Current through Register Vol. 24-18, September 15, 2024
(1)
Requesting an expedited hearing.
(a) An expedited hearing may be requested
only in matters involving applicants or recipients.
(b) An applicant or recipient may request an
expedited administrative hearing when the applicant or recipient believes there
is an urgent health care need as defined in subsection (3) of this
section.
(c) The applicant or
recipient bears the burden of proof to establish an urgent health care need and
must submit evidence or arrange for evidence to be submitted to the office of
administrative hearings (OAH) with the expedited hearing request to support the
need for an expedited hearing. Agency staff may help an applicant or recipient
who asks for assistance in obtaining information that the agency has pursuant
to WAC 182-503-0120.
(d) A recipient may be eligible for continued
coverage according to WAC
182-504-0130.
(2)
Exception to notice
requirements. The notice requirements in this section prevail over
notice requirements in WAC
182-526-0250.
(3)
Standard for granting an expedited
hearing request.
(a) For the purposes
of this section, an urgent health care need means that waiting for an otherwise
timely final order could jeopardize the applicant's or recipient's life, health
or ability to attain, maintain, or regain maximum function.
(b) The administrative law judge (ALJ) grants
a request for an expedited hearing only if the ALJ finds by a preponderance of
the evidence submitted with the applicant's or recipient's expedited hearing
request and the information listed below that the applicant or recipient has an
urgent health care need.
(c)
Information the ALJ may consider when determining whether the applicant or
recipient has an urgent health care need and whether to subsequently grant or
deny an expedited hearing request includes, but is not limited to:
(i) The documentation submitted with the
expedited hearing request to show an urgent health care need;
(ii) Whether the recipient is eligible for
continued coverage of the benefits denied, reduced, or terminated by the agency
or the agency's designee pending resolution of the appeal as an expedited
hearing request may not be granted for individuals receiving continued
coverage;
(iii) The length of time
between the applicant's or recipient's receipt of the agency's or the agency
designee's adverse notice and the applicant's or recipient's request for an
expedited hearing; and
(iv) Whether
the documentation submitted with the expedited hearing request shows that an
appointment with a provider for a health care procedure or treatment to address
the applicant's or recipient's stated urgent health care need:
(A) Is scheduled; or
(B) Cannot be scheduled due to a lack of
coverage.
(4)
Time frame and notice requirements
for expedited hearing request determination. The ALJ must grant or deny
the expedited hearing request and issue the determination within four business
days of receipt of the request by OAH or as expeditiously as possible. OAH must
immediately notify the parties orally and in writing of the ALJ's
determination, unless the parties waive written notification. The oral and
written notice must clearly state:
(a)
Whether the expedited hearing request was approved or denied;
(b) That a hearing has been or will be
scheduled; and
(c) The information
listed in subsection (3)(c) of this section that the ALJ relied upon.
(5)
Scheduling an expedited
hearing. If the ALJ grants a request for an expedited hearing, OAH will
schedule a hearing and provide notice as expeditiously as possible, allowing
for a reasonable amount of notice and time for the parties to prepare for
hearing. The notice rules in WAC
182-526-0250 do not
apply.
(6)
Denial of
expedited hearing. If the ALJ denies an expedited hearing request, OAH
will schedule the hearing based on standard scheduling practices and the notice
rules in WAC
182-526-0250.
(7)
Appeal right. There is no
right to appeal an ALJ's determination to grant or deny an expedited hearing
request.
(8)
Expedited
hearing initial order. If an expedited hearing request is granted and an
expedited hearing is held, the ALJ must issue an initial order as expeditiously
as possible.
(9)
Expedited
final order. Any party may request administrative review of the initial
order with the health care authority board of appeals according to WAC
182-526-0560 through
182-526-0600. The board of
appeals will issue a final order as expeditiously as possible.
(10)
Delayed expedited hearing request
determination or expedited hearing initial order. The ALJ has a duty to
determine whether to grant or deny an expedited hearing request and, if
granted, to issue an expedited hearing initial order as expeditiously as
possible, except in unusual circumstances when:
(a) An ALJ is unable to reach a decision
because the applicant or recipient requests a delay or does not take a required
action; or
(b) There is an
administrative or other emergency beyond OAH's or the agency's
control.
