North Carolina Administrative Code
Title 10A - HEALTH AND HUMAN SERVICES
Chapter 23 - MEDICAL ASSISTANCE ADMINISTRATION
Subchapter C - APPLICATION FOR MEDICAID BENEFITS
Section .0200 - APPLICATION PROCESSING, MONITORING AND CORRECTIVE ACTION
Section 23C .0202 - MONITORING THRESHOLDS AND CORRECTIVE ACTION

(a) Division of Health Benefits employees, known as application monitors, shall review a random sample of applications in all county departments of social services and the Disability Determination Section (DDS) of the Division of Vocational Rehabilitation to determine if counties are denying and withdrawing applications in accordance with federal/state rules. The application monitors shall also review inquiries where a person comes to the agency and decides not to make an application to ensure person was given correct information under federal/state rules. A county and DDS must meet a monitoring threshold of 80 percent in each area of denials, withdrawals and inquiries in order to be found in compliance with federal/state rules.

(b) If the agency falls below the 80 percent threshold, the agency must analyze why it fell below 80 percent and implement a corrective action plan.

(c) The agency or DDS may dispute monitoring findings within 10 workdays of receipt of findings.

(d) Within 30 calendar days of the final monitoring results, the agency must take corrective action to reopen cases the application monitors determine were not handled pursuant to federal/state rules.