10A N.C. Admin. Code 27I.0601

Current through Register Vol. 39, No. 9, November 1, 2024

Section 27I .0601 - SCOPE

(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.

10A N.C. Admin. Code 27I .0601

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.

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;

Amended by North Carolina Register Volume 38, Issue 23, June 3, 2024 effective 5/1/2024.