Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-520 - Fraud referrals and overpayments
Section 182-520-0010 - Washington apple health overpayments resulting from an administrative hearing
Universal Citation: WA Admin Code 182-520-0010
Current through Register Vol. 24-18, September 15, 2024
(1) If a person asks for Washington apple health coverage to continue during an appeal, he or she must pay the agency for the cost of that coverage if both (a) and (b) of this subsection occur:
(a) The
administrative law judge, or review judge if applicable, enters an order:
(i) That the person was not eligible for
apple health coverage during the appeal;
(ii) Dismissing the hearing under WAC
182-526-0285(3)
because the person defaulted (did not attend or refused to participate) and the
agency's action that was appealed included a finding that the person was not
eligible for apple health coverage; or
(iii) Dismissing the hearing under WAC
182-526-0285(4)
due to a written agreement between all the parties that the person will pay for
an overpayment of the cost of apple health coverage.
(b) The agency decides to collect the
overpayment.
(2) The overpayment amount is limited to payments for apple health coverage that were spent:
(a) During the sixty days following
receipt of the hearing request; and
(b) For a person who was not eligible for
apple health coverage.
(3) The agency will not attempt to recover an apple health overpayment from a nonneedy caretaker relative or guardian except in the case of fraud by the caretaker relative or guardian as described in WAC 182-520-0005.
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