Section .0100 ‑ Application Process

Link to law: http://reports.oah.state.nc.us/ncac/title 10a - health and human services/chapter 23 - medical assistance administration/subchapter c/subchapter c rules.html
Published: 2015

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subchapter 23c – application for medicaid benefits

 

SECTION .0100 ‑ APPLICATION PROCESS

 

10A NCAC 23c .0101       ACCEPTANCE OF APPLICATION

(a)  A client shall be allowed to apply without delay. 

Without delay is the same day the client appears at the county department of

social services expressing a financial or medical need.

(b)  The county department of social services shall not act

to discourage any individual from applying for Medicaid.  It shall be

considered discouragement if any employee of the county department of social

services:

(1)           requires or suggests the individual wait to

apply until he applies for other benefits or until an application for other

benefits has been approved or denied; or

(2)           incorrectly states or suggests the

individual is ineligible for Medicaid; or

(3)           gives incorrect or incomplete information

about Medicaid programs; or

(4)           requires the individual provide or obtain

any information needed to establish eligibility prior to signing an

application; or

(5)           discourages a client from applying and this

is proven by facts to the satisfaction of the county agency or a hearing

officer; or

(6)           suggests that the individual make an

appointment to apply when he appears at the agency; or

(7)           suggests that the individual complete a

mail-in application when he appears at the agency; or

(8)           fails to explain the date of application

when he appears at the agency and requests a mail-in application; or

(9)           fails to explain and offer Medicaid to

individuals requesting Work First Employment Services.

(c)  The client shall be informed verbally and in writing,

that:

(1)           he can apply without delay;

(2)           a decision shall be made concerning his

eligibility within 45 calendar days from the date of application for Medicaid,

except for M-AD.  For M-AD the application processing standard shall be 90

calendar days from the date of application; and

(3)           he shall receive a written decision

concerning his eligibility.

(d)  The client shall apply in his county of residence.

(e)  The date of the application shall be:

(1)           The date the client or his representative

signs the state application form for Medicaid, including Work First, under

penalty of perjury at the county department of social services; or

(2)           The date a signed complete state mail-in

application form is received by the county department of social services in the

county of residence.  Complete is defined as information that is legible,

signed, submitted to correct county of residence, and has identifying

information for the person applying, including name, mailing address, date of

birth and gender.

(f)  If an individual requests assistance by mail, the

letter shall be considered a request for information.  Within three workdays

following receipt of the request, the county agency shall mail follow-up

information to the individual.  The county agency shall advise the individual

to come to the agency to apply and be interviewed, or if he is unable to come

in person, to contact the agency so other arrangements can be made to take his

application.

(g)  If an individual requests assistance by telephone, he

shall be advised to come to the county agency to sign an application and be

interviewed; or, if he is unable to come to the agency in person other

arrangements shall be made to take his application.

(h)  If an individual sends in a complete state mail-in

application form, the county department of social services shall use this

application to determine eligibility for Medicaid.  A mail-in application form

may be picked up at a local county department of social services or other

locations as determined by the State and county.

(i)  An individual or his representative must request a

determination for retroactive SSI Medicaid no later than 60 days from the date

of the SSI Medicaid disposition notice or 90 days if good cause is established. 

Good cause exists when:

(1)           the applicant does not receive the SSI

Medicaid notice;

(2)           the applicant or his representative dies;

(3)           the applicant is incapacitated,

incompetent, or unconscious and there is no representative acting on his behalf;

(4)           the applicant or spouse, child, parent, or

representative of applicant is hospitalized for an extended period of time; or

(5)           the applicant's representative fails to

meet the required time frame.

 

History Note:        Authority G.S. 108A-54; 42 C.F.R. 435.906;

42 C.F.R. 435.907; 42 C.F.R. 435.911; Alexander v. Flaherty, U.S.D.C.,

W.D.N.C., File No. C-C-74-183, Consent Order filed 15 December 1989; Alexander

v. Flaherty Consent Order filed February 14, 1992; Alexander v. Bruton Consent

Order dismissed Effective February 1, 2002;

Eff. September 1, 1984;

Amended Eff. January 1, 1995; April 1, 1993; August 1,

1990;

Temporary Amendment Eff. March 1, 2003;

Amended Eff. August 1, 2004;

Transferred from 10A NCAC 21B .0201 Eff. May 1, 2012.

10A NCAC 23c .0102       face-to-face

INTERVIEW

(a)  The county department of social services shall conduct a

face-to-face interview with the client or his representative who appears at the

agency requesting financial or medical assistance.  The client may have any

person or persons of his choice participate in the interview.  During the

interview, the Income Maintenance Caseworker shall explain the application

process, the client's rights and responsibilities, the programs of public assistance

and the eligibility conditions.

(b)  The applicant shall be advised of his right to apply in

more than one program category for which he qualifies and the advantages and

disadvantages of the choices shall be explained.

(c)  The client shall be informed of the following:

(1)           The client shall be told what information

that he is required to provide, and what third party sources the agency shall

contact to check the information.  Third party sources are entities, other than

the client, that can provide verification of information to determine

eligibility.

(2)           The client has the right to:

(A)          Receive assistance if found eligible;

(B)          Be protected against discrimination on the grounds

of race, creed, or national origin by Title VI of the Civil Rights Act of 1964. 

He may appeal such discrimination;

(C)          Have any information given to the agency kept in

confidence;

(D)          Appeal, if he believes the agency's action to deny,

change, or terminate assistance is incorrect, or his request is not acted on

with reasonable promptness;

(E)           Reapply at any time, if found ineligible;

(F)           Withdraw from the program at any time;

(G)          Request the agency's help in obtaining third party

information that he is responsible to provide;

(H)          Be informed of all information he must provide and all

alternative sources for obtaining the information.

(3)           The client shall:

(A)          Provide the county department, state and federal

officials, the necessary sources from which to locate and obtain information

needed to determine eligibility;

(B)          Report to the county department of social services

any change in situation that may affect eligibility within 10 calendar days

after it happens.  The Income Maintenance Caseworker shall explain the meaning

of fraud and shall inform the applicant that he may be suspected of fraud if he

fails to report a change in situation and that in such situations, he may have

to repay assistance received in error and that he may also be tried by the

courts for fraud;

(C)          Inform the county department of social services of

any persons or organization against whom he has a right to recover medical

expenses.  When he accepts medical assistance, the applicant shall assign his

rights to third party insurance benefits to the state.  The Income Maintenance

Caseworker shall inform the applicant that it is a misdemeanor to fail to

disclose the identity of any person or organization against whom he has a right

to recover medical expenses;

(D)          Immediately report to the county department the

receipt of an I.D. card that he knows to be erroneous.  If he does not report

such and uses the I.D. card, he shall repay any medical expenses paid in error.

 

History Note:        Authority G.S. 108A-25(b); 108A-57; 42

C.F.R. 435.908; Alexander v. Flaherty, U.S.D.C., W.D.N.C., File No. C-C-74-183,

Consent Order Filed 15 December 1989; Alexander v. Flaherty Consent Order filed

February 14, 1992; Alexander v. Bruton Consent Order dismissed Effective

February 1, 2002;

Eff. September 1, 1984;

Amended Eff. April 1, 1993; August 1, 1990; March 1,

1986;

Temporary Amendment Eff. August 22, 1996;

Amended Eff. August 1, 1998;

Temporary Amendment Eff. March 1, 2003;

Amended Eff. August 1, 2004;

Transferred from 10A NCAC 21B .0202 Eff. May 1, 2012.

 

10A NCAC 23C .0103       RECOMMENDATION FOR DISPOSITION

(a)  When all information necessary to determine eligibility

has been obtained, the Income Maintenance Caseworker shall recommend whether to

approve or to deny assistance.  The recommendation shall be based on all

reliable, relevant information.

(b)  The authority to approve or deny assistance rests with

the county board of social services.  The county board may, by appropriate

resolution recorded in the board minutes, delegate to the county director of

social services the authority to process applications, to determine

eligibility, or to terminate assistance.

 

History Note:        Authority G.S. 108A-54; 42 C.F.R.

435.913;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Transferred from 10A NCAC 21B .0205 Eff. May 1, 2012.

 

10A NCAC 23c .0104       DISPOSITION

(a)  Disposition of the application shall complete the

application process and shall consist of one of the following actions:

(1)           Approval of assistance;

(2)           Denial of assistance;

(3)           Denial of assistance for ineligible month

or months of the certification period and approval for eligible month or months

of the certification period; or

(4)           Voluntary withdrawal of the application by

the client.  The Income Maintenance Caseworker shall not suggest to the client

that he withdraw his application and shall explain alternatives to withdrawal. 

The Income Maintenance Caseworker shall explain the client's right to reapply

at anytime.

(b)  The county department of social services shall not deny

an application prior to 45 days, or for M-AD, 90 days, except when:

(1)           It is established the applicant will not be

able to meet the deductible;

(2)           The applicant cannot be located; or

(3)           The applicant refuses to cooperate or

provide information to establish eligibility;

 

History Note:        Authority G.S. 108A-54; 42 C.F.R.

435.912; 42 C.F.R. 435.913; Alexander v. Flaherty, U.S.D.C., W.D.N.C., File No.

C-C-74-183, Consent Order filed 15 December 1989; Alexander v. Bruton Consent

Order dismissed Effective February 1, 2002;

Eff. September 1, 1984;

Amended Eff. April 1, 1993; August 1, 1990;

Temporary Amendment Eff. March 1, 2003;

Amended Eff. August 1, 2004;

Transferred from 10A NCAC 21B .0206 Eff. May 1, 2012.

 

10A NCAC 23C .0105       REFERRALS at a face-to-face interview

For all Medicaid applicants who have a face-to-face

interview at the county department of social services, the Income Maintenance

Caseworker shall explain and make referrals for:

(1)           Health Check;

(2)           Family planning services;

(3)           Food stamps;

(4)           Governmental benefits including RSDI, SSI, VA;

(5)           Women, Infants and Children Program (WIC);

(6)           Carolina ACCESS;

(7)           Medicaid Transportation;

(8)           Life Line/Link-up;

(9)           Health Insurance Premium Payment program; and

(10)         Voter Registration.

 

History Note:        Authority G.S. 108A-54; 42 C.F.R. 441.56;

42 U.S.C. 1396a(a); Alexander v. Bruton Consent Order dismissed Effective

February 1, 2002;

Eff. September 1, 1984;

Amended Eff. January 1, 1995; August 1, 1990;

Temporary Amendment Eff. March 1, 2003;

Amended Eff. August 1, 2004;

Transferred from 10A NCAC 21B .0207 Eff. May 1, 2012.

 

10A NCAC 23C .0106       MANDATORY USE OF OUTREACH LOCATIONS

The county department of social services shall provide for

the acceptance of applications and initial interviews for M-PW and M-IC

coverage groups at certain outreach locations as follows:

(1)           disproportionate share acute care hospitals which

serve the coverage groups listed; and

(2)           Medicaid enrolled federally qualified health

centers.

 

History Note:        Filed as a Temporary Adoption Eff. July

1, 1991, for a period of 180 days to expire

on December 31, 1991;

Authority G.S. 108A-43; 108A-54; P.L. 101-508;

Eff. January 1, 1992;

Transferred from 10A NCAC 21B .0208 Eff. May 1, 2012.

 

10A NCAC 23C .0107       hours for accepting financial and

medical assistance applications

The county department of social services must maintain the

same number of operating hours as in February of 2002. Provisions must be made

for acceptance of financial and medical assistance applications if the agency

elects to close for lunch or for other reasons during the week.

 

History Note:        Authority G.S. 108A-54; Alexander v.

Bruton Consent Order dismissed Effective February 1, 2002;

Temporary Adoption Eff. March 1, 2003;

Eff. August 1, 2004;

Transferred from 10A NCAC 21B .0209 Eff. May 1, 2012.

 

section .0200 – application processing, monitoring and

corrective action

 

10A NCAC 23C .0201       APPLICATION PROCESSING STANDARDS

(a)  The county department of social services shall comply

with the following standards in processing applications:

(1)           A decision on an individual's eligibility

for Medicaid shall be made within 45 calendar days from the date of application

for Medicaid except for applications in which a disability determination has

already been made or is needed.  For those applications, a decision on an

individual's eligibility shall be made within 90 days from the date of

application.  These timeframes shall apply in accordance with 42 CFR 435.911.

(2)           Only require information or verification

necessary to establish eligibility for assistance;

(3)           Make at least two requests for all

necessary information from the applicant or third party;

(4)           Allow at least 12 calendar days between the

initial request and a follow-up request and at least 12 calendar days between

the follow-up request and denial of the application;

(5)           Inform the client in writing, and verbally

when possible, of the right to request help in obtaining information requested

from the client. The county department of social services shall not discourage

any client from requesting such help;

(6)           An application may pend up to six months

for verification that the deductible has been met or disability established.

(7)           When a hearing decision reverses the

decision of the County Department of Social Services on an application, the

application shall be reopened within five working days from the date the final

appeal decision is received by the County Department of Social Services.  If no

additional information is needed, the application must be processed within five

additional working days.  If additional information is needed pursuant to the

final decision, the county shall make such requests in accordance with rules

for all applications.  The first request for the additional information shall

be made within five working days of receipt of the final appeal decision.  The

application shall be processed within five workdays of receipt of the last

piece of required information.

(b)  The county department of social services shall obtain

verification other than the applicant's statement for the following:

(1)           Any element requiring medical

verification.  This includes verification of disability, pregnancy, incapacity,

emergency dates for aliens referenced in 10A NCAC 23E .0102(c), incompetence,

and approval of institutional care;

(2)           Proof a deductible has been met;

(3)           Legal alien status;

(4)           Proof of the rebuttal value for resources

and of the rebuttal of intent to transfer resources to become eligible for

Medicaid.  When an applicant or recipient disagrees with the determination of

the county department of social services on the value of an asset, then the

applicant/recipient must provide proof of what the value of the asset is;

(5)           Proof of designation of liquid assets for

burial;

(6)           Proof of legally binding agreement limiting

resource availability;

(7)           Proof of valid social security number or

application for a social security number;

(8)           Proof of reserve reduction when resources

exceed the allowable reserve limit for Medicaid;

(9)           Proof of earned and unearned income,

including deductions, exclusions, and operational expenses when the applicant

or Income Maintenance Caseworker has or can obtain the verification; and

(10)         Any other information for which the

applicant does not know or cannot give an estimate.

(c)  The county department of social services shall verify

or obtain an item of information when:

(1)           A fee must be paid to obtain the

verification;

(2)           It is available within the agency;

(3)           The county department of social services is

required by federal law to assist or to use interagency or intra-agency

verification aids;

(4)           The applicant requests assistance; or

(5)           The applicant is physically, mentally, or

otherwise incapable of obtaining the information, or is unable to speak English

or read and write, or is housebound, hospitalized, or institutionalized, and a

representative does not accept responsibility for obtaining the information.

 

History Note:        Authority G.S. 108A-54; 42 C.F.R.

435.911; Alexander v. Flaherty, V.S.D.C., W.D.N.C., File No. C-C-74-183,

Consent Order Filed 15 December 1989; Alexander v. Flaherty Consent Order filed

February 14, 1992; Alexander v. Bruton Consent Order dismissed Effective

February 1, 2002;

Eff. September 1, 1984;

Amended Eff. April 1, 1993; August 1, 1990;

Temporary Amendment Eff. March 1, 2003;

Amended Eff. August 1, 2004;

Transferred from 10A NCAC 21B .0203 Eff. May 1, 2012.

 

10A NCAC 23C .0202       MONITORING THRESHOLDS AND CORRECTIVE

ACTION

(a)  Division of Medical Assistance employees, known as

application monitors, shall review a random sample of applications in all

county departments of social services and the Disability Determination Section

(DDS) of the Division of Vocational Rehabilitation to determine if counties are

denying and withdrawing applications in accordance with federal/state rules. 

The application monitors shall also review inquiries where a person comes to

the agency and decides not to make an application to ensure person was given

correct information under federal/state rules.  A county and DDS must meet a

monitoring threshold of 80% in each area of denials, withdrawals and inquiries

in order to be found in compliance with federal/state rules.

(b)  If the agency falls below the 80% threshold, the agency

must analyze why it fell below 80% and implement a corrective action plan.  

(c)  The agency or DDS may dispute monitoring findings

within 10 workdays of receipt of findings.

(d)  Within 30 calendar days of the final monitoring

results, the agency must take corrective action to reopen cases the application

monitors determine were not handled pursuant to federal/state rules.

 

History Note:        Authority G.S. 108A-54; Alexander v.

Bruton, U.S.D.C., File No. C-C-74-183-M, Consent Order dismissed effective

February 1, 2002;

Temporary Adoption Eff. March 1, 2003;

Eff. August 1, 2004;

Transferred from 10A NCAC 21A .0605 Eff. May 1, 2012.

 

10A NCAC 23C .0203       timeliness

(a)  Every month, each county department of social services

and the Disability Determination Section (DDS) of the Division of Vocational

Rehabilitation shall process applications as follows:

(1)           The average processing time (APT) for the

county department of social services shall be 90 days for M-AD and 45 days for

all other aid program categories.

(2)           APT for DDS shall be 70 days.

(3)           The percentage processed timely (PPT)

standard for county departments of social services:  Level I counties must

process 85% of applications within the 45/90 day time standard.  Level II and

III counties must process 90% of applications within the 45/90 day time

standard.  Counties are classified as Levels I through III based on population

of the county with Level I counties as the smallest in population while Level

III counties are the largest in population size.

(4)           PPT standard for DDS:  DDS must render a

decision within 70 days on 85% of cases for Level I counties and 90% of cases

for Level II and III counties.  For county levels refer to the table below.



COUNTY    LEVELS







ALAMANCE (II)





CUMBERLAND (III)





JOHNSTON (II)





RANDOLPH (II)







 





 





 





 







ALEXANDER (I)





CURRITUCK (I)





JONES (I)





RICHMOND (I)







 





 





 





 







ALLEGHANY (I)





DARE (I)





LEE (I)





ROBESON (II)







 





 





 





 







ANSON (I)





DAVIDSON (II)





LENOIR (II)





ROCKINGHAM (II)







 





 





 





 







ASHE (I)





DAVIE (I)





LINCOLN (I)





ROWAN (II)







 





 





 





 







AVERY (I)





DUPLIN (II)





MACON (I)





RUTHERFORD (II)







 





 





 





 







BEAUFORT (II)





DURHAM (III)





MADISON (I)





SAMPSON (II)







 





 





 





 







BERTIE (I)





EDGECOMBE (II)





MARTIN (I)





SCOTLAND (II)







 





 





 





 







BLADEN (I)





FORSYTH (III)





MCDOWELL (I)





STANLY (I)







 





 





 





 







BRUNSWICK (II)





FRANKLIN (I)





MECKLENBURG (III)





STOKES (I)







 





 





 





 







BUNCOMBE (III)





GASTON (III)





MITCHELL (I)





SURRY (II)







 





 





 





 







BURKE (II)





GATES (I)





MONTGOMERY (I)





SWAIN (I)







 





 





 





 







CABARRUS (II)





GRAHAM (I)





MOORE (II)





TRANSYLVANIA (I)







 





 





 





 







CALDWELL (II)





GRANVILLE (I)





NASH (II)





TYRRELL (I)







 





 





 





 







CAMDEN (I)





GREENE (I)





NEW HANOVER (III)





UNION (II)







 





 





 





 







CARTERET (II)





GUILFORD (III)





NORTHAMPTON (I)





VANCE (II)







 





 





 





 







CASWELL (I)





HALIFAX (II)





ONSLOW (II)





WAKE (III)







 





 





 





 







CATAWBA (III)





HARNETT(II)





ORANGE (II)





WARREN (I)







 





 





 





 







CHATHAM (I)





HAYWOOD (II)





PAMLICO (I)





WASHINGTON (I)







 





 





 





 







CHEROKEE (I)





HENDERSON (II)





PASQUOTANK (I)





WATAUGA (I)







 





 





 





 







CHOWAN (I)





HERTFORD (I)





PENDER (I)





WAYNE (II)







 





 





 





 







CLAY (I)





HOKE (I)





PERQUIMANS (I)





WILKES (II)







 





 





 





 







CLEVELAND (II)





HYDE (I)





PERSON (I)





WILSON (II)







 





 





 





 







COLUMBUS (II)





IREDELL (II)





PITT (II)





YADKIN (I)







 





 





 





 







CRAVEN (II)





JACKSON (I)





POLK (I)





YANCEY (I)





(b)  If a county department of social services fails to meet

the standards in Paragraph (a) of this Rule, the county shall analyze the

reason for failure, document findings and work with the Medicaid Program

Representative (MPR) to achieve corrective action.  The MPR is a Division of

Medical Assistance employee.

(c)  Failure to meet the time standards in Paragraph (a) of

this Rule, monthly shall result in corrective action to alleviate problems as

outlined in Rules .0204 and .0205 of this Section.  Once eligibility is

determined except for the following requirements:

(1)           sufficient medical expenses to meet a

deductible; or

(2)           the determination of need for

institutionalization; or

(3)           the plan of care for the home and community

based waivers; or

(4)           the disability decision made by the

Disability Determination Section; or

(5)           medical records needed to determine

emergency dates for non-qualified aliens;

days shall be

excluded from the time standard of 45 or 90 days.  Days in the time standard

are again included when the items in Subparagraph (c)(1) through (5) are

received until the application is completed with a written notice to the

applicant.  When the 45/90th day falls on a weekend or holiday, the

next workday in the month is considered the 45/90th day.

 

History Note:        Authority G.S. 108A-54; Alexander v.

Bruton, U.S.D.C., File No. C-C-74-183-M, Consent Order dismissed effective

February 1, 2002;

Temporary Adoption Eff. March 1, 2003;

Adoption Eff. August 1, 2004;

Transferred from 10A NCAC 21A .0606 Eff. May 1, 2012.

 

10A NCAC 23C .0204       local corrective action team

(a)  The Assistant Director for Recipient and Provider

Services (R&PS) in the Division of Medical Assistance shall determine that

a Local Corrective Action Team is needed when the county department of social

services (DSS) is out of compliance with the monitoring or APT or PPT

processing thresholds in any category for three consecutive months, or, five

months out of any 12 consecutive months. The Local Corrective Action Team shall

include the Medicaid Program Representative and any additional state staff

identified by the Assistant Director for R&PS, the county department of

social services director and any county staff the county director designates,

the county manager or the chair of the county board of commissioners as

selected by the county director, a member of the general public as selected by

the county director, the social services board chairman or other board member

for the county as selected by the county director, and an independent

management consultant at the option and expense of the county.

(b)  A Local Corrective Action Team shall not convene when:

(1)           All failures are attributable to DDS.

(2)           It is determined by DMA Assistant Director

for Recipient and Provider Services that the reasons for non-compliance have

been or are being corrected.

(3)           Budgetary constraints decided by DMA

Assistant Director for R&PS do not allow travel for the purpose of

convening a corrective action team.  Conference calls shall be held by the DMA

Assistant Director for R&PS when travel is not allowed as determined by

State officials due to fiscal constraints.

(c)  The Local Corrective Action Team may design any remedy

reasonable and necessary to bring the DSS into compliance with application

processing requirements as in 10A NCAC 21B .0204 and this Subchapter.

(d)  The Team shall establish a corrective action plan

within 40 calendar days of notice from the Assistant Director of Recipient and

Provider Services to the county director of social services that a local

corrective action team was required, and a date for compliance with the plan

shall be set.  The corrective action plan must be submitted to the Assistant

Director for R&PS.  The county must meet the thresholds in 10A NCAC 23C

.0203(a) within three months after the date the compliance plan was required to

be established.

(e)  Failure of a county to take corrective action, or meet

compliance thresholds shall result in a referral by the Division of Medical

Assistance to a State Corrective Action Team, unless the State Corrective

Action Team grants an extension, not to exceed three months, for the county to

meet the thresholds.  In determining if an extension shall be granted, the

State Corrective Action Team shall receive a recommendation from the Division

of Medical Assistance to grant an extension based on the Division's assessment

that the county is taking action to comply with the corrective action plan. 

The State Corrective Action Team shall be formed by the Secretary for the

Department of Health and Human Services based on a request from the Division of

Medical Assistance.  The State Corrective Action Team shall consist of a representative

from the Department of Health and Human Services appointed by the Secretary, a

representative of the NC Association of County Commissioners, two

representatives from county departments of social services, excluding the

county in question, appointed by the presidents of the following associations: 

NC Social Services Association, NC Association of County Directors of Social

Services, and the NC Association of County Boards of Social Services, the

chairman of the Board of Legal Services of North Carolina or his designee, a

recipient of Medicaid appointed by the Secretary, and a representative of the

Institute of Government.

 

History Note:        Authority G.S. 108A-54; Alexander v.

Bruton, U.S.D.C., File No. C-C-74-183-M, Consent Order dismissed effective

February 1, 2002;

Temporary Adoption Eff. March 1, 2003;

Eff. August 1, 2004;

Transferred from 10A NCAC 21A .0607 Eff. May 1, 2012.

 

10A NCAC 23C .0205       state corrective action team

(a)  A State Corrective Action Team shall be convened by the

Chairperson within 10 days when:

(1)           The county department of social services

(DSS) has failed to meet the compliance thresholds by the date established by

the local corrective action team.

(2)           A local corrective action team requests an

extension of time, not to exceed three months, to meet the compliance

thresholds.

(3)           DDS fails to meet its compliance thresholds

for three consecutive months or five out of 12 consecutive months.

(b)  The State Corrective Action Team may design any remedy

reasonable and necessary to bring the DSS or DDS into compliance with

application processing requirements in 10A NCAC 21B .0204 and this Subchapter. 

This includes employing additional staff, altering office procedures (such

procedures must be consistent with federal and state regulations, laws and

Departmental rules), purchasing office equipment, retaining private

consultants, reopening of cases, ordering retroactive relief to applicants

harmed by violation of application processing requirements, and ordering the

State to assist in the operation of a county department.

(c)  The State Corrective Action Team shall establish a

corrective action plan for the DSS or DDS within 45 calendar days of

convening.  A date for compliance shall be established.  The county or DDS must

meet the thresholds in 10A NCAC 23C .0203(a) within three months after the date

the team was convened.

(d)  Failure to achieve compliance shall result in a request

from the Division of Medical Assistance to the Local Government Commission to

assess and determine the capacity of the county to expend resources to bring

the county into compliance.

 

History Note:        Authority G.S. 108A-54; Alexander v. Bruton,

U.S.D.C., File No. C-C-74-183-M, Consent Order dismissed effective February 1,

2002;

Temporary Adoption Eff. March 1, 2003;

Eff. August 1, 2004;

Transferred from 10A NCAC 21A .0608 Eff. May 1, 2012.