Current through Register Vol. 24-18, September 15, 2024
The hearing process described in this section applies to
requests for an appeal made by an intermediate care facility for individuals
with intellectual disabilities (ICF/IID), as defined in WAC
388-825-020.
(1)
Right to hearing. An ICF/IID
may request a hearing when it is dissatisfied with the medicaid agency's
finding of noncompliance resulting in the termination of medicaid funding and
any related provider agreements under
42 C.F.R. Sec.
431.151 through
431.154.
(a) An agency review judge conducts the
hearing and enters the agency's final order for cases held under this
subsection.
(b) An ICF/IID cannot
appeal:
(i) The choice of sanction or
remedy;
(ii) The monitoring
remedy;
(iii) The level of
noncompliance found, except when a favorable review decision would affect the
range of civil money penalty amounts the agency could collect; or
(iv) The decision about when to conduct an
initial survey of a prospective provider.
(2)
Notice of adverse action.
The agency gives the ICF/IID a written notice of adverse action that includes:
(a) The basis for the finding of
noncompliance that resulted in the agency's decision to terminate medicaid
funding and any related provider agreements;
(b) A statement of the deficiencies resulting
in the decision;
(c) The effective
date of the adverse action; and
(d)
The ICF/IID's appeal rights and procedures, including deadlines, for filing a
hearing request.
(3)
Request for hearing. The ICF/IID, its legal representative, or
other authorized official must file a written request for a hearing with the
agency's board of appeals at P.O. Box 42700, Olympia, Washington, or by
facsimile at 360-507-9018 within 60 calendar days of receiving the notice of
adverse action.
(4)
Hearing. If an ICF/IID requests a hearing on the termination of
medicaid funding and any related provider agreements, the hearing is completed
and the agency issues the final order on the hearing within 120 calendar days
of the effective date of the adverse action.
(a) If the agency is unable to hold the
hearing until after the effective date of the adverse action, the agency offers
the ICF/IID an informal reconsideration that meets the requirements of
subsection (5) of this section.
(b)
The informal reconsideration process described in subsection (5) of this
section is not the same reconsideration process defined in WAC
182-526-0010 or described in WAC
182-526-0605 through
182-526-0635.
(5)
Informal reconsideration
for ICF/IID. The informal reconsideration includes:
(a) Written notice to the ICF/IID of the
agency's findings resulting in the termination of medicaid funding and any
related provider agreements;
(b) A
reasonable opportunity for the ICF/IID to dispute those findings in writing;
and
(c) A written affirmation or
reversal of the agency's action.
(6)
Termination of medicaid funding and
related provider agreements.
(a) The
medicaid funding and any related provider agreements end on the effective date
of the termination, unless:
(i) A hearing is
timely requested and not provided by the agency until after the effective date
of the termination; and
(ii) The
termination is based on a survey agency certification stating that there is no
jeopardy to beneficiaries' health and safety.
(b) If medicaid funding extends past the
termination date, funding will be available only through the earlier of:
(i) The issuance date of a hearing decision
that upholds the agency's action; or
(ii) One hundred twenty calendar days after
the effective date of termination, as required by
42 C.F.R. Sec.
442.40.
