H382 Summary

• Creates a two-level review process for North Carolina Health Choice Program recipients to appeal delays, denials, reductions, suspensions, or terminations of health services, including determinations about type or level of services.

• First-level internal review must be completed within 30 days by the Clinical Medical Director of the Division of Medical Assistance, with expedited review available within 72 hours if health is seriously jeopardized.

• Second-level external review conducted by Department of Health and Human Services Hearing Office within 90 calendar days (or 72 hours for expedited cases plus up to 14-day extension), with recipients permitted to represent themselves and present evidence.

• Continues existing review process for enrollment and eligibility decisions under G.S. 108A-79, with recipients remaining enrolled during termination or suspension appeals.

• Exempts health services review determinations from contested case provisions of the Administrative Procedure Act and becomes effective July 1, 2010.