108D-1. Definitions. The following definitions apply in this Chapter: (1) Adverse benefit determination. – As defined in 42 C.F.R. 438.400(b). In accordance with 42 C.F.R. 457.1260, this definition applies to NC Health Choice beneficiaries in the same manner as it applies to Medicaid beneficiaries. (2) Adverse disenrollment determination. – A determination by the Department of […]
108D-2. Scope; applicability of this Chapter. This Chapter applies to every managed care entity, applicant, enrollee, provider of emergency services, and network provider of a managed care entity. This Chapter does not apply to Medicaid or NC Health Choice services delivered through the fee-for-service program. Nothing in this Chapter shall be construed to grant a […]
108D-3. Conflicts; severability. (a) To the extent that this Chapter conflicts with the Social Security Act or 42 C.F.R. Parts 438 and 457, federal law prevails, except when the applicability of federal law or rules have been waived by agreement between the State and the U.S. Department of Health and Human Services. (b) To the […]
