NC H320

Establishes Chapter 108D of North Carolina General Statutes to set standards for Medicaid managed care of behavioral health services operated by Local Management Entities/Managed Care Organizations (LME/MCOs) under federal 1915(b)/(c) waivers.

Requires LME/MCOs to establish grievance and appeal procedures complying with federal law (42 C.F.R. Part 438) that protect enrollee due process rights, including protection against punitive action against providers who file grievances or appeals.

Creates three-tier appeal process: internal LME/MCO grievances (90-day resolution), standard LME/MCO level appeals (45-day resolution), and expedited appeals (3-day resolution), with continuation of benefits during appeals as required by federal law.

Establishes contested case hearing procedures before the Office of Administrative Hearings for enrollees disputing managed care action denials, with hearings scheduled within 55 days and simplified procedures allowing telephonic/video hearings and mandatory mediation.

Exempts LME/MCOs and their enrollees from existing provider dispute resolution procedures under G.S. 108C-1 and G.S. 122C-151; effective July 1, 2013.