make changes in their own documents, including the notice or the hearing request;
   6. Agree to facts and documents to be entered during the hearing;
   7. Set a deadline to exchange names and phone numbers of witnesses and documents before the hearing;
   8. Schedule additional prehearing conferences;
   9. Resolve the dispute;
   10. Consider granting a stay if authorized by law or program rule; or
   11. Rule on any procedural issues and substantive motions raised by any party.
9. After the prehearing conference, the ALJ must enter a written order describing:
   1. The actions taken at the prehearing conference;
   2. Any changes to the documents;
   3. A statement of the issue or issues identified for the hearing;
   4. Any agreements reached; and
   5. Any ruling of the ALJ.
10. OAH must serve the prehearing order on the parties at least fourteen calendar days before the scheduled hearing.
11. A party may object to the prehearing order by notifying OAH in writing within ten calendar days after the mailing date of the order. The ALJ must issue a ruling on the objection within five days from the date a party files an objection.
12. If no objection is made to the prehearing order, the order determines how the hearing is conducted, including whether the hearing will be in person or held by telephone conference or other means, unless the ALJ changes the order for good cause.
13. The ALJ may take further appropriate actions to address other concerns raised by the parties.

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 182-526-0280 Continuing a hearing when an appellant is an applicant or recipient.

Effective January 5, 2018

1. Any party may request a continuance under this section either orally or in writing.
2. Before contacting the office of administrative hearings (OAH) to request a continuance, the party seeking the continuance must make a good faith effort to contact the other parties to find out if they agree to a continuance. The party making the request for a continuance must let OAH know whether the other parties agreed to the continuance.
3. Standard when less than sixty days. When a continuance request is made less than sixty days from the date OAH received the hearing request:
   1. If all parties agree to the continuance, the ALJ must grant the request unless the ALJ holds a prehearing conference and finds that good cause for a continuance does not exist under WAC 182-526-0020.
   2. If the parties do not agree to the continuance, the ALJ must schedule a prehearing conference and determine if good cause for a continuance exists under WAC 182-526-0020 and under the following factors:
      1. Why the party is requesting a continuance;
      2. Why the other party or parties are objecting to the request;
      3. Whether a continuance in the case has previously been granted at the request of the same party who is now requesting the continuance and, if so, whether it was for the same reason;
      4. The extent to which the requesting or objecting parties could have prevented the need for delay;
      5. The number and duration of previous continuances in the case and who requested them;
      6. The legal or factual complexity of the case;
      7. The relative harm to the parties if the continuance is granted or denied, including the risk of harm to the appellant if he or she is not receiving continued benefits;
      8. The impact of a continuance on the parties' ability to adequately prepare and present their cases;
      9. Any need to provide accommodation, translation, or interpreter services; and
      10. The impact of a continuance on the ability of OAH to issue a timely initial decision; or
      11. Other relevant factors.
4. Standard when sixty days or greater. When a continuance request is made sixty days or more from the date OAH received the hearing request:
   1. The ALJ must not only consider whether there is good cause to continue the hearing but also must find a compelling reason for the continuance.
   2. Compelling reasons include:
      1. Medical evidence is required;
      2. Extraordinary circumstances exist, such as the sudden unforeseen onset of an illness or adverse event that was beyond the party's ability to prevent;
      3. The hearing format changes or the ALJ finds a compelling reason to change the way a witness appears at the hearing according to WAC 182-526-0360;
      4. The appellant needs more time to prepare or present evidence or argument because the agency issued an amended notice under WAC 182-526-0260;
      5. The need for more time was caused by another party's action or inaction, considering the relative capacity and resources of the parties;
      6. The need to provide accommodation, translation, or interpreter services;
      7. A party received notice of the date or deadline thirty days or more after OAH received the hearing request;
      8. Whether the continuance is needed to allow for effective assistance of counsel of record; or
      9. Other compelling reasons.
5. The ALJ must notify all parties whether a continuance was granted or denied orally on the record, or must do so in writing within five business days of the prehearing conference.
6. If the ALJ grants a continuance, OAH must serve a new notice of hearing on the parties at least fourteen calendar days before the new hearing date, unless the parties agree to a shorter time period.

WAC 182-526-0285 Orders of dismissal.

Effective August 18, 2018

1. An order of dismissal may be entered when the appellant withdraws the request for hearing under WAC 182-526-0115.
2. An appellant may file a petition (request) to vacate an order of dismissal under WAC 182-526-0290.
3. An order of dismissal becomes a final order by operation of law, disposing of the appellant's request for a hearing under RCW 34.05.440 if:
   1. The appellant fails to appear at a prehearing conference scheduled to address the petition to vacate under WAC 182-526-0290 (3) and (4) (a).
4. The health care authority or managed care organization action stands after an order of dismissal becomes a final order.
5. The appellant may seek judicial review of a final order of dismissal to the superior court under WAC 182-526-0640.

WAC 182-526-0520 Information which must be included in the ALJ's initial order.

Effective March 16, 2017

In an initial order, the administrative law judge (ALJ) must:

1. Identify the matter as a health care authority appeal;
2. List the name and docket number of the case and the names of all parties and representatives;
3. Make findings concerning the facts used to resolve the dispute based on the hearing record;
4. Explain how the ALJ determined that evidence is credible or not credible when the facts or conduct of a witness is questioned;
5. State the law that applies to the dispute;
6. Apply the law to the facts of the case in the conclusions of law;
7. Discuss the reasons for the decision based on the facts and the law;
8. State the result and remedy ordered;
9. Explain how to request corrections to the initial order or petition for review by the board of appeals (BOA) and provide the deadlines for such requests;
10. State the date the initial order becomes final according to WAC 182-526-0525; and
11. Include any other information required by law or program rules.

WAC 182-526-0525  When initial orders become final.

Effective March 16, 2017

An initial order becomes a final order at 5:00 p.m. on the twenty-first calendar day after the office of administrative hearings (OAH) serves the initial order, unless:

1. Any party files a request for review of the initial order within twenty-one calendar days of the serving (mailing) of the initial order in accordance with WAC 182-526-0580(1);
2. Any party files a request for extension of the deadline for filing a request for review which is granted by the review judge under WAC 182-526-0580(2); or
3. Any party files a late request for review which is accepted by a review judge in accordance with WAC 182-526-0580(3);
4. A managed care enrollee requests review by an independent review (IR) organization in accordance with RCW 48.43.535 prior to the initial order becoming final or a final order being entered by a review judge. See WAC 182-526-0200 for enrollee appeals.

WAC 182-526-0530 How to correct or appeal an initial order.

Effective February 1, 2013

1. If a party disagrees with an administrative law judge's (ALJ) initial order because of a clerical error, the party may ask for a corrected initial order from the ALJ as provided in WAC 182-526-0540 through 182-526-0555.
2. If a party disagrees with an initial order for a reason other than a clerical error and wants the initial order changed, the party must request review by a review judge as provided in WAC 182-526-0560 through 182-526-0595.

WAC 182-526-0605 Reconsideration of a final order entered by a review judge.

Effective March 16, 2017

1. If a party does not agree with the final order and wants it reconsidered, the party may request the review judge to reconsider the decision.
2. The party must make the request in writing and clearly state why the party wants the final order reconsidered. The party must file the written reconsideration request with the BOA and it must be received by the deadline under WAC 182-526-0620.
3. The party should send a copy of the request to all other parties or their representatives.
4. After receiving a reconsideration request, BOA serves a copy to the other parties and representatives and gives them time to respond.
5. The final order or the reconsideration decision is the final HCA decision. If a party disagrees with that decision, the party must petition for judicial review to change it.
6. If a party asks for reconsideration of the final order, the reconsideration process must be completed before a party requests judicial review. However, the party does not need to request reconsideration of a final order before requesting judicial review.
7. The party may ask the court to stay or stop the HCA action after filing the petition for judicial review.