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.

WAC 182-518-0010 Washington apple health -- Notice requirements approval and denial notices.

Effective August 29, 2014.

1. We send written notice when we approve, reopen, reinstate, or deny coverage for any Washington apple health (WAH) program. The notice includes the information described in WAC 182-518-0005(4) and all of the following:
   1. The WAH coverage for each person approved, reopened or reinstated;
   2. The date that each person's coverage begins (the effective date); and
   3. The dates for which we approved each person's coverage (certification period).
2. Denial and withdrawal notices include:
   1. The date of denial;
   2. Specific facts and reason(s) supporting the decision;
   3. Specific rules or statutes that support or require the decision; and
   4. Information to get help applying for nonmodified adjusted gross income (MAGI)-based WAH.
3. If we deny your request for health care coverage or consider it withdrawn because you failed to give us requested information, the denial notice also includes:
   1. A list of the information you did not give us;
   2. The date we asked you for the information and the date it was due;
   3. Notice that we will reconsider your eligibility if we receive any information related to determining your eligibility, including any changes to information we have, within thirty days of the date of the notice;
   4. Information described in subsection (1) of this section; and
   5. Notice of administrative hearing rights.

WAC 182-516-0001 Definitions

Effective February 2, 2018

"Acquire" means, in the context of trusts, to gain title to, or to gain ownership interest in an asset in a trust. Receiving payment or benefit from an asset in a trust is not acquiring the asset.

"Annuitant" means a person or entity that receives the stream of payments from an annuity.

"Annuity" means a policy, certificate or contract that is an agreement between two parties in which one party pays a lump sum to the other, and the other party agrees to guarantee payment of a set amount of money over a set amount of time.

"Beneficiary" means, in the context of a trust, a person or entity that is entitled to benefit from a trust.

"Grantor" means the person or entity who owned the asset immediately before establishing a trust with that asset.

"Immediate" means, in the context of annuities, an annuity that is fully funded at purchase with no accumulation or deferral to allow accumulation.

"Income" means, in the context of a trust, the undistributed proceeds that a trust principal generates over a period including, but not limited to, interest, dividends, rents and realized gains on the sale or exchange. Any income not disbursed in one period is principal the next period.

"Irrevocable":
     a. For a trust, "irrevocable" means the grantor or someone act­ ing on behalf of the grantor cannot reacquire any portion of the as­ sets in the trust for the benefit of the grantor or unilaterally change the terms of the trust; and the beneficiary or someone acting on behalf of the beneficiary cannot acquire any portion of the assets in the trust for the benefit of the beneficiary or unilaterally change the terms of the trust. A legal instrument that is called irrevocable, but permits acquisition or reacquisition of any portion of the assets if some action is taken by or on behalf of the grantor or the benefi­ciary, is revocable for the purposes of this chapter.

     b. A trust or annuity that is not irrevocable is revocable.

     c. A trust is still irrevocable if it meets the definition under (a) of this definition, but allows modifications to the trust to conform with changes in trust law, which occur after the establishment of the trust.

     d. For an annuity, "irrevocable" means the contract cannot be canceled and the terms of the contract cannot be changed.

"Principal" means the assets, other than income, that make up the trust, promissory note, or loan.

"Revocable" means the instrument is not irrevocable. See the def­inition of "irrevocable."

"Self-settled trust" means any trust established with assets that were originally owned by the beneficiary, or would have been owned by the beneficiary if they had not been diverted into the trust by the beneficiary, the court, or someone acting on the beneficiary's behalf. Depending on the date a trust is established, a trust may be self-set­tled if the assets were originally owned by the beneficiary's spouse, or would have been owned by the beneficiary's spouse if they had not been diverted into the trust by the beneficiary's spouse, the court, or someone acting on the beneficiary's spouse's behalf.

Trustee" means a person or entity that manages and administers a trust for the beneficiary.

"Uncompensated asset transfer" means the entirety of the fair market value of the asset transferred was uncompensated, regardless of any consideration received in return for the asset.

WAC 182-514-0250 Program for adults age nineteen and older.

Effective February 29, 2016.

1. To qualify for coverage under the modified adjusted gross income (MAGI)-based long-term care (LTC) program under this section, a person ((twenty-one years of)) age nineteen or older must be eligible for one of the following Washington apple health (WAH) programs:
   1. WAC 182-505-0240 Washington apple health—Parents and caretaker relatives;
   2. WAC 182-523-0100 Washington apple health—Medical extension;
   3. WAC 182-505-0250 Washington apple health—MAGI-based adult medical;
   4. WAC 182-505-0115 Washington apple health—Eligibility for pregnant women; or
   5. WAC 182-507-0110 Washington apple health—Alien medical programs.
2. The categorically needy (CN) income level for health care coverage under this section is the applicable standard for the program the person receives after the standard five percentage point income disregard. See WAC 182-505-0100 for standards based on the federal poverty level.
3. The medicaid agency determines countable income for CN coverage under this section using MAGI methodology under chapter 182-509 WAC.
4. The agency approves CN coverage under this section for twelve calendar months.
5. A person is ineligible for medically needy (MN) coverage under this section if the person's income exceeds CN eligibility standards, unless the person is age nineteen, twenty, or pregnant.
6. If a person who is age nineteen, twenty, or pregnant is not eligible for CN coverage under this section, the agency determines eligibility for MN coverage under WAC 182-514-0263.
7. A person who applies for or receives MAGI-based LTC coverage at Eastern or Western State Hospital in the month of his or her twenty-first birthday and who receives active inpatient psychiatric treatment that will likely continue through the person's twenty-first birthday is eligible for CN coverage until:(a) The facility discharges the person; or(b) The end of the month in which the person turns age twenty-two, whichever occurs first.
8. Except for a person described in subsection (7) of this section, a person who is admitted to Eastern or Western State Hospital who is older than age twenty but younger than age sixty-five is not eligible for WAH coverage.

WAC 182-513-1440 Determining how many of my assets can be protected.

Effective February 20, 2017

You can protect assets based on the amount paid by your LTC partnership policy. Assets are protected in both LTC eligibility and estate recovery. If the partnership for long-term care program is discontinued, an individual who purchased an approved plan before the date the program is discontinued remains eligible to receive dollar-for-dollar asset disregard and asset protection under the long-term care (LTC) medicaid program.

WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.

Effective February 20, 2017

The following assets cannot be protected under a LTC partnership policy.

1. Resources in a trust under WAC 182-516-0100 (6) and (7).
2. Annuity interests in which Washington must be named as a preferred remainder beneficiary as under WAC 182-516-0201.
3. Home equity in excess of the standard under WAC 182-513-1350. Individuals who have excess home equity interest are not eligible for long-term care medicaid services.
4. Any portion of the value of an asset that exceeds the dollar amount paid out by the LTC partnership policy.
5. The unprotected value of any partially protected asset is subject to estate recovery described in chapter 182-527 WAC.

WAC 182-513-1319 State-funded programs for noncitizens who are not eligible for a federally funded program.

Effective February 20, 2017

1. This section describes the state-funded programs available to a person who does not meet the citizenship and immigration status criteria under WAC 182-513-1316 for federally funded coverage.
2. If a person meets the eligibility and incapacity criteria of the medical care services (MCS) program under WAC 182-508-0005, the person may receive nursing facility care or state-funded residential services in an alternate living facility (ALF).
3. Noncitizens age nineteen or older may be eligible for the state-funded long-term care services program under WAC 182-507-0125. A person must be preapproved by the aging and long-term support administration (ALTSA) for this program due to enrollment limits.
4. Noncitizens under age nineteen who meet citizenship and immigration status under WAC 182-503-0535 (2)(e) are eligible for:
   1. Nursing facility services if the person meets nursing facility level of care; or
   2. State-funded personal care services if functionally eligible based on a department assessment under chapter 388-106 or 388-845 WAC.