182-520-0005  <<  182-520-0010 >>   182-520-0015

WAC 182-520-0010

Washington apple health overpayments resulting from an administrative hearing.

(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.
[Statutory Authority: RCW 41.05.021, 41.05.160, 41.05A.005, 41.05.010, and 74.09.741. WSR 16-13-059, § 182-520-0010, filed 6/13/16, effective 7/14/16. Statutory Authority: RCW 41.05.021, Patient Protection and Affordable Care Act (P.L. 111-148), 42 C.F.R. §§ 431, 435, 457, and 45 C.F.R. § 155. WSR 14-01-021, § 182-520-0010, filed 12/9/13, effective 1/9/14.]
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