10A NCAC 22H .0102. REQUESTS FOR FORMAL AND INFORMAL APPEALS

There are two levels of appeals that may be utilized when the recipient/applicant or his/her representative is dissatisfied with a decision concerning level of care or denial, suspension, reduction, or termination of service, or prior approval.  These levels are informal and formal appeals.

(1)           Informal.  The recipient/applicant or his/her representative may request an informal Reconsideration Review by the Division of Medical Assistance (DMA) Hearing Unit.

(2)           Formal.  Formal appeals are conducted by the Office of Administrative Hearings (OAH) under G.S. 150B, and the rules promulgated by the Office of Administrative Hearings.

 

History Note:        Authority G.S. 108A‑25(b); 42 C.F.R. 431; 42 C.F.R. 456;

Eff. April 13, 1979;

Amended Eff. December 1, 1995; May 1, 1990; November 1, 1983; October 4, 1979.

Note

Editor's Note:   Thomas R. West, Administrative Law Judge with the Office of Administrative Hearings, declared Rule 10 NCAC 26I .0102 (codified as 10A NCAC 22H .0102 effective July 1, 2003) void as applied in Linda Allred, Petitioner v. North Carolina Department of Human Resources, Division of Medical Assistance, Respondent (90 DHR 0940).