reglab/statecodes huggingface dataset:
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-146.13 - Modernized presumptive IGT adjustment component.

§ 108A-146.13. Modernized presumptive IGT adjustment component.
(a) Repealed by Session Laws 2023-7, s. 1.7(h), effective April 1, 2023, and applicable to assessments imposed on or after that date.
(b) Repealed by Session Laws 2023-7, s. 1.7(h), effective April 1, 2023, and applicable to assessments imposed on or after that date.
(c) The modernized presumptive IGT adjustment component is an amount of money equal to the sum of all of the following subcomponents:
(1) The public hospital IGT subcomponent is the total of the following amounts:
a. Sixteen and forty-three hundredths percent (16.43%) of the amount of money that is equal to the total modernized nonfederal receipts under G.S. 108A-146.5(b) for the current quarter minus the modernized HASP component under G.S. 108A-146.10 for the current quarter.
b. Sixty percent (60%) of the nonfederal share for not newly eligible individuals of the aggregate amount of HASP directed payments due to PHPs in the current quarter for reimbursements to public acute care hospitals and that are not attributable to newly eligible individuals.
(2) The UNC Health Care System IGT subcomponent is the total of the following amounts:
a. Four and sixty-two hundredths percent (4.62%) of the difference of the total modernized nonfederal receipts under G.S. 108A-146.5(b) for the current quarter minus the modernized HASP component under G.S. 108A-146.10 for the current quarter.
b. The nonfederal share for not newly eligible individuals of the aggregate amount of HASP directed payments due to PHPs in the current quarter for reimbursements to UNC Health Care System hospitals that are not attributable to newly eligible individuals.
(3) The East Carolina University IGT subcomponent is the total of the following amounts:
a. One and four hundredths percent (1.04%) of the difference of the total modernized nonfederal receipts under G.S. 108A-146.5(b) for the current quarter minus the modernized HASP component under G.S. 108A-146.10 for the current quarter.
b. The nonfederal share for not newly eligible individuals of the aggregate amount of HASP directed payments due to PHPs in the current quarter for reimbursements to the primary affiliated teaching hospital for the East Carolina University Brody School of Medicine that are not attributable to newly eligible individuals. (2021-61, s. 2; 2021-180, s. 9D.13A(d); 2022-74, s. 9D.10(b); 2023-7, s. 1.7(h).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-146.14 - Modernized IGT actual receipts adjustment component.

§ 108A-146.14. Modernized IGT actual receipts adjustment component.
The modernized IGT actual receipts adjustment component is a positive or negative dollar amount equal to the modernized presumptive IGT adjustment component under G.S. 108A-146.13 for the previous quarter minus the amount of money received during the previous quarter by the Department through intergovernmental transfer and designated in the Department's accounting system as a receipt related to the modernized assessments. (2023-7, s. 1.7(i).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-146.15 - Use of funds.

§ 108A-146.15. Use of funds.
The proceeds of the assessments imposed under this Part, and all corresponding matching federal funds, must be used to make the State's annual Medicaid payment to the State and to fund all of the following:
(1) Payments to hospitals made directly by the Department.
(2) A portion of capitation payments to prepaid health plans attributable to hospital care.
(3) HASP directed payments attributable to hospital reimbursements for not newly eligible individuals.
(4) Graduate medical education payments. (2021-61, s. 2; 2023-7, s. 1.7(j).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-146.17 - Changes of hospital status.

§ 108A-146.17. Changes of hospital status.
(a) For purposes of this section, hospital status includes all of the following:
(1) A hospital's status as a public acute care hospital, a private acute care hospital, or a hospital owned or controlled by the UNC Health Care system.
(2) The operating status of an acute care hospital as open or closed, including new hospitals and hospital closures.
(b) The Department of Health and Human Services shall report to the House of Representatives Appropriations Committee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, and the Fiscal Research Division whenever the Department is notified of a possible change of hospital status. The report shall be due 60 days after the Department is notified of the possible change. The report shall include all of the following:
(1) The anticipated change of hospital status and the anticipated time frame during which the change of hospital status may occur.
(2) Any proposed revisions to Article 7B of Chapter 108A of the General Statutes that would be needed if the change in hospital status occurs, including proposed changes to the public and private hospital historical assessment shares in G.S. 108A-145.3 and the intergovernmental transfer adjustment component in G.S. 108A-146.13, as well as the mathematical calculations supporting the proposed changes.
(c) The Department of Health and Human Services shall report to the House of Representatives Appropriations Committee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, and the Fiscal Research Division whenever the Department is notified that a change in hospital status has occurred. The report shall be due 60 days after the Department is notified of the change. The report shall include all of the following:
(1) The change of hospital status and the date of the change.
(2) Any proposed revisions to Article 7B of Chapter 108A of the General Statutes that are needed as a result of the change in hospital status, including proposed changes to the public and private hospital historical assessment shares in G.S. 108A-145.3 and the intergovernmental transfer adjustment component in G.S. 108A-146.13, as well as the mathematical calculations supporting the proposed changes.
(3) If the change of hospital status occurred because a public acute care hospital closed or became a private acute care hospital, then the amount of the public acute care hospital's intergovernmental transfer to the Department made during its last quarter of operation. (2021-61, s. 2.)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.1 - Public hospital health advancement assessment.

§ 108A-147.1. Public hospital health advancement assessment.
(a) The public hospital health advancement assessment imposed under this Part shall apply to all public acute care hospitals.
(b) The public hospital health advancement assessment shall be assessed as a percentage of each public acute care hospital's hospital costs. The assessment percentage shall be calculated quarterly by the Department in accordance with this Part. The percentage for each quarter shall equal the aggregate health advancement assessment collection amount calculated under G.S. 108A-147.3 multiplied by the public hospital historical assessment share and divided by the total hospital costs for all public acute care hospitals holding a license on the first day of the assessment quarter. (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.2 - Private hospital health advancement assessment.

§ 108A-147.2. Private hospital health advancement assessment.
(a) The private hospital health advancement assessment imposed under this Part shall apply to all private acute care hospitals.
(b) The private hospital health advancement assessment shall be assessed as a percentage of each private acute care hospital's hospital costs. The assessment percentage shall be calculated quarterly by the Department in accordance with this Part. The percentage for each quarter shall equal the aggregate health advancement assessment collection amount calculated under G.S. 108A-147.3 multiplied by the private hospital historical assessment share and divided by the total hospital costs for all private acute care hospitals holding a license on the first day of the assessment quarter. (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.3 - Aggregate health advancement assessment collection amount.

§ 108A-147.3. Aggregate health advancement assessment collection amount.
(a) The aggregate health advancement assessment collection amount is an amount of money that is calculated quarterly by adjusting the total nonfederal receipts for health advancement calculated under subsection (b) of this section by (i) subtracting the health advancement presumptive IGT adjustment component calculated under G.S. 108A-147.9, (ii) adding the positive or negative health advancement IGT actual receipts adjustment component calculated under G.S. 108A-147.10, and (iii) subtracting the positive or negative IGT share of the reconciliation adjustment component calculated under G.S. 108A-147.11(b).
(b) The total nonfederal receipts for health advancement is an amount of money that is calculated quarterly by adding all of the following:
(1) The presumptive service cost component calculated under G.S. 108A-147.5.
(2) The HASP health advancement component calculated under G.S. 108A-147.6.
(3) The administration component calculated under G.S. 108A-147.7.
(4) The State retention component under G.S. 108A-147.9.
(5) The positive or negative health advancement reconciliation adjustment component calculated under G.S. 108A-147.11(a). (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.5 - Presumptive service cost component.

§ 108A-147.5. Presumptive service cost component.
(a) For every State fiscal quarter prior to the fiscal quarter in which G.S. 108A-54.3A(24) becomes effective, the presumptive service cost component is zero.
(b) For the State fiscal quarter in which G.S. 108A-54.3A(24) becomes effective, the presumptive service cost component is the product of forty-eight million seven hundred fifty thousand dollars ($48,750,000) multiplied by the number of months in that State fiscal quarter in which G.S. 108A-54.3A(24) is effective during any part of the month.
(c) For the first State fiscal quarter after the State fiscal quarter in which G.S. 108A-54.3A(24) becomes effective, the presumptive service cost component is one hundred forty-six million two hundred fifty thousand dollars ($146,250,000).
(d) For the second State fiscal quarter after the State fiscal quarter in which G.S. 108A-54.3A(24) becomes effective, and for each State fiscal quarter thereafter, the presumptive service cost component is an amount of money that is the greatest of the following:
(1) The prior quarter's presumptive service cost component amount.
(2) The prior quarter's presumptive service cost component amount increased by a percentage that is the sum of each monthly percentage change in the Consumer Price Index: Medical Care for the most recent three months available on the first day of the current quarter.
(3) The prior quarter's presumptive service cost component amount increased by the percentage change in the weighted average of the base capitation rates for standard benefit plans for all rating groups associated with newly eligible individuals compared to the prior quarter. The weight for each rating group shall be calculated using member months documented in the Medicaid managed care capitation rate certification for standard benefit plans.
(4) The prior quarter's presumptive service cost component amount increased by the percentage change in the weighted average of the base capitation rates for BH IDD tailored plans for all rating groups associated with newly eligible individuals compared to the prior quarter. The weight for each rating group shall be calculated using member months documented in the Medicaid managed care capitation rate certification for BH IDD tailored plans.
(5) The amount produced from multiplying 1.15 by the highest amount produced when calculating, for each quarter that is at least two and not more than five quarters prior to the current quarter, the actual nonfederal expenditures for the applicable quarter minus the HASP health advancement component calculated under G.S. 108A-147.6 for the applicable quarter. (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.6 - HASP health advancement component.

§ 108A-147.6. HASP health advancement component.
The HASP health advancement component is an amount of money that is calculated by multiplying the aggregate amount of HASP directed payments due to PHPs in the current quarter for hospital reimbursements attributable to newly eligible individuals by the nonfederal share for newly eligible individuals. (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.7 - Administration component.

§ 108A-147.7. Administration component.
(a) The administration component is an amount of money that is calculated by adding the State administration subcomponent calculated under subsection (b) of this section and the county administration subcomponent calculated under subsection (c) of this section.
(b) For each quarter of the 2023-2024 State fiscal year, the State administration subcomponent is the product of one million three hundred fifty thousand dollars ($1,350,000) multiplied by the number of months in that State fiscal quarter in which G.S. 108A-54.3A(24) is effective during any part of the month. For each quarter of the 2024-2025 State fiscal year, the State administration subcomponent is four million fifty thousand dollars ($4,050,000) increased by the Consumer Price Index: All Urban Consumers. For each subsequent State fiscal year, the State administration subcomponent shall be increased over the prior year's quarterly amount by the Consumer Price Index: All Urban Consumers.
(c) For each quarter of the 2022-2023 State fiscal year and the 2023-2024 State fiscal year, the county administration subcomponent is the product of one million six hundred sixty-seven thousand dollars ($1,667,000) multiplied by the number of months in that State fiscal quarter in which G.S. 108A-54.3A(24) is effective during any part of the month. The county administration subcomponent is seven million four hundred thousand dollars ($7,400,000) for each quarter of the 2024-2025 State fiscal year and seven million eight hundred thousand dollars ($7,800,000) for each quarter of the 2025-2026 State fiscal year. For each State fiscal year after the 2025-2026 State fiscal year, the county administration subcomponent shall be increased over the prior year's quarterly amount by the Consumer Price Index: All Urban Consumers. (2023-7, s. 1.6(b), (e).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.8 - State retention component.

§ 108A-147.8. State retention component.
(a) For every State fiscal quarter prior to the fiscal quarter in which G.S. 108A-54.3A(24) becomes effective, the State retention component is zero.
(b) For the State fiscal quarter in which G.S. 108A-54.3A(24) becomes effective, and each State fiscal quarter thereafter, the State retention component is ten million seven hundred fifty thousand dollars ($10,750,000) for each assessment quarter. (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.10 - Health advancement IGT actual receipts adjustment component.

§ 108A-147.10. Health advancement IGT actual receipts adjustment component.
The health advancement IGT actual receipts adjustment component is a positive or negative dollar amount equal to the health advancement presumptive IGT adjustment component calculated under G.S. 108A-147.9 for the previous quarter, plus the positive or negative IGT share of the reconciliation adjustment component calculated under G.S. 108A-147.11(b) for the previous quarter, and minus the amount of money received during the previous quarter by the Department through intergovernmental transfer and designated in the Department's accounting system as a receipt for health advancement. (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.11 - Health advancement reconciliation adjustment component.

§ 108A-147.11. Health advancement reconciliation adjustment component.
(a) The health advancement reconciliation adjustment component is a positive or negative dollar amount equal to the actual nonfederal expenditures for the quarter that is two quarters prior to the current quarter minus the sum of the following specified amounts:
(1) The presumptive service cost component calculated under G.S. 108A-147.5 for the quarter that is two quarters prior to the current quarter.
(2) The positive or negative gross premiums tax offset amount calculated under G.S. 108A-147.12(b).
(3) The HASP health advancement component calculated under G.S. 108A-147.6 for the quarter that is two quarters prior to the current quarter.
(b) The IGT share of the reconciliation adjustment component is a positive or negative dollar amount that is calculated by multiplying the health advancement reconciliation adjustment component calculated under subsection (a) of this section by the share of public hospital costs calculated under subsection (c) of this section.
(c) The share of public hospital costs is calculated by adding total hospital costs for the UNC Health Care System, total hospital costs for the primary affiliated teaching hospital for the East Carolina University Brody School of Medicine, and sixty percent (60%) of the total hospital costs for all public acute care hospitals and dividing that sum by the total hospital costs for all acute care hospitals except for critical access hospitals. (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.12 - Gross premiums tax offset amount.

§ 108A-147.12. Gross premiums tax offset amount.
(a) For the purposes of this section, the term "annualized offset" means the total paid capitation for all rating groups associated with newly eligible individuals in all capitated contract plan types for the calendar year that was completed immediately prior to the start of the applicable State fiscal year multiplied by one and nine-tenths percent (1.9%) and then multiplied by sixty percent (60%).
(b) The gross premiums tax offset amount is as follows:
(1) For each quarter of the 2022-2023 State fiscal year and the 2023-2024 State fiscal year, the gross premiums tax offset amount is zero.
(2) For the 2024-2025 State fiscal year, and each fiscal year thereafter, the gross premiums tax offset amount is the following:
a. For the first quarter of the applicable State fiscal year, the gross premiums tax offset amount is a positive or negative number equal to the annualized offset minus the sum of the gross premiums tax offset amounts for the second, third, and fourth quarters of the previous State fiscal year.
b. For the second, third, and fourth quarters of the applicable State fiscal year, the gross premiums tax offset amount is the annualized offset multiplied by one–third. (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-147.13 - Use of funds.

§ 108A-147.13. Use of funds.
(a) Except as provided in subsection (d) of this section, the proceeds of the health advancement assessments imposed under this Part, and all corresponding matching federal funds, shall only be used to fund the following:
(1) Medicaid actual nonfederal expenditures for newly eligible individuals, including HASP directed payments.
(2) Administrative expenditures for newly eligible individuals.
(3) Administrative expenditures related to the HASP program.
(b) The Department shall use an amount of the proceeds of the health advancement assessments that is equal to the county administration subcomponent of the administration component in G.S. 108A-147.7 to provide funding to county departments of social services to support the counties in determining eligibility for newly eligible individuals.
(c) The amount of the proceeds of the health advancement assessments that may be used for administrative expenses attributable to providing Medicaid coverage to newly eligible individuals and administrative expenditures associated with the HASP program shall not exceed, for any State fiscal year, an amount equal to the sum of the State administration subcomponent of the administration component in G.S. 108A-147.7 for each quarter of the State fiscal year, and all corresponding matching federal funds.
(d) The Department shall use an amount from the proceeds of the health advancement assessments equal to the State retention component in G.S. 108A-147.8, and all corresponding matching federal funds, for Medicaid program costs. (2023-7, s. 1.6(b).)
2023 North Carolina General Statutes › Chapter 108A - Social Services › Article 7B - Hospital Assessment Act. › § 108A-148.1 - Healthcare access and stabilization program.

§ 108A-148.1. Healthcare access and stabilization program.
(a) The healthcare access and stabilization program is a directed payment program that provides acute care hospitals with increased reimbursements funded through hospital assessments in accordance with this section.
(b) The Department shall submit a 42 C.F.R. § 438.6(c) preprint requesting approval for the HASP program that includes any required demonstration for the financing of the nonfederal share of the HASP program costs. The Department shall not make any HASP directed payments prior to CMS approval of the initial preprint. The Department may not request any date of service for claims eligible for reimbursement through the HASP program earlier than July 1, 2022. The Department shall continue to submit any necessary documentation requesting continued approval for the HASP program as described in this section in the time and manner as required by CMS.
(c) All State funds required to make HASP directed payments shall be derived from HASP components of the hospital assessments under this Article, subject to all of the following limitations:
(1) If the Department determines that the HASP components under this Article will not generate funds in an amount equal to or greater than the total State funds required to make all HASP directed payments in any given quarter of the State fiscal year, then the Department shall reduce the amount of the HASP directed payments in the lowest amount necessary to ensure that the HASP components under this Article will generate enough funds to equal the total State funds required to make all the HASP directed payments in that quarter.
(2) If the aggregate amount of all assessments due from hospitals under this Article are determined by the Department to exceed the permissible limit established under 42 C.F.R. § 433.68(f) in any quarter of the State fiscal year, then the Department shall reduce the amount of the HASP directed payments in the lowest amount necessary to ensure that these hospital assessments in aggregate do not exceed the permissible limit.
(d) As part of the preprint submission required under this section, for the 2022-2023 State fiscal year, the Department shall not request any amount of HASP hospital reimbursements that is greater than the maximum amount allowable under 42 C.F.R. § 438.6(c). Beginning with the 2023-2024 State fiscal year, the Department shall not request any amount of HASP hospital reimbursements that is (i) greater than the maximum amount allowable under 42 C.F.R. § 438.6(c) or (ii) less than an annual estimated total dollar amount of three billion two hundred million dollars ($3,200,000,000) for services provided to not newly eligible individuals. (2023-7, s. 1.4.)
2023 North Carolina General Statutes › Chapter 108B - Community Action Programs › Article 2 - Community Action Partnership Act. › § 108B-21 - Short title.

§ 108B-21. Short title.
This Article may be cited as the Community Action Partnership Act. (1983 (Reg. Sess., 1984), c. 1034, s. 111.1.; 1989 (Reg. Sess., 1990), c. 1004, s. 34(c).)
2023 North Carolina General Statutes › Chapter 108B - Community Action Programs › Article 2 - Community Action Partnership Act. › § 108B-22 - Purpose.

§ 108B-22. Purpose.
It is the purpose of this Article to provide financial assistance to Community Action Agencies and Limited Purpose Agencies (hereinafter referred to as "agency" or "agencies") to enable those agencies to effectively mobilize public and private resources in order to promote economic self-sufficiency among the poor of the State and to expand those services to all political subdivisions of the State. (1983 (Reg. Sess., 1984), c. 1034, s. 111.1.; 1989 (Reg. Sess., 1990), c. 1004, s. 34(c).)
2023 North Carolina General Statutes › Chapter 108B - Community Action Programs › Article 2 - Community Action Partnership Act. › § 108B-23 - Designation of administering agency powers and responsibilities.

§ 108B-23. Designation of administering agency powers and responsibilities.
(a) For purposes of this Article, "Department" means the Department of Health and Human Services and "Secretary" means the Secretary of Health and Human Services.
(b) The Department is directed to carry out the purposes and provisions of this Article. In carrying out this directive, the Secretary shall promulgate rules consistent with the purposes and provisions of this Article. (1983 (Reg. Sess., 1984), c. 1034, s. 111.1; 1989, c. 727, s. 48; c. 751, ss. 7(9), 8(11a); 1989 (Reg. Sess., 1990), c. 1004, ss. 34(c), 35; 1997-443, s. 11A.118(a).)
2023 North Carolina General Statutes › Chapter 108B - Community Action Programs › Article 2 - Community Action Partnership Act. › § 108B-24 - Designation of eligible agencies.

§ 108B-24. Designation of eligible agencies.
The Secretary shall designate agencies to fulfill the requirements of this Article in the service areas governed by one or more units of local government. An agency so designated may be one of the following:
(1) Agencies which have been officially designated as community action agencies or limited purpose agencies pursuant to Section 210 of the Economic Opportunity Act of 1964, Public Law 88-452, 78 Stat. 508 and which have not lost their designation as a result of a failure to comply with the provisions of that act.
(2) Private nonprofit agencies designated by the chief elected official of a political subdivision or one or more political subdivisions, in areas not served by agencies as defined in subdivision (1) of this section on July 1, 1984. Agencies eligible under this subdivision must apply to the Secretary for designation 60 days in advance of the beginning date of their fiscal year. Political subdivisions designated under this section are authorized to join existing community action agencies contiguous with their boundaries or to organize their own community action agency in order to provide services pursuant to this Article. (1983 (Reg. Sess., 1984), c. 1034, s. 111.1; 1989 (Reg. Sess., 1990), c. 1004, s. 34(c).)
2023 North Carolina General Statutes › Chapter 108B - Community Action Programs › Article 2 - Community Action Partnership Act. › § 108B-25 - Activities of Community Action Agency.

§ 108B-25. Activities of Community Action Agency.
Agencies shall serve as the local catalyst for the reduction of the causes, conditions, and effects of poverty and shall provide social and economic opportunities that foster self-sufficiency for low-income persons. As such, agencies designated pursuant to G.S. 108B-24(1) shall be sponsors of the Community Services Block Grant and any successor program thereto. (1983 (Reg. Sess., 1984), c. 1034, s. 111.1; 1989 (Reg. Sess., 1990), c. 1004, s. 34(c).)
2023 North Carolina General Statutes › Chapter 108B - Community Action Programs › Article 2 - Community Action Partnership Act. › § 108B-26 - Organization and authority.

§ 108B-26. Organization and authority.
(a) Agencies, as provided in G.S. 108B-24 shall have or be required to establish a governing board of directors which shall consist of not less than 15 nor more than 51 members. One-third of the members shall be low-income, elderly, or handicapped consumers residing in the service area of the agency. Consumer representatives shall be selected through a democratic process pursuant to guidelines established by the Department. Not less than one-third of the members of the board shall be appointed by the chief elected officials in the service area. The remaining positions on the board, if any, shall be filled by officials or members of business, industry, labor, religious, welfare, education, or civic organizations located in the service area.
(b) The board of directors shall be responsible for all of the following:
(1) The appointment and dismissal of an executive director.
(2) The approval of contracts, budgets, requests, and major modifications of budgets and contracts.
(3) The performance of an annual audit by certified public accountants to include all assets, liabilities, revenue, and expenditures.
(4) The establishment of policies for the operation of the agency.
(5) Annually advising the chief elected officials of the units of local government within the service area of the nature and extent of poverty within the area. Included in this annual report will be an assessment of the community action agency policies and programs and their impact on the problems of poverty in the service area.
(6) The convening of public meetings to provide low-income and other persons the opportunity to comment upon public policies and programs to reduce poverty. (1983 (Reg. Sess., 1984), c. 1034, s. 111.1; 1989 (Reg. Sess., 1990), c. 1004, s. 34(c).)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-2 - Definitions.

§ 108C-2. Definitions.
The following definitions apply in this Chapter:
(1) Adverse determination. – A final decision by the Department to deny, terminate, suspend, reduce, or recoup a Medicaid payment or to deny, terminate, or suspend a provider's or applicant's participation in the Medical Assistance Program.
(2) Applicant. – An individual, partnership, group, association, corporation, institution, or entity that applies to the Department for enrollment as a provider in the North Carolina Medicaid program.
(3) Department. – The North Carolina Department of Health and Human Services, its legally authorized agents, contractors, or vendors who acting within the scope of their authorized activities, assess, authorize, manage, review, audit, monitor, or provide services pursuant to Title XIX or XXI of the Social Security Act, the North Carolina State Plan of Medical Assistance, or any waivers of the federal Medicaid Act granted by the United States Department of Health and Human Services.
(4) Division. – The Division of Health Benefits of the Department.
(5) Final overpayment, assessment, or fine. – The amount the provider owes after appeal rights have been exhausted, which shall not include any agency decision that is being contested at the Department or the Office of Administrative Hearings or in Superior Court, provided that the Superior Court has entered a stay pursuant to the provisions of G.S. 150B-48.
(6) Repealed by Session Laws 2022-74, s. 9D.15(k).
(7) Managing employee. – As defined in 42 C.F.R. § 455.101.
(8) Medicaid. – The Medical Assistance program authorized by G.S. 108A-54 and as set forth in the North Carolina State Plan of Medical Assistance.
(9) Owner and/or operator. – As defined in 42 C.F.R. § 455.101.
(10) Provider. – An individual, partnership, group, association, corporation, institution, or entity required to enroll in the North Carolina Medicaid program to provide services, goods, supplies, or merchandise to a Medicaid recipient.
(11) Revalidation. – The reenrollment of a provider in the Medicaid program as required under federal law.
(12) Secretary. – The Secretary of the Department of Health and Human Services. (2011-399, s. 1; 2018-5, s. 11H.12(b); 2019-81, s. 15(a); 2022-74, s. 9D.15(k).)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-2.1 - Provider application and revalidation fee.

§ 108C-2.1. Provider application and revalidation fee.
(a) Each provider that submits an application to enroll in the Medicaid program shall submit an application fee. The application fee shall be the sum of the amount federally required and one hundred dollars ($100.00).
(b) The fee required under subsection (a) of this section shall be charged to all providers at revalidation every five years. (2017-57, s. 11H.3; 2021-62, s. 4.5.)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-5.1 - Post-payment review and recovery audit contracts.

§ 108C-5.1. Post-payment review and recovery audit contracts.
The Department shall not pay contingent fees pursuant to any contract with an entity conducting Medicaid post-payment reviews or Recovery Audit Contractor (RAC) audits before all appeal rights have been exhausted. Any contingent fee for Medicaid post-payment reviews or RAC audits shall be calculated as a percentage of the amount of the final overpayment, as defined in G.S. 108C-2(5). The State share of the contingent fee paid for Medicaid post-payment reviews or RAC audits shall not exceed the State share of the amount actually recovered by the Department and applied to the final overpayment. (2013-360, s. 12H.16(b).)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-6 - Agents, clearinghouses, and alternate payees; registration required.

§ 108C-6. Agents, clearinghouses, and alternate payees; registration required.
The Department is authorized to establish a registry of billing agents, clearinghouses, and/or alternate payees that submit claims on behalf of providers and to charge a fee to recover the costs of maintaining the registry in accordance with 42 U.S.C. § 1396a(a)(79) and implementing regulations. All billing agents, clearinghouses, or alternate payees shall register with the Department before submitting claims on behalf of providers or within six months of enactment of this Chapter, whichever is later. Any billing agent, clearinghouse, or alternate payee that fails to register with the Department prior to submitting claims on behalf of providers shall be excluded from the registry for a period not to exceed one year. (2011-399, s. 1.)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-8 - Threshold recovery amount.

§ 108C-8. Threshold recovery amount.
The Department shall not pursue recovery of Medicaid overpayments owed to the State for any total amount less than one hundred fifty dollars ($150.00) unless directed to do so by the Centers for Medicare and Medicaid Services or unless such recovery would be cost-effective and in the best interest of the State of North Carolina and Medicaid recipients. (2011-399, s. 1; 2022-74, s. 9D.15(z).)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-9 - Provider enrollment criteria.

§ 108C-9. Provider enrollment criteria.
(a) Applicants who submit an initial application for enrollment in North Carolina Medicaid shall be required to submit an attestation and complete trainings prior to being enrolled.
(b) The applicant's attestation shall contain a statement that the applicant's organization has met the minimum business requirements necessary to comply with all federal and State requirements governing the Medicaid and Children's Health Insurance programs, does not owe any outstanding taxes or fines to the U.S. or North Carolina Departments of Revenue or Labor or the Division of Employment Security (DES) of the Department of Commerce, does not owe any final overpayment, assessment, or fine to the North Carolina Medicaid program, the former NC Health Choice program, or any other State Medicaid or Children's Health Insurance program, and has implemented a corporate compliance program as required under federal law. The Department shall set forth by rule the minimum business requirements necessary to comply with all federal and State requirements governing the Medicaid or Children's Health Insurance programs.
(c) Prior to being initially enrolled in the North Carolina Medicaid program, an applicant's representative shall attend trainings as designated by the Department in rules, including, but not limited to, the following:
(1) The Basic Medicaid Billing Guide, common billing errors, and how to avoid them.
(2) Audit procedures, including explanation of the process by which the Department extrapolates audit results.
(3) How to identify Medicaid recipient fraud.
(4) How to report suspected fraud or abuse.
(5) Medicaid recipient due process and appeal rights.
Online training shall be available for completion through the Department's Web site. The Department may charge a fee to recover costs of such trainings.
(d) Making any materially false or misleading statement in an attestation or enrollment application shall be grounds for denial, termination of, or permanent exclusion from enrollment in the North Carolina Medicaid program. (2011-399, s. 1; 2011-401, s. 5.1; 2022-74, s. 9D.15(n).)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-10 - Change of ownership and successor liability.

§ 108C-10. Change of ownership and successor liability.
(a) For providers subject to this Chapter, any of the following occurrences shall constitute a change of ownership:
(1) In the case of a partnership, the removal, addition, or substitution of a partner, unless the partners expressly agree otherwise, as permitted by Chapter 59 of the General Statutes.
(2) In the case of a Limited Liability Company (LLC), the withdrawal or removal of a member, or when a person acquires a membership interest from the LLC or when a business entity converts or merges into the LLC pursuant to Chapter 57A of the General Statutes.
(3) In the case of an unincorporated sole proprietorship, the transfer of title and property of the provider that constitute the provider's business of providing services, goods, supplies, or merchandise to a Medicaid recipient to another party.
(4) The merger of the provider corporation into another corporation, or the consolidation of two or more corporations, resulting in the creation of a new corporation. Transfer of corporate stock or the merger of another corporation into the provider corporation shall not constitute change of ownership. Merger of related provider corporations shall not constitute a change in ownership.
(5) The lease of all or part of a provider's facility that will continue to be utilized for the provision of services, goods, supplies, or merchandise to a Medicaid recipient shall constitute a change of ownership of the leased portion.
(b) A provider must notify the Department at least 30 calendar days prior to the effective date of any change of ownership.
(c) An assigned Medicaid administrative participation or enrollment agreement shall be subject to all applicable statutes and regulations and to the terms and conditions under which it was originally issued including, but not limited to, both of the following:
(1) Any existing plan of correction.
(2) Payment of any outstanding final overpayments, assessments, or fines owed to the Department.
(d) The Department shall not as a condition of enrollment require a provider to accept an assigned Medicaid administrative participation or enrollment agreement upon a change in ownership. (2011-399, s. 1; 2022-74, s. 9D.15(z).)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-11 - Cooperation with investigations and audits.

§ 108C-11. Cooperation with investigations and audits.
(a) Providers shall cooperate with all announced and unannounced site visits, audits, investigations, post-payment reviews, or other program integrity activities conducted by the Department. Providers who fail to grant prompt and reasonable access or who fail to timely provide specifically designated documentation to the Department may be terminated from the North Carolina Medicaid program.
(b) The Department shall make all attempts to examine documentation without interfering with the clinical activities of the provider while conducting activities on the provider's premises.
(c) Nothing in this Chapter shall be construed to limit the ability of the federal government, the Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services Office of Inspector General, the U.S. Department of Justice, or any of the foregoing entities' contractors or agents, to enforce federal requirements for the submission of documentation in response to an audit or investigation. (2011-399, s. 1; 2022-74, s. 9D.15(z); 2023-11, s. 3.2(h).)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-12 - Appeals by Medicaid providers and applicants.

§ 108C-12. Appeals by Medicaid providers and applicants.
(a) General Rule. – Notwithstanding any provision of State law or rules to the contrary, this section shall govern the process used by a Medicaid provider or applicant to appeal an adverse determination made by the Department.
(b) Appeals. – Except as provided by this section, a request for a hearing to appeal an adverse determination of the Department under this section is a contested case subject to the provisions of Article 3 of Chapter 150B of the General Statutes.
(c) Final Decision. – The Office of Administrative Hearings shall make a final decision within 180 days of the date of filing of the appeal with the Office of Administrative Hearings. The time to make a final decision shall be extended in the event of delays caused or requested by the Department.
(d) Burden of Proof. – The petitioner shall have the burden of proof in appeals of Medicaid providers or applicants concerning an adverse determination. (2011-399, s. 1; 2014-100, s. 12H.27(a).)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-13 - Certain waivers of Medicaid copayments prohibited.

§ 108C-13. Certain waivers of Medicaid copayments prohibited.
(a) No provider that has obtained a permit pursuant to G.S. 90-85.21 or G.S. 90-85-21A shall waive the collection of copayments owed by Medicaid recipients with the intent to induce recipients to purchase, lease, or order items or services from the permitted provider. For enforcement purposes, a permitted provider that waives a copayment owed by a Medicaid recipient is in violation of this subsection regardless of the monetary amount that is waived by the permitted provider. A permitted provider shall not be in violation of this subsection if the provider waives a copayment owed by a Medicaid recipient for any of the following reasons:
(1) The waiver is authorized under the North Carolina Medicaid program.
(2) The permitted provider determines on an individual basis that the collection of the co-payment amount would create a substantial financial hardship for the recipient, provided the waiver of co-payments is not a regular business practice of the provider. For the purposes of this subdivision, a provider shall be considered engaged in the regular business practice of waiving co-payments if the permitted provider holds himself or herself out to recipients as waiving required co-payments.
(3) The permitted provider has made a good-faith effort to collect the co-payment amount, but the permitted provider's reasonable collection efforts fail.
(4) The permitted provider is a health care facility regulated pursuant to Chapter 131E or Chapter 122C of the General Statutes or that is owned or operated by the State of North Carolina.
(b) A violation of this section shall result in suspension or termination by the Department of a permitted provider's participation in the North Carolina Medicaid program in accordance with administrative sanctions and remedial measures established by the Department for violations of this section. (2013-145, s. 1; 2022-74, s. 9D.15(o).)
2023 North Carolina General Statutes › Chapter 108C - Medicaid Provider Requirements › § 108C-14 - Provider performance bonds.

§ 108C-14. Provider performance bonds.
(a) Subject to the provisions of this section, the Department may require Medicaid-enrolled providers to purchase a performance bond in an amount not to exceed one hundred thousand dollars ($100,000) naming as beneficiary the Department of Health and Human Services, Division of Health Benefits, or provide to the Department a validly executed letter of credit or other financial instrument issued by a financial institution or agency honoring a demand for payment in an equivalent amount. The Department may require the purchase of a performance bond or the submission of an executed letter of credit or financial instrument as a condition of initial enrollment, reenrollment, recredentialing, or reinstatement if any of the following are true:
(1) The provider fails to demonstrate financial viability.
(2) The Department determines there is significant potential for fraud and abuse.
(3) The Department otherwise finds it is in the best interest of the Medicaid program to do so.
The Department shall specify the circumstances under which a performance bond or executed letter of credit will be required.
(b) The Department may waive or limit the requirements of subsection (a) of this section for individual Medicaid-enrolled providers or for one or more classes of Medicaid-enrolled providers based on the following:
(1) The provider's or provider class's dollar amount of monthly billings to Medicaid.
(2) The length of time an individual provider has been licensed, endorsed, certified, or accredited in this State to provide services.
(3) The length of time an individual provider has been enrolled to provide Medicaid services in this State.
(4) The provider's demonstrated ability to ensure adequate record keeping, staffing, and services.
(5) The need to ensure adequate access to care.
In waiving or limiting requirements of this section, the Department shall take into consideration the potential fiscal impact of the waiver or limitation on the State Medicaid Program. The Department shall provide to the affected provider written notice of the findings upon which its action is based and shall include the performance bond requirements and the conditions under which a waiver or limitation apply. (2013-360, s. 12H.17(a); 2019-81, s. 15(a).)
2023 North Carolina General Statutes › Chapter 108D - Medicaid and NC Health Choice Managed Care Programs › Article 1 - General Provisions. › § 108D-2 - Scope; applicability of this Chapter.

§ 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 services delivered through the fee-for-service program. (2013-397, s. 1; 2019-81, s. 1(a); 2022-74, s. 9D.15(s).)