North Carolina § 108D-12 - Managed care entity grievances.

§ 108D-12. Managed care entity grievances.

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. 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). Right to Appeal. - There is no right to appeal the resolution of a grievance to OAH or any other forum. History (2013-397, s. 1; 2019-81, s. 1(a).) Editor's Note. - This section was enacted as G.S. 108D-5. It has been renumbered as G.S. 108D-12 at the direction of the Revisor of Statutes. Session Laws 2019-81, s. 1(b), provides: "This section is effective October 1, 2019, and applies to (i) appeals arising from local management entity/managed care organization (LME/MCO) notices of adverse benefit determination mailed on or after that date and (ii) grievances received by an LME/MCO on or after that date." Effect of Amendments. - Session Laws 2019-81, s. 1(a), rewrote the section. For effective date and applicability, see Editor's note.