North Carolina General Statutes
Chapter 108D - Medicaid and NC Health Choice Managed Care Programs

Article 1 - General Provisions.

§ 108D-1 - Definitions. - 108D-1. Definitions. The following definitions apply in this Chapter: (1)...

§ 108D-2 - (Effective until contingency met see note) Scope; applicability of this Chapter. - 108D-2. Scope; applicability of this Chapter. This Chapter applies to...

§ 108D-3 - Conflicts; severability. - 108D-3. Conflicts; severability. (a) To the extent that this Chapter...

Article 1A - Disenrollment from Prepaid Health Plans.

§ 108D-5.1 - (Effective until contingency met see note) General provisions. - 108D-5.1. General provisions. (a) Nothing in this Article shall be...

§ 108D-5.3 - Enrollee requests for disenrollment. - 108D-5.3. Enrollee requests for disenrollment. (a) In General. - An...

§ 108D-5.5 - PHP requests for disenrollment. - 108D-5.5. PHP requests for disenrollment. (a) In General. - A...

§ 108D-5.7 - Notices. - 108D-5.7. Notices. (a) Notices of Resolution. - For each disenrollment...

§ 108D-5.9 - Appeals of adverse disenrollment determinations. - 108D-5.9. Appeals of adverse disenrollment determinations. (a) Appeals. - An...

Article 2 - Enrollee Grievances and Appeals.

§ 108D-11 - Managed care entity grievance and appeal procedures, generally. - 108D-11. Managed care entity grievance and appeal procedures, generally. (a)...

§ 108D-12 - Managed care entity grievances. - 108D-12. Managed care entity grievances. (a) Filing of Grievance. -...

§ 108D-13 - Standard managed care entity level appeals. - 108D-13. Standard managed care entity level appeals. (a) Notice of...

§ 108D-14 - Expedited managed care entity level appeals. - 108D-14. Expedited managed care entity level appeals. (a) Request for...

§ 108D-15 - Contested case hearings on disputed adverse benefit determinations. - 108D-15. Contested case hearings on disputed adverse benefit determinations. (a)...

§ 108D-15.1 - Expedited 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. - 108D-16. Notice of final decision and right to seek judicial...

Article 3 - Managed Care Entity Provider Networks.

§ 108D-21 - LME/MCO provider networks. - 108D-21. LME/MCO provider networks. Each LME/MCO operating the combined 1915(b)...

§ 108D-22 - PHP provider networks. - 108D-22. PHP provider networks. (a) Except as provided in G.S....

§ 108D-23 - BH IDD tailored plan networks. - 108D-23. BH IDD tailored plan networks. Entities operating BH IDD...

Article 4 - Prepaid Health Plans.

§ 108D-30 - (Effective until contingency met see note) Intent and Goals. - 108D-30. Intent and Goals. It is the intent of the...

§ 108D-35 - (Effective until contingency met see note) Services covered by PHPs. - 108D-35. Services covered by PHPs. Capitated PHP contracts shall cover...

§ 108D-40 - (Effective until contingency met see note) Populations covered by PHPs. - 108D-40. Populations covered by PHPs. (a) Capitated PHP contracts shall...

§ 108D-45 - (Effective until contingency met see note) Number and nature of capitated PHP contracts. - 108D-45. Number and nature of capitated PHP contracts. The number...

§ 108D-50 - Defined measures and goals. - 108D-50. Defined measures and goals. The new delivery system and...

§ 108D-55 - Administrative functions. - 108D-55. Administrative functions. PHPs shall be responsible for all administrative...

§ 108D-60 - BH IDD tailored plans. - 108D-60. BH IDD tailored plans. (a) BH IDD tailored plans...

§ 108D-65 - (Effective until contingency met see note) Role of the Department. - 108D-65. Role of the Department. The role and responsibility of...

§ 108D-70 - Advanced Medical Homes. - 108D-70. Advanced Medical Homes. PHPs shall be required to implement...