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WAC 182-520-0015

Long-term services and supports client overpayments.

(1) General right to recover.
(a) A long-term services and supports (LTSS) client overpayment is any payment for LTSS made by the agency or the agency's designee on a client's behalf in excess of that to which the client is legally entitled.
(b) An LTSS client overpayment may be caused by:
(i) A client or a client's authorized representative misstating or failing to reveal a fact affecting eligibility under WAC 182-503-0505;
(ii) A client or a client's authorized representative failing to timely report a change required under WAC 182-504-0105; or
(iii) The agency or the agency's designee's error.
(c) The agency or the agency's designee may recoup an LTSS client overpayment:
(i) Up to six years after the date of the notice in subsection (2) of this section; and
(ii) Regardless of whether the program is state-funded, federally funded, or both.
(d) The amount of the LTSS client overpayment equals the amount the agency or the agency's designee paid on the client's behalf minus the amount to which the client was legally entitled.
(2) Notice.
(a) The agency notifies the client or the client's authorized representative by:
(i) Personal service under RCW 4.28.080; or
(ii) Certified mail, return receipt requested.
(b) The agency or the agency's designee may prove that it notified the client by providing:
(i) A sworn statement;
(ii) An affidavit or certificate of mailing; or
(iii) The certified mail receipt signed by the client or the client's authorized representative.
(c) The notice states:
(i) The client's name;
(ii) The client's address;
(iii) The date the agency or the agency's designee issued the notice;
(iv) The amount of the LTSS client overpayment;
(v) How the agency calculated the LTSS client overpayment;
(vi) How the client may request an administrative hearing; and
(vii) How the client may make a payment.
(3) Response.
(a) The client must respond to the notice within ninety days of the date the agency or the agency's designee served the client with the notice of the LTSS client overpayment by:
(i) Paying the agency or the agency's designee;
(ii) Establishing a payment plan with the agency or the agency's designee; or
(iii) Requesting an administrative hearing.
(b) If the client does not respond to the notice within ninety days of the date the agency or the agency's designee served the client with the notice, the agency or the agency's designee may initiate collection action.
(4) Hearings. A person who disagrees with agency or the agency's designee's action under this section may request an administrative hearing under chapter 182-526 WAC.
[Statutory Authority: RCW 41.05.021, 41.05.160, 41.05A.005, 41.05.010, and 74.09.741. WSR 16-13-059, ยง 182-520-0015, filed 6/13/16, effective 7/14/16.]
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