Current through Register Vol. 24-18, September 15, 2024
(1)
The provisions in chapter 182-518 WAC apply to COFA islander health care, where
applicable. This section applies only to notices and letters that we send
regarding COFA islander health care.
(2) We send you written notices (letters)
when we:
(a) Approve you for COFA islander
health care;
(b) Deny you for COFA
islander health care;
(c) Change or
terminate your eligibility from COFA islander health care;
(d) Ask you for more information;
and
(e) Reimburse you for premium
costs, as determined by WAC 182-524-0600.
(3) All written notices we send to you
include:
(a) The date of the notice;
(b) Specific contact information for you to
use if you have questions or need help with the notice;
(c) The nature of the action;
(d) The effective date of the
action;
(e) The facts and reasons
for the action;
(f) The specific
regulation on which the action is based;
(g) Your appeal rights, if an appeal is
available; and (h) Other information required by the state.
(4) If we request information from
you, we allow at least ten calendar days for you to submit requested
information. If you ask, we may allow you more time to get us the information.
(a) If the due date falls on a weekend or a
legal holiday as described in
RCW
1.16.050, the due date is the next business
day.
(b) We do not deny or
terminate your eligibility when we ask you to provide information.
(c) If we do not receive your information by
the due date, we make a determination based on all the information
available.
(5) We send a
written notice to you at least ten days before taking any adverse action. The
ten-day notice period starts on the day we send the notice.
(6) We may send a notice fewer than ten days
before the date of the adverse action if:
(a)
You request the action;
(b) You
request termination;
(c) A change
in statute, federal regulation, or administrative rule is the sole cause of the
action;
(d) You are incarcerated
and expect to remain incarcerated at least thirty days;
(e) Mail sent to you is returned without a
forwarding address and we do not have a more current address for you;
(f) You move out-of-state;
(g) Your plan ends because you move to a
county where your current silver level qualified health plan (QHP) is not
available and you fail to select a new plan;
(h) You die;
(i) You begin receiving other state or
federal medical assistance that provides minimum essential coverage;
or
(j) Your silver level QHP is
closed and you do not enroll in another silver level QHP.
