Administrative Hearing Coordinator Responsibilities:

There are several offices within the Health Care Authority (HCA) that make decisions that are subject to administrative hearings. It is important to contact the appropriate office as soon as a notice of hearing is received to coordinate representation

A. Medical assistance hearings:

For hearings involving medical services, equipment, transportation, managed care enrollment, and Patient Review and Coordination (PRC) program, contact the HCA’s Office of Hearings and Appeals at: MS 45504, 360-725-1254 or 1-800-351-6827.

The HCA staff may act as the agency’s representative for these cases, coordinate testimony of medical consultants, help you obtain additional medical information, and arrange medical examinations, if necessary.

The HCA Appeals Administrator will coordinate review and implementation of hearing decisions as required by HCA.

The DSHS AHC acts as liaison between HCA’s staff and the Appellant and their representative if required. For example, if the Appellant requests an in-person hearing and it is scheduled at the local CSO, the DSHS AHC may assist the ALJ and the Appellant during the hearing because HCA staff participates in the hearing telephonically from Olympia, WA.

For insurance issues, contact HCA’s Revenue, Recovery and Premium Payment Section or HCA’s Coordination of Benefits (COB) Section, as appropriate: COB Health Units: 1-800-562-3022 ext # 16134 COB Casualty Unit: 1-800-562-3022 ext # 15462 RRPS Premium Payment: 1-800-562-3022 ext # 15473

If a Medicaid policy clarification is required, contact Eligibility Policy Innovation and Community Support (EPICS) at HCAAHEligibilityPolicy@hca.wa.gov.

For hearings involving CHIP (N13), After Pregnancy Coverage (N04/N24/N07/N27), BCCTP (S30) or other cases assigned to CSO 76 contact Ariane Takano 360-725-1795 MS 45531 or contact 800-351-6827.

For hearings involving a cash AND medical program, such as TANF or ABD, the AHC will need to cite the correct hearing rules when necessary, which may mean citing both the HCA hearing rules and the DSHS hearing rules. The administrative law judge will also need to use the correct rules when entering and serving an order. All ALJ decisions on HCA cases must be "initial orders", not "final orders."

B. Non-grant medical assistance (NGMA) hearings:

The AHC acts as the agency representative, and a DDDS employee provides testimony to support the decision. Clients have up to 90 days to request a hearing on a NGMA decision. As soon as the hearing request is received:

If the original denial is affirmed in the DDDS review process, consult with the DDDS hearing supervisor who will assign someone to testify in support of the denial.

Notify the appellant if the original DDDS decision is reversed in the DDDS review process.

Coordinate requested continuances from either the appellant or DDDS with the local OAH office. Continuances are often necessary in these cases to obtain additional medical information. It is important that the AHC keep all parties informed of the status of the case prior to the hearing.

Notify DDDS of the scheduled date and time of the hearing.

Forward the DSHS 14-144 and the DDDS original decision packet in hard copy to the appropriate DDDS office. Attach any new medical documentation and release of information authorizations, if appropriate. (Do not use the automated Barcode referral process for administrative hearing reviews.)

Initiate reconsideration of the original decision by completing in hard copy a DSHS 14-144, Transmittal Summary, and check the box for the Administrative Hearing Review. The reconsideration is a required step in the DDDS process prior to hearing. Request continuances as appropriate to allow sufficient time for the reconsideration.

NOTE: A hearing request is not always needed for the Department to review a NGMA decision. Clients may ask for a review within 30 days of the initial denial if medical evidence exists that was not used to make the original decision. Please follow the above steps and note on the referral that it is a reconsideration of denial.

Additional information regarding NGMA hearings can be found at Non-Grant Medical Assistance (NGMA) hearings | Washington State Health Care Authority