North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 27 - MENTAL HEALTH, COMMUNITY FACILITIES AND SERVICES › Subchapter G - RULES FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES, AND SUBSTANCE ABUSE FACILITIES AND SERVICES › Section .0800 - WAIVERS AND APPEALS › Section 27G .0810 - STATE MH/DD/SA APPEALS PANEL ADMINISTRATIVE REVIEW PROCEDURES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Appellants, as identified in
				  G.S.
				  122C-151.4(c), shall file
				  written notice of appeal of the final decision of the Local Management Entity
				  (LME), with the Director of the Division of Mental Health, Developmental
				  Disabilities and Substance Abuse Services (Division) within 15 calendar days of
				  the date of the final LME decision.
(b) "File or Filing" means personal delivery,
				  delivery by certified mail, or delivery by overnight express mail to the
				  current Director of the North Carolina Division of Mental Health, Developmental
				  Disabilities and Substance Abuse Services. A document or paper is deemed filed
				  as of the date it is delivered to the Director. Filings addressed to a person
				  other than the Division Director, or which fail to be filed within the time
				  periods established by this Rule, or which otherwise fail to be filed in
				  conformity with the rules in this Section shall be considered as improper
				  filings and denied.
(c) The
				  Division Director shall notify the LME that an appeal has been filed. Upon
				  notification of the appeal filed pursuant to
				  G.S.
				  122C-151.4(c)(1), (c)(2) and
				  (c)(3), an LME shall forward a copy of its
				  final decision, the signed contract between the LME and the contractor or
				  former contractor, where applicable a copy of the endorsement application, and
				  all supplementary documentation considered during the local appeals process, to
				  the Division Director, with a copy to the appellant, within five business days
				  of the date of the notification.
(d) Upon notification of the appeal filed
				  under G.S. 122C-151.4(c)(4) and
				  (5), an LME shall forward notification of its
				  final decision and all supplementary documentation considered during the local
				  appeals process to the Division Director, with a copy to the appellant, within
				  five business days of the date of the notification.
(e) The Division Director shall appoint an
				  impartial Panel, consisting of a Chairman, an LME representative and a provider
				  representative, and shall forward all information to the Chairman of the Panel
				  within 10 business days of receipt of the appeal record from the appellant and
				  LME.
(f) The Panel shall deliberate
				  in open session on each specific item being appealed; however, the panel may
				  deliberate in closed session to prevent the disclosure of confidential
				  information, pursuant to
				  G.S.
				  143-318.11(a)(1).
(g) The Panel shall vote on each specific
				  item being appealed.
(h) Findings
				  and decisions of the Panel shall be by majority vote.
(i) The Panel may obtain any form of
				  technical assistance or consultation relevant to the appeal in conducting the
				  administrative review.
(j) The
				  Panel shall complete an administrative review and notify the appealing party
				  and the LME of its decision, in writing, within 20 business days of the Panel's
				  receipt of the appeal record.
(k)
				  Any decision may be delayed until a subsequent meeting if the Panel determines
				  that it lacks sufficient information to render a decision at the initial
				  administrative review.
(l) In all
				  cases the administrative review decision shall be distributed within 10
				  business days of the decision being rendered.
(m) The appellant or the LME may appeal the
				  administrative review decision by requesting an informal hearing before the
				  Panel by submitting a written request to the Chairman of the Panel within 15
				  business days of the date of the administrative review decision.
(n) Unless the appellant or the LME requests
				  a hearing before the Panel within 15 business days of the date of the
				  administrative review decision, the administrative review decision shall be
				  considered final.
(o) This Rule
				  does not apply to contracts for personal services provided by a professional
				  individual which include those of a doctor, dentist, attorney, architect,
				  professional engineer, scientist or performer of the fine arts or similar
				  professionals, or consultative service on a temporary or occasional
				  basis.
Authority
					 G.S.
					 122C-151.4;
Eff. May 1,
					 1996;
Amended Eff. December 1, 2009;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. July 20,
					 2019.