WAC 182-513-1600 Medicaid Alternative Care (MAC)

Effective July 1, 2017

Medicaid alternative care (MAC) is a Washington apple health benefit authorized under section 1115 of the Social Security Act. It enables the medicaid agency and the agency's designees to deliver an array of person-centered long-term services and supports (LTSS) to unpaid caregivers caring for a medicaid-eligible person who meets nursing facility level of care under WAC 388-106-0355.

1. For services included with the MAC benefit package, see WAC 388-106-1900 through 388-106-1990.
2. For financial eligibility for MAC services, see WAC 182-513-1605.

WAC 182-526-0540 Correction of clerical errors in an initial order.

Effective March 16, 2017

1. A clerical error is a mistake that does not change the intent of the initial order.
2. The administrative law judge (ALJ) may correct clerical errors in the initial order by entering a corrected initial order. The ALJ may correct clerical errors in response to a request by one of the parties.
3. Some examples of clerical error are:
   1. Missing or incorrect words or numbers;
   2. Dates inconsistent with the decision or evidence in the record such as using May 3, 2004, instead of May 3, 2014; or
   3. Math errors when adding the total of an overpayment.
4. If the ALJ does not agree that the initial order contains one or more clerical errors, the ALJ enters a written order denying the request for a corrected order.

WAC 182-526-0405 Stipulations.

Effective February 1, 2013

1. A stipulation is an agreement among two or more parties that certain facts or evidence is correct or authentic.
2. If an administrative law judge (ALJ) accepts a stipulation, the ALJ must enter it into the record.
3. A stipulation may be made before or during the hearing.
4. A party may change or reject a stipulation after it has been made.
5. To change or reject a stipulation, a party must show the administrative law judge that:
   1. The party did not intend to make the stipulation or was mistaken when making it; and
   2. Changing or rejecting the stipulation does not harm the other parties.

WAC 182-526-0355 People who may attend the hearing.

Effective March 16, 2017

1. All parties and their representatives may attend a hearing under this chapter.
2. Witnesses may be excluded from the hearing if the administrative law judge (ALJ) finds good cause to do so.
3. The ALJ may also exclude other people from all or part of the hearing.

WAC 182-526-0320 Subpoenas.

Effective March 16, 2017

1. An administrative law judge (ALJ), the health care authority hearing representative, and an attorney for a party may issue subpoenas. If a party is not represented by an attorney, that party may ask the ALJ to issue a subpoena on the party's behalf. The ALJ may schedule a prehearing conference to decide whether to issue a subpoena.
2. An ALJ may deny a party's request for a subpoena. For example, an ALJ may deny a request for a subpoena when the ALJ determines that a witness has no actual knowledge regarding the facts or that the documents are not relevant.
3. There is no cost when OAH issues a subpoena on behalf of a party, but the party may have to pay for:
   1. Serving the subpoena;
   2. Complying with the subpoena; and
   3. Witness fees according to RCW 34.05.446(7).
4. Any person who is at least eighteen years old and not a party to the hearing may serve a subpoena.
5. Service of a subpoena is complete when the server:
   1. Gives the witness a copy of the subpoena; or
   2. Leaves a copy at the residence of the witness with a person over the age of eighteen.
6. To prove that a subpoena was served on a witness, the person serving the subpoena must sign a written, dated statement including:
   1. Who was served with the subpoena;
   2. When the subpoena was served;
   3. The address where the subpoena was served; and
   4. The name, age, and address of the person who served the subpoena.
7. A party may request that an ALJ quash (set aside) or change the requirements of a subpoena at any time before the deadline given in the subpoena.
8. An ALJ may set aside or change a subpoena if it is unreasonable.
9. Witnesses with safety or accommodation concerns should contact the office of administrative hearings (OAH) upon receipt of a subpoena.

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 182-526-0218 The authority of a review judge when conducting a hearing as a presiding officer.

Effective February 1, 2013

1. A review judge has the same authority and responsibilities as an administrative law judge, as described in WAC 182-526-0215, when conducting a hearing.
2. A review judges conducts the hearing and enters the final order in cases where a contractor for the delivery of nursing facility services requests an administrative hearing under WAC 388-96-904(5).
3. The review judge enters final HCA decisions on all cases in the form of a final order.
4. Following a review judge’s final order:
   1. Any party may request reconsideration of the final order as provided in this chapter and WAC 388-96-904(12); and
   2. The party who requested the hearing, but not the health care authority or any of its authorized agents, may file a petition for judicial review as provided in this chapter.

WAC 182-526-0175 Prehearing meetings.

Effective March 16, 2017

1. A prehearing meeting is an informal meeting with a health care authority (HCA) hearing representative that may be held before any prehearing conference or hearing.
2. The HCA hearing representative may contact the party who requested the hearing before the ((scheduled)) hearing date to arrange a prehearing meeting. Any party may also contact the HCA hearing representative to request a prehearing meeting.
3. A prehearing meeting is voluntary, but strongly encouraged. A party is not required to request a prehearing meeting and is not required to participate in one. A party's refusal to participate in a prehearing meeting does not affect the party's right to a hearing.
4. The prehearing meeting may include all or some of the parties, but does not include an administrative law judge (ALJ).
5. The prehearing meeting gives the parties an opportunity to:
   1. Clarify issues;
   2. Exchange documents and witness statements;
   3. Resolve issues through agreement or withdrawal; and
   4. Ask questions about the hearing process and the laws and rules that apply.
6. During a prehearing meeting:
   1. The HCA hearing representative may:
      1. Explain the role of the HCA hearing representative in the hearing process;
      2. Explain how a hearing is conducted and the relevant laws and rules that apply;
      3. Explain the right to representation during the hearing;
      4. Respond to questions about the hearing process;
      5. Identify accommodation and safety issues;
      6. Distribute copies of the documents to be presented during the hearing;
      7. Provide, upon request, copies of relevant laws and rules;
      8. Identify additional documents or evidence a party may want or be required to present during the hearing;
      9. Provide information about how to obtain relevant documents;
      10. Clarify the issues; and
      11. Attempt to settle the dispute, if possible.
   2. Parties should explain their position and provide documents that relate to the case. Parties may consult legal resources.
   3. Parties may enter into written agreements or stipulations, including agreements that settle the dispute.
7. A prehearing meeting may be held or information exchanged:
   1. In person;
   2. By telephone conference call;
   3. Through correspondence; or
   4. Any combination of the above that is agreeable to the parties.

WAC 182-526-0130 Limited-English-proficient parties--Notice requirements.

Effective February 1, 2013

If the office of administrative hearings is notified that the party who has requested the hearing is a limited-English-proficient (LEP) person, all hearing notices, decisions and orders must:

1. Be written in that party's primary language; or
2. Include a statement in the party's primary language:
   1. Indicating the importance of the notice; and
   2. Providing information about how to get help in understanding the notice and responding to it.

WAC 182-526-0085 Determining if a hearing right exists.

Effective March 16, 2017

1. A person or entity has a right to a hearing only if a law or program rule gives that right.
2. Some programs may require a person or entity to go through an informal administrative process before requesting or having a hearing. The notice of the agency's action includes information about this requirement if it applies.
3. Program rules and statutes may limit the time a person or entity has to request a hearing. The deadline for filing the request for hearing varies by the program involved. Hearing requests should be submitted right away to protect the right to a hearing, even if the parties are also trying to resolve the dispute informally. The notice of the agency's action contains information about this requirement.
4. If the health care authority (HCA) hearing representative or the administrative law judge (ALJ) questions the person's or entity's right to a hearing, the ALJ or review judge (RJ) must address whether the hearing right exists.
5. If on appeal of the initial order the HCA hearing representative or the review judge questions the right to a hearing, the review judge decides whether the hearing right exists.
6. If the ALJ or RJ decides that the person or entity does not have a right to a hearing, the ALJ or RJ enters an order dismissing the hearing.
7. If the ALJ or RJ decides that a person or entity has a right to a hearing, the hearing proceeds.