Changes to LME/MCO Enrollee Grievance and Appeals Statutes

nc-stampSB 161 – Conforming LME/MCO Grievances/Appeals

Primary Sponsors: Sen. Ralph Hise (R – Madison), Sen. Louis Pate (R – Wayne), Sen. Joyce Krawiec (R – Forsyth)

This bill would make changes to the NC LME/MCO enrollee grievances and appeals statutes in order to conform to changes in federal law. This bill would change the request for an appeal from 30 days to 60 days after the mailing date of the adverse benefit determination. This bill states the enrollee could request a contested case hearing if the enrollee has exhausted the LME/MCO process under the Code of Federal Regulation or the NC General Statute 108D -14.

This bill would also change the LME/MCO requirement to resolve an expedited appeal from three working days to 72 hours.


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