108D-12. Managed care entity grievances.
(a) Filing of Grievance. - An enrollee, or the enrollee's authorized representative, has the right to file a grievance with a managed care entity at any time to express dissatisfaction about any matter other than an adverse benefit determination. Upon receipt of a grievance, a managed care entity shall cause a written acknowledgment of receipt of the grievance to be sent by mail.
(b) Notice of Grievance Disposition. - The managed care entity shall resolve the grievance and cause a notice of grievance resolution to be sent by mail to the enrollee and all other affected parties as expeditiously as the enrollee's health condition requires, but no later than 30 days after receipt of the grievance, provided that the managed care entity may extend such time frame to the extent permitted under 42 C.F.R. 438.408(c).
(c) Right to Appeal. - There is no right to appeal the resolution of a grievance to OAH or any other forum. (2013-397, s. 1; 2019-81, s. 1(a).)
Structure North Carolina General Statutes
North Carolina General Statutes
Chapter 108D - Medicaid and NC Health Choice Managed Care Programs
Article 2 - Enrollee Grievances and Appeals.
§ 108D-11 - Managed care entity grievance and appeal procedures, generally.
§ 108D-12 - Managed care entity grievances.
§ 108D-13 - Standard managed care entity level appeals.
§ 108D-14 - Expedited managed care entity level appeals.
§ 108D-15 - Contested case hearings on disputed adverse benefit determinations.
§ 108D-15.1 - Expedited contested case hearings on disputed adverse benefit determinations.
§ 108D-16 - Notice of final decision and right to seek judicial review.