North Carolina § 108D-5 - 9. Appeals of adverse disenrollment determinations.

§ 108D-5. 9. Appeals of adverse disenrollment determinations.

Appeals. - An enrollee, or the enrollee's authorized representative, who is dissatisfied with an adverse disenrollment determination may request a hearing to appeal the determination by filing the appeal request form provided under G.S. 108D-5.7(a) with the Office of Administrative Hearings within 30 calendar days of the date on the notice of resolution. 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. A request for a hearing to appeal an adverse disenrollment determination of the Department under this section is a contested case subject to the provisions of Article 3 of Chapter 150B of the General Statutes. The appeal shall be conducted in accordance with the procedures in Part 6A of Article 2 of Chapter 108A of the General Statutes. Parties. - The Department shall be the respondent for purposes of appeals under this section. History (2019-81, s. 1(a); 2021-62, s. 2.1(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 subsection (a) of this section by Session Laws 2021-62, s. 2.1(e), 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. Effect of Amendments. - Session Laws 2021-62, s. 2.1(e), rewrote subsection (a). For effective date and applicability, see editor's note. §§ 108D-6 through 108D-10: Reserved for future codification purposes.