10A NCAC 22F .0505. NOTICE OF PEER REVIEW

Once it has been determined that a case will be referred to a Peer Review Board or when a decision of the Division has been referred for reconsideration to a Peer Review Board, the following procedures must be followed to provide notice to all parties:

(1)           The Director, Division of Medical Assistance or his designee shall notify the provider that certain aspects of his practice will be referred to the Peer Review Board and that he has the right to appear before the Board to present evidence and argument concerning these matters.

(2)           The Notice of Peer Review will be sent at least thirty days prior to the scheduled date of the peer review, which notice shall include:

(a)           a statement of the date, time, and place of the peer review;

(b)           a statement of the following:

(i)            the patients whose cases may be considered;

(ii)           the investigative findings and allegations to be considered;

(iii)          the possible remedial measures to be considered;

(iv)          the policy statements and/or guidelines relied upon by the Division;

(v)           the Peer Review Board members who will sit at the review; and

(vi)          the name, address, and telephone number of a person whom the provider can contact to obtain further information.

(3)           Notice of Peer Review shall be given by certified mail.

(4)           The notification shall advise the provider that he may request an investigative conference to be held prior to the Peer Review.

 

History Note:        Authority G.S. 108A‑25(b); 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, 1984.