§ 143-730. Managed Care Patient Assistance Program. - North Carolina Statutes

Article 77.

Managed Care Patient Assistance Program.

§ 143‑730.  Managed Care Patient AssistanceProgram.

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

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

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

(1)        Develop and distribute educational and informationalmaterials for consumers, explaining their rights and responsibilities asmanaged care plan enrollees.

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

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

(4)        Assist enrollees with the grievance, appeal, and externalreview procedures established by Article 50 of Chapter 58 of the GeneralStatutes.

(5)        Publicize the Office of the Managed Care Patient AssistanceProgram.

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

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

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

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

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

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

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

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

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

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