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 work days after the notice is mailed or delivered, except that it may be effective immediately when:

(1) Modification is beneficial to the client; or

(2) Federal regulations at 42 C.F.R. 431.213 are adopted by reference pursuant to G.S. 150B‑14(c).

 

History Note: Authority G.S. 108A‑54; 108A‑79; 150B‑14(c); 42 C.F.R. 431.211; 42 C.F.R. 431.213;

Eff. September 1, 1984;

Amended Eff. August 1, 1990.

 

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

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

(b) A state appeal hearing may be delayed when there is good cause. The postponement may not exceed 30 calendar days.

(c) Good cause exists when:

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

(2) The appellant or someone in his 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 work day notice expires;

(6) The appellant is unable to obtain transportation;

(7) The hearing officer determines that the hearing should be delayed for other circumstances satisfactory to the hearing officer.

 

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

Eff. September 1, 1984;

Amended Eff. August 1, 1990.

 

10A NCAC 21A .0303 APPEAL DECISION

(a) The hearing officer shall make a tentative decision which shall be served upon the county department and the appellant by mail. Decisions proposing to reverse the county department's action shall be sent by certified mail to the county department while decisions affirming the county department's actions will be sent by certified mail to the appellant.

(b) The county and the appellant may present oral and written argument, for and against the decision. Written argument may be submitted to or contact made with the Chief Hearing officer to request a hearing for oral argument.

(c) If the Chief Hearing Officer is not contacted within 10 calendar days of the date the notice of the tentative decision is signed, the tentative decision shall become final.

(d) If the party that requested oral argument fails to appear at the hearing for oral argument, the tentative decision becomes final.

(e) If oral and written arguments are presented, such arguments shall be considered and a final decision shall be rendered.

(f) The final decision shall be mailed to the appellant any the county by certified mail.

(g) A decision upholding the appellant shall be put into effect within two weeks after receipt of the final decision.

(h) As provided for in 42 C.F.R. 431.245, the decision shall contain the appellant's right to request a State agency hearing and seek judicial review to the extent that either is available to him.

 

History Note: Authority G.S. 108A‑54; 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.

 

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)