10A NCAC 22H .0104       PAYMENT PENDING APPEALS

(a)  If no informal appeal is requested, payment shall continue for the existing level of care or approved service(s) rendered until the required change (action) date stated in the notification or until the recipient moves from that level of care or discontinues approved service(s), whichever comes first.

(b)  If an informal appeal is requested in accordance with Rule .0103 of this Section, Medicaid payment for that level of care or approved service(s) shall continue until the informal appeal process is completed.

(c)  If a formal appeal is requested in accordance with Rule .0102(b) of this Section, Medicaid payment for that level of care or approved service(s) shall continue until the formal appeal process is completed.

(d)  If the formal appeal decision upholds the original decision by DMA, MR/IPR, PAU, other State Agency or entity, DMA may institute recovery procedures against the applicant or recipient to recoup the cost of any services furnished resulting from the formal appeal process.

 

History Note:        Authority G.S. 108A‑25(b); 42 C.F.R. 431;

Eff. April 13, 1979;

Amended Eff. December 1, 1995; October 4, 1979.