North Carolina Administrative Code
Title 10A - HEALTH AND HUMAN SERVICES
Chapter 27 - MENTAL HEALTH, COMMUNITY FACILITIES AND SERVICES
Subchapter I - AREA AUTHORITY OR COUNTY PROGRAM REQUIREMENTS
Section .0600 - NON-MEDICAID APPEAL PROCESS
Section 27I .0601 - SCOPE

Universal Citation: 10A NC Admin Code 27I .0601

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

(a) The rules of this Section shall govern appeals made to the Division of decisions made by an area authority or county program affecting a non-Medicaid eligible client.

(b) A non-Medicaid eligible client, or the client's legally responsible person, may appeal to the Division Director the clinical review decision of an LME-MCO, area authority or county program to deny, reduce, suspend, or terminate a non- Medicaid state funded service.

(c) Nothing in these Rules shall be interpreted as granting a non- Medicaid eligible client the right to appeal decisions of third party payers to the Division.

(d) Non-Medicaid services shall be provided in accordance with G.S. 122C-2. As set forth in G.S. 143B-147(a)(9), nothing in these Rules shall be interpreted as granting a non-Medicaid eligible client the right to appeal the findings of the Division by requesting a contested case hearing pursuant to G.S. 150B.

(e) There shall be no reprisal or retaliation to anyone who is a party to an appeal.

(f) The LME-MCO, area authority or county program may authorize interim services until the final written decision as set forth in Rule .0609 of this Section is reached.

Authority G.S. 143B-147;
Eff. October 1, 2006;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. June 24, 2017.

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