2009 North Carolina Code
Chapter 143 - State Departments, Institutions, and Commissions.
§ 143-730. Managed Care Patient Assistance Program.

Article 77.

Managed Care Patient Assistance Program.

§ 143‑730.  Managed Care Patient Assistance Program.

(a)        The Office of Managed Care Patient Assistance Program is established in an existing State agency or department designated by the Governor. The Director of the Office of Managed Care Patient Assistance Program shall be appointed by the Governor.

(b)        The Managed Care Patient Assistance Program shall provide information and assistance to individuals enrolled in managed care plans. The Managed Care Patient Assistance Program shall have expertise and experience in both health care and advocacy and will assume the specific duties and responsibilities set forth in subsection (c) of this section.

(c)        The duties and responsibilities of the Managed Care Patient Assistance Program are as follows:

(1)        Develop and distribute educational and informational materials for consumers, explaining their rights and responsibilities as managed care plan enrollees.

(2)        Answer inquiries posed by consumers and refer inquiries of a regulatory nature to staff within the Department of Insurance.

(3)        Advise managed care plan enrollees about the utilization review process.

(4)        Assist enrollees with the grievance, appeal, and external review procedures established by Article 50 of Chapter 58 of the General Statutes.

(5)        Publicize the Office of the Managed Care Patient Assistance Program.

(6)        Compile data on the activities of the Office and evaluate such data to make recommendations as to the needed activities of the Office.

(d)        The Director of the Managed Care Patient Assistance Program shall annually report the activities of the Managed Care Patient Assistance Program, including the types of appeals, grievances, and complaints received and the outcome of these cases. The report shall be submitted to the General Assembly, upon its convening or reconvening, and shall make recommendations as to efforts that could be implemented to assist managed care consumers.

(e)        All health information in the possession of the Managed Care Patient Assistance Program is confidential and is not a public record pursuant to G.S. 132‑1 or any other applicable statute.

For purposes of this section, "health information" means any of the following:

(1)        Information relating to the past, present, or future physical or mental health or condition of an individual.

(2)        Information relating to the provision of health care to an individual.

(3)        Information relating to the past, present, or future payment for the provision of health care to an individual.

(4)        Information, in any form, that identifies or may be used to identify an individual, that is created by, provided by, or received from any of the following:

a.         An individual or an individual's spouse, parent, legal guardian, or designated representative.

b.         A health care provider, health plan, employer, health care clearinghouse, or an entity doing business with these entities. (2001‑446, s. 1.6; 2002‑159, s. 45.)