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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Administrative Hearings and Appeals

Lavette Young
Telephone 919-814-0090
Fax 919-814-0032

The DHHS Hearing Office conducts impartial informal appeals (reconsideration reviews) regarding adverse determinations made by the Division of Medical Assistance or one of its agents or contractors (e.g., recoupment amounts accessed after post-payment reviews or Medicaid provider denial or enrollment termination).  This office also hears appeals by long-term care residents who are being transferred or discharged from an adult care home or skilled nursing facility and for individuals who appeal a Preadmission and Resident Review (PASRR) determination.  The DHHS Hearing Office also has the authority to conduct external second level reviews for Health Choice recipients who have a denial, reduction, suspension or termination of health services.

Under 10A NCAC 22H.0200, the DHHS Hearing Office conducts formal hearings for residents appealing a notice of discharge from a Skilled Nursing Facility.

Under Session Law 2011-272 and10A NCAC 13F.0702, the DHHS Hearing Office conducts formal hearings for residents appealing a notice of discharge from an Adult Care Home.

Under 10A NCAC 22H.0300, the DHHS Hearing Office conducts formal hearings for adverse PASRR determinations.  PASRR is a federally mandated program for screening applicants and residents of Medicaid certified nursing facilities to assure that individuals with serious mental illness (SMI), mental retardation (MR), and/or conditions related to mental retardation (RC) entering or residing in Medicaid-certified nursing facilities receive appropriate placement and services.  

Requests for the continuance of a hearing will be granted at the discretion of the Hearing Officer if good cause is shown. Good cause is defined as circumstances beyond the control of the party requesting the continuance.

Hearing continuance requests must be made in writing and must be received by the Hearing Officer assigned to the case at least five (5) days prior to the scheduled hearing date. No continuances will be granted after that time except for extraordinary circumstances as determined by the Hearing Officer if good cause is shown. Parties should notify the opposing party when requesting a continuance.

Examples of good cause include but are not limited to:

  • Death or illness of a party, representative or attorney
  • Lack of proper notice of the hearing
  • Parties have agreed to enter into settlement negotiations and both sides request a continuance to pursue settlement
  • Attorney has a scheduling conflict with another court appearance that takes precedence
  • Party obtained legal counsel subsequent to filing the appeal and the attorney needs additional time to prepare for hearing

 

June 8, 2012