The Decision

Revised October 28, 2015

DSHS Hearing Rules are found in chapter 388-02 WAC.

Clarifying Information:

Once a hearing request has been scheduled, a decision must be issued by the ALJ. 

Administrative Hearing Coordinator (AHC) Responsibilities: 

When a hearing decision is received by the department:

  1. Document the AHCS with the docket number, the type of decision, and the date of mailing.

  2. Include any other information necessary for a complete record.

  3. Summarize the hearing decision in the ACES narrative.

1. Order of dismissal: Issued when an appellant withdraws the hearing request or does not appear at the scheduled time for the administrative hearing.  An appellant can request that an Order of Dismissal be vacated or canceled. If the Order of Dismissal is vacated, the administrative hearing will be reinstated. Document the circumstances that led to the dismissal so that the department can respond in those cases.

a.  Default/no show: If the administrative hearing notice was correctly addressed and the appellant failed to appear, document the AHCS and ACES narrative and file the hearing decision with any related documents in the case record.  

If the notice of hearing was not correctly addressed or there is some other reason that the notice of hearing was not properly delivered, contact the Office of Administrative Hearings (OAH) and provide them with the correct address or other information needed to deliver the notice of hearing.

b.  Withdrawal: Document the AHCS, ACES narrative and file the hearing decision, with the request for withdrawal and any other related documents attached in the case record.

​2.  Initial decision: The initial decision is issued by the Administrative Law Judge (ALJ) who presided at the administrative hearing. The initial hearing decision becomes the final hearing decision if it is not appealed by either party within 21 days of the date that it is mailed.

The ALJ who conducted the administrative hearing is responsible for writing the initial hearing decision and mailing a copy to all parties. It is appropriate to follow up with the ALJ if the decision is delayed. No details of the case can be discussed before the hearing decision is issued.

The Health Care Authority (HCA) is responsible for administrative hearings involving medical equipment or medical services. Refer questions about these hearing decisions to the HCA Appeals Manager, MS 45503. (See Special Procedures in this category.)

HCA shall not implement hearing decisions concerning medical procedures, medical equipment, or dental services until a final order is issued. The HCA Appeals Manager will coordinate these cases

3.  Reversed decisions: When the department decision is reversed, immediately:

a. Authorize benefits for an applicant effective with the date of eligibility determined in the hearing decision.

b. Reinstate benefits for a recipient at the level paid prior to the hearing request, if the benefits are not already being continued, or at the level determined correct by the initial hearing decision.

c. Adjust overpayments or take any other action addressed in the initial hearing decision.

4.   Stay: When the department disagrees with the initial hearing decision, request a stay of the action per the initial hearing decision.

5.  Affirmed decisions:  When the department decision is affirmed, immediately:

a. Terminate the continued benefits. Adequate notice must be provided to the appellant. Advance notice is not required.

b. Review the period of continued benefits, and establish an overpayment, as appropriate.

c. Distribute the hearing decision to other offices or divisions (OFR, WorkFirst Division, etc.), as appropriate.

6.  Petition for review of initial decision: The AHC is responsible for filing a petition to review in cases involving public assistance cash and eligibility for medical assistance.

The Health Care Authority (HCA) is responsible for filing petitions for review in cases involving medical equipment, medical services, or MAGI medical cases. The HCA Appeals Manager at: MS 45503 coordinates the cases.

6.  AHC petitions for review to the DSHS Board of Appeals (BOA):

     a.  After implementing the initial hearing decision, determine if a review is appropriate:

  1. Consult with CSO supervisors or administrator, as appropriate
  2. Consult with regional trainers or program staff, if necessary
  3. See chapter 388-02 WAC, which gives a full explanation of the BOA review judge's authority.

     b.  If the department decides to petition the BOA fir a review of the initial hearing decision, prepare a memorandum for the BOA Board of Appeals, MS  45803 which includes:

  1. Appellant's name and docket number,
  2. All areas in which the department believes the ALJ erred. See chapter 388-02 WAC for the review standard. The review judge usually only addresses areas that have been raised in the petition for review. Refer to findings of fact and conclusions of law by the number assigned in the hearing decision.
  3. Cite WAC's, findings of fact or evidence in the record that support the department argument.
  4. New evidence which affects the hearing decision, and could not have been provided by the AHC at the hearing with reasonable diligence.
  5. A request asking the review judge to find in the department's favor.
  6. Refer to chapter 388-02 WAC for complete instructions regarding distribution and time frames for a petition for reconsideration.

7.  Appellant petition for review:

a. Do not reinstate continued benefits pending a review of the initial hearing decision requested by the appellant.

b. Review the appellant's petition to determine if a response is appropriate. A response may not be required if the appellant raises issues which are irrelevant or which are outside the authority of the ALJ, e.g., issues relating to the behavior of department workers.

c. If a response is required, prepare a memorandum to the Board of Appeals, MS 45803, which includes:

  1. The appellant's name and the docket number,
  2. A response which speaks only to the issues raised by the appellant,
  3. Argument(s) which supports the finding in the initial hearing decision.

d. Refer to chapter 388-02 WAC  for complete instructions regarding distribution and time frames for a response to a petition for review.

8. Receipt of review decision from BOA:

a. Implement the BOA review decision immediately.

b. See chapter 388-02 WAC to determine if a request for reconsideration is appropriate.

c. If a request for reconsideration is appropriate, prepare a memorandum to the Board of Appeals, MS 45803 including the specific reason why the department does not agree with the BOA review decision.

9. Judicial Review: The appellant has the right to request judicial review of the final agency decision in superior court. Instructions regarding requesting judicial review are attached to the BOA review decision. If an appellant asks about  judicial review, they should be advised to seek legal counsel and referred to the local legal services office.