Current through Register Vol. 24-18, September 15, 2024
(1) When you have a mental, neurological,
cognitive, physical or sensory impairment, or limitation that prevents you from
receiving health care coverage, we provide services to help you apply for,
maintain, and understand the health care coverage options available and
eligibility decisions we make. These services are called equal access (EA)
services.
(2) We provide EA
services on an ongoing basis to ensure that you are able to maintain health
care coverage and access to services we provide. EA services include, but are
not limited to:
(a) Helping you to:
(i) Apply for or renew coverage;
(ii) Complete and submit forms;
(iii) Give us information to determine or
continue your eligibility;
(iv) Ask
for continued coverage;
(v) Ask for
reinstated (restarted) coverage after your coverage ends; and
(vi) Ask for and participate in a
hearing.
(b) Giving you
additional time, when needed, for you to give us information before we reduce
or end your health care coverage;
(c) Explaining our decision to change,
reduce, end, or deny your health care coverage;
(d) Working with your authorized
representative, if you have one, and giving that person copies of notices and
letters we send you; and
(e)
Providing you the services of a sign language inter-preter/transliterator who
is certified by the Registry of Interpreters for the Deaf at the appropriate
level of certification.
(i) These services
may include in-person sign language interpreter services, relay interpreter
services, and video interpreter services, as well as other services; we decide
which services to offer you based on your communication needs and
preferences.
(ii) We offer these
services as a reasonable accommodation, free of charge, if you are deaf,
hard-of-hearing, or a deaf-blind person who uses sign language to
communicate.
(f) Not
taking adverse action in your case, or automatically reinstating your coverage
for up to three months after the adverse action was taken, if we determine that
your impairment or limitation was the cause of your failure to follow through
on something you need to do to get or keep your Washington apple health
coverage, such as:
(i) Applying for or
renewing coverage;
(ii) Completing
and submitting forms;
(iii) Giving
us information to determine or continue your eligibility;
(iv) Asking for continued or reinstated
coverage; or
(v) Asking for and
participating in a hearing.
(3) We inform you of your right to EA
services listed in subsection (2) of this section:
(a) On printed applications and notices,
including the printed rights and responsibilities form;
(b) In the Washington healthplanfinder web
site, including the electronic rights and responsibilities form; and
(c) During contact with us.
(4) We provide you the EA services
listed in subsection (2) of this section if you ask for EA services, you are
receiving services through the aging and long-term support administration, or
we determine that you would benefit from EA services. We determine you would
benefit from EA services if you:
(a) Appear
to have or claim to have any impairment or limitation described in subsection
(1) of this section;
(b) Have a
developmental disability;
(c) Are
disabled by alcohol or drug addiction;
(d) Are unable to read or write in any
language;
(e) Appear to have
limitations in your ability to communicate, understand, remember, process
information, exercise judgment and make decisions, perform routine tasks, or
relate appropriately with others (whether or not you have a disability) that
may prevent you from understanding the nature of EA services or affect your
ability to access our programs; or
(f) Are a minor not residing with your
parents.
(5) If we
determine that you are eligible for EA services, we develop and document an EA
plan appropriate to your needs. The plan may be updated or changed at any time
based on your request or a change in your needs.
(6) You may at any time refuse the EA
services offered to you.
(7) We
reinstate your coverage when:
(a) We end
coverage because we were unable to determine if you continue to qualify;
and
(b) You provide proof that you
are still qualified for coverage within twenty calendar days from when we ended
your coverage. We restore your coverage retroactive to the first of the month
so there is no break in your coverage.
(8) If you believe that we have discriminated
against you on the basis of a disability or another protected status, the
person may file a complaint with the U.S. Department of Health and Human
Services athttp://www.hhs.gov/ocr/civilrights/complaints
or Region Manager, Office for Civil Rights, U.S. Department of Health and Human
Services, 2201 Sixth Ave. M/S: RX-11, Seattle, WA 98121-1831 (voice phone
800-368-1019, fax 206-615-2297, TDD 800-537-7697).
Statutory Authority: RCW 41.05.021 and Patient Protection
and Affordable Care Act (P.L. 111-148), 42 C.F.R. §§ 431, 435, and
457, and 45 C.F.R. § 155.
