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PDFWAC 182-503-0090

Washington apple health—Exceptions to rule.

(1) An individual may request an exception to a Washington apple health financial eligibility rule in Title 182 WAC. An individual must request an exception to rule (ETR) within ninety calendar days of the agency action with which the individual disagrees. The individual or the individual's representative may request an ETR orally or in writing. The request must:
(a) Identify the rule for which an exception is being requested;
(b) State what the individual is requesting; and
(c) Describe how the request meets subsection (2) of this section.
(2) The agency director or designee has the discretion to grant an ETR if he or she determines that the individual's circumstances satisfy the conditions below:
(a) The exception would not contradict a specific provision of federal or state law; and
(b) The individual's situation differs from the majority; and
(c) It is in the interest of the overall economy and the individual's welfare, and:
(i) It increases opportunity for the individual to function effectively; or
(ii) The individual has an impairment or limitation that significantly interferes with the usual procedures required to determine eligibility and payment.
(3) Individuals cannot appeal ETR decisions under chapter 182-526 WAC.
(4) An individual is mailed a decision in writing within ten calendar days when agency staff:
(a) Approve or deny an ETR request; or
(b) Request more information.
(5) If the ETR is approved, the notice includes information on the approval period.
(6) The agency designates staff at the aging and disability services administration (ADSA) to process all ETRs specifically relating to long-term care programs described in Title 182 WAC.
(7) This section does not apply to requests that the agency pay for noncovered medical or dental services or related equipment. WAC 182-501-0160 applies to such requests.
[Statutory Authority: RCW 41.05.021, Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, and 457, and 45 C.F.R. § 155. WSR 13-14-019, § 182-503-0090, filed 6/24/13, effective 7/25/13.]
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