10A NCAC 22F .0504. COMPOSITION OF PEER REVIEW BOARD

(a)  The Medicaid Agency will establish five standing committees representing the various professions, which shall act as Peer Review Boards.

(1)           The Medical Peer Review Board which sits to review a particular case shall be composed of seven members of the standing committee chosen by the Director, Division of Medical Assistance or his designee.  The Peer Review Board shall designate one of the Board members as the chairman.

(2)           The Dental Peer Review Board which sits to review a particular case will be composed of three members of the standing committee and two members of the Dental District Committee from the area in which the provider practices.  The District Committee members who serve on the Board for a particular case shall be chosen by the Director, Division of Medical Assistance or his designee.

(3)           The Podiatry, Optometry, and Chiropractic Peer Review Boards which sit to review particular cases in their specialty shall be composed of three members of the Podiatry, Optometry, and Chiropractic standing committees respectively.  The three members shall be chosen by the Director, Division of Medical Assistance or his designee.

(b)  In the event that the provider appearing before the Board practices a specialty or subspecialty not represented on the Board, the Board shall refer for advice or consultation to those Medicaid Agency on‑call consultants representing that specialty or subspecialty.

(c)  The Boards must have a majority of voting members present to proceed with a review.

 

History Note:        Authority G.S. 108A‑25(b); 150B‑11; 42 C.F.R. Part 455; 42 C.F.R. Part 456;

Eff. April 15, 1977;

Readopted Eff. October 31, 1977;

Amended Eff. May 1, 1990; January 1, 1987; January 1, 1986; May 1, 1984.