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Lavette Young
Phone: 919-647- 8200
Fax: 919-715- 6394
Under 10A NCAC 22F.0400, the Department of Health and Human Services (DHHS) Hearing Office conducts informal reconsideration reviews for Medicaid providers (e.g., hospitals, physicians, pharmacies, home health agencies, etc.) appealing recoupments assessed by DMA's Program Integrity Section based upon post-payment reviews.
Under 10A NCAC 22H.0200, the DHHS Hearing Office conducts more formal hearings for residents appealing a notice of discharge from a Skilled Nursing Facility.
Under 10A NCAC 13F.0702, the DHHS Hearing Office conducts more formal hearings for residents appealing a notice of discharge from an Adult Care Home.
Under N.C. Session Law 2008-107, Section 10.15A(e1)-(f), the DHHS Hearing Office conducts evidentiary hearings on a temporary basis (through July 1, 2010) for Community Support providers appealing an adverse decision made by the Department to recoup reimbursment for Community Support Services or appealing withdrawal or denial of endorsement to provide Community Support Services by a Local Management Entity. Appeals under the Session Law can be made by filing a petition with the Chief Hearings Clerk within 30 days of the mailing of the adverse notice.
Per N.C. Session Law 2008-107, Section 10.15A(h1), the DHHS Hearing Office no longer conducts informal appeals for Medicaid recipients dissatisfied with a decision of the Department regarding Medicaid covered medical services. The Office of Administrative Hearing (OAH) now handles these appeals.
