Current through Register Vol. 24-18, September 15, 2024
(1) An eligibility, premium surcharges, or
enrollment decision made by a state agency may be appealed by submitting a
written request for administrative review to the state agency. The state agency
must receive the request for administrative review no later than thirty days
after the date of the denial notice. The contents of the request for
administrative review are to be provided as described in WAC
182-16-2070.
(a) Upon receiving the request for
administrative review, the state agency must perform a complete review of the
denial by one or more staff who did not take part in the decision resulting in
the denial.
(b) The state agency
must render a written decision within thirty days of receiving the written
request for administrative review. The written decision must be sent to the
employee or employee's dependent who submitted the request for administrative
review and must include a description of the appeal rights. The state agency
must also send a copy of the state agency's written decision to the state
agency's administrator (or designee) and to the public employees benefits board
(PEBB) appeals unit. If a state agency fails to render a written decision
within thirty days of receiving the written request for administrative review,
the request for administrative review may be considered denied as of the
thirty-first day and the original underlying state agency decision may be
appealed to the PEBB appeals unit by following the process in this
section.
(c) The state agency may
reverse eligibility, premium surcharges, or enrollment decisions as permitted
by WAC
182-08-187.
(2) Any current or former employee
or employee's dependent who disagrees with the state agency's decision in
response to a written request for administrative review, as described in
subsection (1) of this section, may request a brief adjudicative proceeding to
be conducted by the authority by submitting a written request to the PEBB
appeals unit.
(a) The PEBB appeals unit must
receive the request for a brief adjudicative proceeding no later than thirty
days after the date of the state agency's written decision on the request for
administrative review. If a state agency fails to render a written decision
within thirty days of receiving a written request for administrative review,
the PEBB appeals unit must receive the request for a brief adjudicative
proceeding no later than thirty days after the date the request for
administrative review was deemed denied. The contents of the request for a
brief adjudicative proceeding are to be provided as described in WAC
182-16-2070.
(i) The PEBB appeals unit must notify the
appellant in writing when the request for a brief adjudicative proceeding has
been received.
(ii) Once the PEBB
appeals unit receives a request for a brief adjudicative proceeding, the PEBB
appeals unit will send a request for documentation and information to the
applicable state agency. The state agency will then have two business days to
respond to the request and provide the requested documentation and information.
The state agency will also send a copy of the documentation and information to
the appellant.
(iii) The brief
adjudicative proceeding will be conducted by a presiding officer designated by
the director.
(b) If an
employee fails to timely request a brief adju-dicative proceeding, the state
agency's prior written decision becomes the authority's final order without
further action.
