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 .0203 - TIMELINESS

Universal Citation: 10A NC Admin Code 23C .0203

Current through Register Vol. 39, No. 6, September 16, 2024

(a) Every month, each county department of social services and the Disability Determination Section (DDS) of the Division of Vocational Rehabilitation shall process applications as follows:

(1) The average processing time (APT) for the county department of social services shall be 90 days for M-AD and 45 days for all other aid program categories.

(2) APT for DDS shall be 70 days.

(3) The percentage processed timely (PPT) standard for county departments of social services: Level I counties must process 85 percent of applications within the 45/90 day time standard. Level II and III counties must process 90 percent of applications within the 45/90 day time standard. Counties are classified as Levels I through III based on population of the county with Level I counties as the smallest in population while Level III counties are the largest in population size.

(4) PPT standard for DDS: DDS must render a decision within 70 days on 85 percent of cases for Level I counties and 90 percent of cases for Level II and III counties. For county levels refer to the table below.

COUNTY LEVELS

ALAMANCE (II)

CUMBERLAND (III)

JOHNSTON (II)

RANDOLPH (II)

ALEXANDER (I)

CURRITUCK (I)

JONES (I)

RICHMOND (I)

ALLEGHANY (I)

DARE (I)

LEE (I)

ROBESON (II)

ANSON (I)

DAVIDSON (II)

LENOIR (II)

ROCKINGHAM (II)

ASHE (I)

DAVIE (I)

LINCOLN (I)

ROWAN (II)

AVERY (I)

DUPLIN (II)

MACON (I)

RUTHERFORD (II)

BEAUFORT (II)

DURHAM (III)

MADISON (I)

SAMPSON (II)

BERTIE (I)

EDGECOMBE (II)

MARTIN (I)

SCOTLAND (II)

BLADEN (I)

FORSYTH (III)

MCDOWELL (I)

STANLY (I)

BRUNSWICK (II)

FRANKLIN (I)

MECKLENBURG (III)

STOKES (I)

BUNCOMBE (III)

GASTON (III)

MITCHELL (I)

SURRY (II)

BURKE (II)

GATES (I)

MONTGOMERY (I)

SWAIN (I)

CABARRUS (II)

GRAHAM (I)

MOORE (II)

TRANSYLVANIA (I)

CALDWELL (II)

GRANVILLE (I)

NASH (II)

TYRRELL (I)

CAMDEN (I)

GREENE (I)

NEW HANOVER (III)

UNION (II)

CARTERET (II)

GUILFORD (III)

NORTHAMPTON (I)

VANCE (II)

CASWELL (I)

HALIFAX (II)

ONSLOW (II)

WAKE (III)

CATAWBA (III)

HARNETT(II)

ORANGE (II)

WARREN (I)

CHATHAM (I)

HAYWOOD (II)

PAMLICO (I)

WASHINGTON (I)

CHEROKEE (I)

HENDERSON (II)

PASQUOTANK (I)

WATAUGA (I)

CHOWAN (I)

HERTFORD (I)

PENDER (I)

WAYNE (II)

CLAY (I)

HOKE (I)

PERQUIMANS (I)

WILKES (II)

CLEVELAND (II)

HYDE (I)

PERSON (I)

WILSON (II)

COLUMBUS (II)

IREDELL (II)

PITT (II)

YADKIN (I)

CRAVEN (II)

JACKSON (I)

POLK (I)

YANCEY (I)

(b) If a county department of social services fails to meet the standards in Paragraph (a) of this Rule, the county shall analyze the reason for failure, document findings and work with the Medicaid Program Representative (MPR) to achieve corrective action. The MPR is a Division of Health Benefits employee.

(c) Failure to meet the time standards in Paragraph (a) of this Rule, monthly shall result in corrective action to alleviate problems as outlined in Rules .0204 and .0205 of this Section. Once eligibility is determined except for the following requirements:

(1) sufficient medical expenses to meet a deductible; or

(2) the determination of need for institutionalization; or

(3) the plan of care for the home and community-based waivers; or

(4) the disability decision made by the Disability Determination Section; or

(5) medical records needed to determine emergency dates for non-qualified aliens; days shall be excluded from the time standard of 45 or 90 days. Days in the time standard are again included when the items in Subparagraph (c)(1) through (5) are received until the application is completed with a written notice to the applicant. When the 45/90th day falls on a weekend or holiday, the next workday in the month is considered the 45/90th day.

Authority G.S. 108A-54; Alexander v. Bruton, U.S.D.C., File No. C-C-74-183-M, Consent Order dismissed effective February 1, 2002;
Temporary Adoption Eff. March 1, 2003;
Eff. August 1, 2004;
Transferred from 10A NCAC 21A .0606 Eff. May 1, 2012;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. July 23, 2016;
Amended Eff. March 1, 2020.

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