North Carolina § 108D-5 - 7. Notices.

§ 108D-5. 7. Notices.

Notices of Resolution. - For each disenrollment request by an enrollee or a PHP, the Department shall issue a written notice of resolution approving or denying the request by mail to the enrollee before the first day of the second month following the month in which the enrollee or PHP requested disenrollment. For expedited enrollee requests for disenrollment made under G.S. 108D-5.3(d), the Department shall issue the written notice of resolution approving or denying the expedited request within three calendar days of receipt of the request. In the same mailing as the notice, the Department shall also provide the enrollee with an appeal request form that includes all of the following: A statement that, in order to request an appeal, the enrollee must file the form with OAH no later than 30 days after the mailing date of the notice of resolution, and the form may be filed by either (i) sending the form by mail or fax to the address or fax number listed on the form or (ii) calling the telephone number on the form and providing the information requested on the form. The enrollee's name, address, telephone number, and Medicaid or NC Health Choice identification number. A preprinted statement that indicates that the enrollee would like to appeal the specific adverse disenrollment determination identified in the notice of resolution. A statement informing the enrollee of the right to be represented at the contested case hearing by a lawyer, a relative, a friend, or other spokesperson. A space for the enrollee's signature and date. Notices Pertaining to Expedited Enrollee Requests for Disenrollment. - If the Department determines that an enrollee's request for disenrollment does not meet the criteria for an expedited request, the Department shall do the following: No later than three calendar days after receiving the enrollee's request for disenrollment, make reasonable efforts to give the enrollee and all other affected parties oral notice of the denial and follow up with a written notice of the denial. The denial is not appealable. Issue the notice of resolution within the time limits established for standard disenrollment requests under subsection (a) of this section. History (2019-81, s. 1(a); 2021-62, ss. 2.1(d), 2.2(e).) Editor's Note. - 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." Session Laws 2021-62, s. 2.1(i), made the rewriting of subdivision (a)(1) of this section by Session Laws 2021-62, s. 2.1(d), effective June 29, 2021, and applicable to (i) appeal request forms under G.S. 108A-70.9A(e), 108D-5.7(a), and 108D-15(f) issued on or after that date and (ii) appeals requested on or after that date. Session Laws 2021-62, s. 2.2(j), made the substitution of "denial" for "determination by mail" at the end of the first sentence, and the addition of the second sentence in subdivision (b)(1) by Session Laws 2021-62, s. 2.2(e), effective June 29, 2021, and applicable to (i) notices of action under G.S. 108A-79(c) and appeal request forms under G.S. 108A-70.9A(e) and G.S. 108D-15(f) issued on or after that date and (ii) requests to expedite an appeal made on or after that date. Effect of Amendments. - Session Laws 2021-62, s. 2.1(d), rewrote subdivision (a)(1). For effective date and applicability, see editor's note. Session Laws 2021-62, s. 2.2(e), in subdivision (b)(1), substituted "denial" for "determination by mail" at the end of the first sentence, and added the second sentence. For effective date and applicability, see editor's note.