North Carolina Administrative Code

10A ncac 63F .0506 PRIORITY CATEGORIES (a) The priority categories for the order of selection for services for eligible individuals are as follows: (1) Category One - Individuals with the most significant disabilities; (2) Category Two - Individuals with a significant disability;…

10A ncac 63F .0507 PROCEDURES (a) Eligible individuals who are already receiving services under an Individualized Plan for Employment (IPE) at the time the order of selection is implemented shall not be subject to the order of selection process. Their rehabilitation programs shal…

10A NCAC 63F .0508 POST EMPLOYMENT SERVICES When a former recipient of services requires post-employment services and is otherwise eligible for such services, the services shall be provided without regard for the order of selection. History Note: Authority G.S. 143-545.1; P.L. 10…

10A NCAC 63F .0509 CASE FINDING AND REFERRAL Case finding efforts shall not be modified because of an order of selection. The Division shall make the public and referral sources aware of the services it has to offer eligible individuals with disabilities. Referral sources shall b…

10A NCAC 63F .0510 THIRD-PARTY FUNDING ARRANGEMENTS The Division shall ensure that its funding arrangements for providing services, including third-party arrangements and establishment grants, are consistent with the order of selection. History Note: Authority G.S. 143-545.1; P.L…

section .0600 – hearing procedure 10A ncac 63F .0601 APPLICABILITY OF RULES (a) The Rules in this Section apply to contested cases of applicants for and consumers receiving vocational rehabilitation services or independent living rehabilitation services from the Division of Servi…

10A ncac 63F .0602 WRITTEN INFORMATION FOR APPLICANTS AND consumers (a) The Division shall inform all applicants for and consumers receiving vocational rehabilitation or independent living rehabilitation services of the opportunities for an administrative review, mediation, and i…

10A ncac 63F .0603 REQUEST FOR ADMINISTRATIVE Review, mediation, AND impartial due process HEARING (a) When any applicant for or consumer receiving vocational rehabilitation or independent living rehabilitation services wishes to request an administrative review, mediation, or an…

10A ncac 63F .0604 DIVISION ACTIONS IN RESPONSE TO REQUEST (a) Upon receipt of a request for an impartial due process hearing, the area rehabilitation supervisor shall immediately forward the original request to the Division Director for appointment of a hearing officer to conduc…

10A ncac 63F .0605 SCHEDULING AND NOTICE OF ADMINISTRATIVE REVIEW and mediation (a) Administrative Review (1) If an administrative review is to be conducted, the area rehabilitation supervisor or his designee shall: (A) set a date, time and place for the administrative review; (B…

10A ncac 63F .0606 APPOINTMENT OF HEARING OFFICER AND MEDIATOR Upon receipt of the applicant's or consumer's request for an impartial due process hearing from the area rehabilitation supervisor, the Director shall arrange for the appointment of an impartial hearing officer who is…

10A NCAC 63F .0607 SCHEDULING AND NOTICE OF impartial due process HEARING (a) The hearing officer shall schedule the impartial due process hearing to be held within 60 days of the original request by the applicant or consumer as described in Rule .0603 of this Section. (b) The he…

10A ncac 63F .0608 ADMINISTRATIVE REVIEW and mediation (a) Administrative Review (1) Within 15 days of the original request for an administrative review by the applicant or consumer, the area rehabilitation supervisor or his designee shall hold the administrative review with the …

10A ncac 63F .0609 RESPONSE TO ADMINISTRATIVE REVIEW DECISION and mediation (a) Administrative Review (1) If the applicant or consumer is satisfied with the decision resulting from the administrative review, the individual shall sign the form described in Rule .0608(a)(2)(C) of t…

10A ncac 63F .0610 ADMINISTRATIVE REVIEW BY DIRECTOR In situations where the issue currently in controversy involves action taken by the central office of the Division, the Director or a designee of the Director shall perform the duties prescribed for the area rehabilitation supe…

10A ncac 63F .0611 PROCEDURES GOVERNING HEARING The impartial due process hearing shall be conducted according to the provisions of 34 C.F.R. 361.57(e)(1) and 34 C.F.R. 361.57(e)(2) and according to Rules .0612 through .0621 and Rule .0624 of this Section. History Note: Authority…

10A ncac 63F .0612 VENUE (a) Absent a change of venue pursuant to the procedure described in this Rule, the impartial due process hearing shall be held in the county of residence in this state of the applicant or consumer. (b) Any party desiring a change of venue shall file a wri…

10A ncac 63F .0613 DISCOVERY (a) Parties in impartial due process hearings shall exchange information, seek access to public documents as provided by law, and exhaust other informal means of obtaining discoverable material. (b) Any dispute regarding discovery shall be referred to…

10A ncac 63F .0614 PRE-HEARING CONFERENCE (a) Upon notice to all parties, the hearing officer may instruct the parties to participate in a pre-hearing conference. (b) The conference shall be informal in nature. (c) The purpose of the conference shall be to discuss: (1) The possib…

10A NCAC 63F .0615 SIMPLIFICATION OF ISSUES The parties to the hearing may agree in advance to simplification of issues by: (1) eliminating issues to be contested at the hearing, (2) accepting the validity of certain proposed evidence, (3) accepting the findings in some other cas…

10A ncac 63F .0616 EVIDENCE (a) G.S. 150B-29, G.S. 150B-30, and G.S. 150B-31 are hereby incorporated by reference, including subsequent amendments and editions. (b) A copy can be obtained from the Division at no cost. History Note: Authority G.S. 143B-157; 150B-1(e)(5); 150B-2; 1…

10A ncac 63F .0617 DISQUALIFICATION OF HEARING OFFICER (a) If at any time the hearing officer believes he or she cannot conduct the hearing in a fair and impartial manner, the hearing officer shall submit to the Director a written statement indicating why he or she should be disq…

10A ncac 63F .0618 EX PARTE COMMUNICATIONS (a) Ex parte communications in the impartial due process hearing shall be governed by G.S. 150B-35, which is hereby incorporated by reference, including subsequent amendments and editions. (b) A copy may be obtained from the Division at …

10A NCAC 63F .0619 OATH No person may testify or present views or data orally at the hearing before being put under oath or affirmation. History Note: Authority G.S. 143B-157; 150B-1(d)13; 150B-2; 150B-23; 34 C.F.R. 361.57; 34 C.F.R.. 361.57(b)(3); Eff. December 1, 1990; Pursuant…

10A ncac 63F .0620 CONDUCT OF HEARING (a) The hearing officer shall have complete control over the hearing including: (1) the responsibility of having a record made of the hearing; (2) the administration of oaths and affirmations; (3) recognition of speakers; (4) prevention of re…

10A ncac 63F .0621 FAILURE TO APPEAR (a) If the applicant or consumer fails to appear at the hearing and does not have a representative present, the hearing officer shall cancel the hearing. (b) The applicant or consumer may submit a written request for rescheduling of the hearin…

10A ncac 63F .0622 HEARING OFFICER'S DECISION Following the hearing, the hearing officer shall make and issue a decision as specified in 34 C.F.R. 361.57(e)(3). The decision shall be given to the applicant or consumer personally or by certified mail. If given by certified mail, i…

10A ncac 63F .0623 SECRETARY'S REVIEW AND FINAL DECISION (a) Either party may request a review of the hearing officer's decision by the Secretary of the Department of Health and Human Services within 20 days of the receipt of the decision. (b) The Secretary may delegate the respo…

10A ncac 63F .0624 EXTENSIONS OF TIME (a) Time extensions may be granted for the procedures in these Rules for good cause at the request of a party or at the request of both parties except for: (1) the time for continuation of services during an administrative review or mediation…

10A ncac 63F .0625 RECORD (a) The official records of impartial due process hearings shall be maintained in the central office of the Division. (b) Any person wishing to examine a hearing record shall submit a written request to the Director in sufficient time to allow the record…

10A ncac 63F .0626 TRANSCRIPTS Any person desiring a transcript of all or part of an impartial due process hearing shall contact the office of the Director. A fee to cover the cost of preparing the transcript shall be charged, and the party may be required to pay the fee in advan…

10A NCAC 63F .0627 CIVIL ACTION Judicial review of decisions issued pursuant to Rules .0602 through .0624 of this Section shall be as specified in Sec. 102(c) of the Rehabilitation Act of 1973 (as amended by the Rehabilitation Act Amendments of 1998, P.L. 105-220). History Note: …

SUBCHAPTER 63G - MEDICAL/EYE CARE PROGRAM section .0100 – services 10A ncac 63G .0101 COVERED SERVICES (a) Services provided to any eligible North Carolina resident, pursuant to G.S. 111-8, include: (1) eye examinations. Refractions are restricted to one every two years for perso…

10A ncac 63G .0102 ELIGIBILITY CRITERIA (a) A North Carolina resident is eligible to receive services if: (1) the services are not covered by the North Carolina medical assistance (medicaid) program; or (2) the resident is a medicaid recipient on a spend-down who qualifies under …

10A ncac 63G .0103 APPLICATION FOR SERVICES (a) In order to be determined eligible for services, pursuant to this Subchapter, the resident must: (1) have been determined to be ineligible for medicaid and other state or federal programs that offer eye care services or eligible for…

10A ncac 63G .0104 ELIGIBILITY FOR SERVICES (a) The Division may, based upon the availability of funds, issue any resident determined eligible for services an authorization for an eye examination and a certification for fitting and dispensing of eyeglasses. These copies must be t…

10A ncac 63G .0105 RETROACTIVE ELIGIBILITY The division may issue authorizations to pay for emergency inpatient and outpatient surgery and hospital services plus other services or treatment provided prior to determining eligibility if: (1) services were received no more than 90 d…

10A NCAC 63G .0106 REDETERMINATION A redetermination of eligibility is mandatory every six months because of possible changes in economic circumstances. History Note: Authority G.S. 111-8; 143B-157; Eff. February 1, 1976; Readopted Eff. November 16, 1977; Amended Eff. January 1, …

section .0200 – administrative procedures 10A ncac 63G .0201 USE OF authorization and certification (a) The consumer shall deliver the authorization to the eye practitioner for the examination and the certification for fitting and dispensing to the eye practitioner or licensed op…

10A ncac 63G .0202 CLAIMS (a) Claims for services or supplies must be submitted no later than twelve months from the date of service. The division shall not pay claims received more than 12 months from the date of service. (b) The amount reimbursed is payment in full. The consume…

10A ncac 63G .0203 FRAUD: PAYMENT OF CLAIM (a) All services billed by licensed eye practitioners and optical providers, institutions and suppliers must be consistent with the services actually performed. (b) The Division shall use the Medicaid schedule of benefit payments for ser…

10A ncac 63G .0204 FREEDOM OF CHOICE In accordance with G.S. 90-127.1, all eligible consumers shall be afforded a free choice to select a licensed eye practitioner or optical provider to receive services. History Note: Authority G.S. 90-127.1; 111-8; 143B-157; Eff. February 1, 19…

10A ncac 63G .0205 EXAMINATION REPORTS (a) An eye examination report shall be completed by ophthalmologists and optometrists on all persons having: (1) a chronic, degenerative eye disorder; or (2) no vision or vision with glasses so defective as to prevent the performance of ordi…

SECTION .0300 - HEARING 10A ncac 63G .0301 appeal of division actions (a) If a consumer is dissatisfied with an action or service delivered by the medical/eye care program, that consumer may request a conference with the program chief for the Medical/Eye Care Program. (b) A confe…

10A ncac 63G .0302 request FOR contested case HEARING (a) If the results of the conference are unsatisfactory, the consumer shall be informed by the Division of his or her right to a contested case hearing. (b) All contested case hearings shall be heard by the Office of Administr…

chapter 67 – social services - procedures subchapter 67A – general administration section .0100 - administration 10A NCAC 67A .0101 CONTENTS History Note: Authority G.S. 108A-25; 108A-29; 108A-29.1; 143B-10; 143B-153; 143B-138; .S.C. 301 et seq.; Eff. February 1, 1976; Readopted …

10A NCAC 67A .0102 SEPARATION OF SERVICES FROM INCOME MAINTENANCE History Note: Authority G.S. 143B-153; Eff. December 24, 1976; Readopted Eff. October 31, 1977; Expired Eff. October 1, 2016 pursuant to G.S. 150B-21.3A.