CHAPTER 21 ‑ MEDICAL ASSISTANCE ADMINISTRATION

 

SUBCHAPTER 21A ‑ GENERAL PROGRAM ADMINISTRATION

 

SECTION .0100 ‑ SUPERVISION

 

10A NCAC 21A .0101 SUPERVISION (TRANSFERRED TO 10A NCAC 23A .0101)

 

section .0200 DEFINITIONS

 

10A NCAC 21A .0201 DEFINITIONS (TRANSFERRED TO 10A NCAC 23A .0102)

 

section .0300 - appeals

 

10A NCAC 21A .0301 NOTICE

In cases involving termination or modification of assistance, no action shall become effective until ten business days after the notice is mailed, except that it may be effective immediately upon the mailing of notice when:

(1) modification results in an increase in benefits to the applicant or beneficiary; or

(2) permitted pursuant to 42 C.F.R. 431.213, which is adopted and incorporated by reference with subsequent changes or amendments and available free of charge at https://www.ecfr.gov/.

 

History Note: Authority G.S. 108A‑54; 108A-54.1B; 108A-79(b); 42 C.F.R. 431.211; 42 C.F.R. 431.213;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Readopted Eff. July 1, 2018.

 

10A NCAC 21A .0302 GOOD CAUSE FOR DELAYED HEARINGS

(a) A local appeal hearing under G.S. 108A-79 shall be delayed as provided in G.S. 108-79(e) for good cause.

(b) A State appeal hearing under G.S. 108A-79 may be delayed when there is good cause. The postponement shall not exceed 30 calendar days.

(c) For purposes of this Rule, good cause exists when:

(1) there is a death in the appellant's family;

(2) the appellant or someone in his or her family is ill;

(3) the appellant is unable to obtain representation;

(4) the appellant's representative has a conflict with the scheduled date;

(5) the appellant receives a notice of action proposing a reduction or termination of assistance after the ten business day notice expires;

(6) the appellant is unable to obtain transportation; or

(7) the hearing officer determines that the hearing should be delayed for some other reason in the interests of justice or to promote judicial economy.

 

History Note: Authority G.S. 108A‑54; 108A-54.1B; 108A‑79;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Readopted Eff. July 1, 2018.

 

10A NCAC 21A .0303 APPEAL DECISION

(a) The hearing officer shall make a tentative decision on the appeal that shall be served upon the county department, the appellant, and representatives by mail. Decisions reversing the county department's action shall be sent by certified mail to the county department. Decisions affirming the county department's actions shall be sent by certified mail to the appellant. Decisions shall be sent by regular mail to representatives. The tentative decision shall contain a notification of the right to present oral and written argument for and against the decision as set out in this Rule.

(b) The county and the appellant may present oral and written argument, for and against the decision by contacting the Chief Hearing Officer.

(c) If a written argument, a request for a time extension to submit a written argument, or a request for oral argument is not received by the Chief Hearing Officer within 10 calendar days of the date the notice of the tentative decision is signed, the tentative decision shall become final.

(d) If a request for a time extension to submit a written argument or a request for an oral argument is received by the Chief Hearing Officer within 10 calendar days of the date the notice of the tentative decision is signed, an extension shall be granted and a letter shall be mailed stating the date the written argument is due or the date and time the oral argument shall be heard.

(e) If the party that requested oral argument fails to appear for the scheduled oral argument, the tentative decision shall become final.

(f) If arguments are presented within the timeframes established pursuant to Paragraphs (c) and (d) of this Rule, then all such arguments shall be considered and a final decision shall be rendered.

(g) The final decision shall be served upon the appellant and the county department by certified mail. Decisions shall be sent by regular mail to representatives.

(h) A decision upholding the appellant shall be put into effect within two weeks after the county department's receipt of the final decision by certified mail.

(i) As provided for in 42 C.F.R. 431.245 and G.S. 108A-79(k), the decision shall contain the appellant's right to seek judicial review.

 

History Note: Authority G.S. 108A‑54; 108A-54.1B; 108A‑79; 42 C.F.R. 431.244; 42 C.F.R. 431.245; 42 C.F.R. 431.246;

Eff. September 1, 1984;

Amended Eff. September 1, 1992;

Readopted Eff. July 1, 2018.

 

SECTION .0400 ‑ CONFIDENTIALITY AND ACCESS TO CLIENT RECORDS

 

10A NCAC 21A .0401 SCOPE (TRANSFERRED TO 10A NCAC 23H .0101)

 

10A NCAC 21A .0402 INFORMATION FROM OTHER AGENCIES (TRANSFERRED TO 10A NCAC 23H .0102)

 

10A NCAC 21A .0403 CONFIDENTIALITY (TRANSFERRED TO 10A NCAC 23H .0103)

 

10A NCAC 21A .0404 OWNERSHIP OF RECORDS (TRANSFERRED TO 10A NCAC 23H .0104)

 

10A NCAC 21A .0405 SECURITY OF RECORDS (TRANSFERRED TO 10A NCAC 23H .0105)

 

10a NCAC 21A .0406 LIABILITY OF PERSONS WITH ACCESS (TRANSFERRED TO 10A NCAC 23H .0106)

 

10A NCAC 21A .0407 RIGHT OF ACCESS (TRANSFERRED TO 10A NCAC 23H .0107)

 

10A NCAC 21A .0408 WITHHOLDING INFORMATION FROM THE CLIENT (TRANSFERRED TO 10A NCAC 23H .0108)

 

10A NCAC 21A .0409 PROCEDURE FOR REVIEW OF RECORDS (TRANSFERRED TO 10A NCAC 23H .0109)

 

10A NCAC 21A .0410 CONSENT FOR RELEASE (TRANSFERRED TO 10A NCAC 23H .0110)

 

10A NCAC 21A .0411 DISCLOSURE WITHOUT CLIENT CONSENT (TRANSFERRED TO 10A NCAC 23H .0111)

 

10A NCAC 21A .0412 DOCUMENTATION OF CONSENT OR DISCLOSURE (TRANSFERRED TO 10A NCAC 23H .0112)

 

10A NCAC 21A .0413 PERSONS DESIGNATED TO DISCLOSE INFORMATION (TRANSFERRED TO 10A NCAC 23H .0113)

 

SECTION .0500 ‑ QUALITY CONTROL

 

10A NCAC 21A .0501 QUALITY CONTROL (TRANSFERRED TO 10a NCAC 23A .0103)

 

SECTION .0600 ‑ CORRECTIVE ACTIONS IN MEDICAID CASES

 

10A NCAC 21A .0601 GENERAL (TRANSFERRED TO 10A NCAC 23G .0201)

 

10a NCAC 21A .0602 CORRECTIVE ACTIONS (TRANSFERRED TO 10A NCAC 23G .0202)

 

10A NCAC 21A .0603 TIME LIMITS FOR CORRECTIONS (TRANSFERRED TO 10A nCAC 23G .0203)

 

10A NCAC 21A .0604 RESPONSIBILITY FOR ERRORS (tRANSFERRED TO 10A nCAC 23G .0204)

 

10A NCAC 21A .0605 MONITORING THRESHOLDS AND CORRECTIVE ACTION (TRANSFERRED TO 10A NCAC 23C .0202)

 

10A NCAC 21A .0606 timeliness (TRANSFERRED TO 10A NCAC 23C .0203)

 

10A NCAC 21A .0607 local corrective action team (TRANSFERRED TO 10A NCAC 23C .0204)

 

10A NCAC 21A .0608 state corrective action team (TRANSFERRED TO 10A NCAC 23C .0205)

 

SECTION .0700 ‑ AVAILABILITY OF MANUALS

 

10A NCAC 21A .0701 AVAILABILITY OF MANUALS (TRANSFERRED TO 10A NCAC 23A .0104)