reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0600 - ADMINISTRATIVE SANCTIONS AND RECOUPMENT › Section 22F .0602 - ADMINISTRATIVE ACTIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The following
				  types of administrative actions may be imposed in any particular order by the
				  Division in instances of program abuse by providers:
(1) warning letters for instances of abuse
				  that can be settled by issuing a warning to cease the specific abuse. The
				  letter shall state that any further violations shall result in administrative
				  or legal action initiated by the Division;
(2) suspension of a provider from further
				  participation in the Medicaid Program for a specified period of time, subject
				  to appeal rights under G.S. 150B, Article 3, provided that findings have been
				  made by the Division that this action shall not deprive recipients of access to
				  reasonable service of adequate quality as set out in
				  42 C.F.R.
				  440.230,
				  440.260, and
				  455.23, which are adopted and
				  incorporated by reference with subsequent changes or amendments and available
				  free of charge at
https://www.ecfr.gov/
;
(3) termination of a provider from further
				  participation in the Medicaid Program, subject to appeal rights under G.S.
				  150B, Article 3, provided that findings have been made by the Division that
				  this action shall not deprive recipients of access to reasonable services of
				  adequate quality as set out in
				  42 C.F.R.
				  440.230,
				  440.260, and
				  455.23, which are adopted and
				  incorporated by reference with subsequent changes or amendments and available
				  free of charge at
https://www.ecfr.gov
;
(4) probation whereby a provider's
				  participation is monitored for a specified period of time not to exceed one
				  year, subject to appeal rights under G.S. 150B, Article 3. At the termination
				  of the probation period the Division shall conduct a follow-up review of the
				  provider's Medicaid practice to ensure compliance with all applicable laws,
				  regulations, and conditions of participation in Medicaid;
(5) negotiation of a financial settlement
				  with the provider;
(6) placing the
				  provider on prepayment review in accordance with
				  G.S.
				  108C-7; or
(7) establishing a monitoring program not to
				  exceed one year whereby the provider shall comply with pre-established
				  conditions of participation to allow review and evaluation of the provider's
				  Medicaid claims.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0600 - ADMINISTRATIVE SANCTIONS AND RECOUPMENT › Section 22F .0603 - PROVIDER LOCK-OUT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The Division
				  may suspend the provider, based on the factors set out in Rule .0602(b) of this
				  Subchapter, from participating in the Medicaid program, provided that the
				  Division meets the requirements of
				  42 C.F.R.
				  431.54(f), which is adopted
				  and incorporated by reference with subsequent changes or amendments and
				  available free of charge at
https://www.ecfr.gov/
.
(b) Suspension or termination from
				  participation of any provider shall preclude the provider from submitting
				  claims for payment to the Division. No claims may be submitted by or through
				  any clinic, group, corporation, or other association for any services or
				  supplies provided by a person within such organization who has been suspended
				  or terminated from participation in the Medicaid program, except for those
				  services or supplies provided prior to the suspension or termination effective
				  date.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-54.1B;
					 42 C.F.R.
					 440.230;
					 42 C.F.R. 440.260; 42 C.F.R. Part
					 431; 42 C.F.R.
					 431.54;
					 42 C.F.R. Part 455;
Eff. May 1, 1984;
Amended Eff. December 1, 1995;
Readopted Eff. September 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0600 - ADMINISTRATIVE SANCTIONS AND RECOUPMENT › Section 22F .0604 - REPEALED - WITHHOLDING OF MEDICAID PAYMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-54.1B;
					 108C-5;
					 150B-21.6; 42 C.F.R. Part 431;
					 42 C.F.R.
					 455.23;
Eff. May 1,
					 1984;
Amended Eff. December 1, 1995;
Repealed Eff.
					 September 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0600 - ADMINISTRATIVE SANCTIONS AND RECOUPMENT › Section 22F .0605 - REPEALED - TERMINATION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b); 42 C.F.R. Part
					 431; 42 C.F.R. Part 455;
Eff. May 1, 1984;
Repealed
					 Eff. July 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0600 - ADMINISTRATIVE SANCTIONS AND RECOUPMENT › Section 22F .0606 - REPEALED - TECHNIQUE FOR PROJECTING MEDICAID OVERPAYMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-63; 42 C.F.R. Part 455,
					 Subpart F;
Eff. October 1, 1987;
Temporary Amendment
					 Eff. November 8, 1996;
Amended Eff. August 1, 1998;
Repealed Eff. July 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0700 - RECIPIENT FRAUD AND ABUSE › Section 22F .0701 - DEFINITION OF FRAUD AND ABUSE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) For
				  purposes of this Section the word "person" includes any natural person,
				  association, consortium, corporation, body politic, partnership, or other
				  group, entity or organization.
(b)
				  Abuse. The type of abuse to which the Medicaid program is extremely vulnerable
				  is recipient overutilization of medical and health care services for which he
				  or she is eligible. A recipient may be regarded as overutilizing the program
				  care and services if he or she has been furnished covered items or services at
				  a frequency or amount not medically necessary, as determined in accordance with
				  utilization guidelines established by the State, and the services were
				  furnished at the request of the recipient.
Authority
					 G.S.
					 108A-25(b);
					 108A-64; 42 C.F.R. Part 431; 42
					 C.F.R. Part 455;
42 C.F.R. Part 456;
Eff. May 1,
					 1984;
Amended Eff. May 1, 1990;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. August 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0700 - RECIPIENT FRAUD AND ABUSE › Section 22F .0702 - GENERAL

Current through Register Vol. 39, No. 2, July 15, 2024
The Division will establish a statewide program for the
					 prevention, detection, investigation, referral, prosecution, recoupment of
					 overpayments, and reporting of fraud, abuse, and overutilization due to
					 recipient aberrant practices. The program will be supervised by the Division
					 and administered by the county departments of social
					 services.
Authority
					 G.S.
					 108A-25(b);
					 108A-64; 42 C.F.R. Part 431; 42
					 C.F.R. Part 455;
42 C.F.R. Part 456;
Eff. May 1,
					 1984;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. August 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0700 - RECIPIENT FRAUD AND ABUSE › Section 22F .0703 - EXPIRED - WARNING NOTIFICATION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-64; 42 C.F.R. Part 431; 42
					 C.F.R. Part 455; 42 C.F.R. Part 456;
Eff. May 1, 1984;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0700 - RECIPIENT FRAUD AND ABUSE › Section 22F .0704 - RECIPIENT MANAGEMENT LOCK IN SYSTEM

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  Division shall have methods and procedures for the control of recipient
				  overutilization of Medicaid benefits. These methods and procedures shall
				  include Lock-In of a recipient, shown to be an overutilizer, to specified
				  providers of health care and services, as set out in
				  42 C.F.R.
				  440.230,
				  440.260, and
				  431.54(e), which
				  are adopted and incorporated by reference with subsequent changes or amendments
				  and available free of charge at
https://www.ecfr.gov/
.
(b) Prior to implementing Lock-In, the
				  following steps shall be taken:
(1)
				  Recipient's utilization pattern shall be documented as inappropriate;
(2) Recipient shall be notified that the
				  State is imposing a Lock-In procedure;
(3) Recipient shall be offered the
				  opportunity to select a provider;
(4) In the event the recipient fails to
				  select a provider, a provider shall be selected for him or her by the Division;
				  and
(5) Recipient shall receive an
				  eligibility card indicating the selected providers.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0700 - RECIPIENT FRAUD AND ABUSE › Section 22F .0705 - EXPIRED - OVERUTILIZATION SURVEILLANCE (SUR INDICATOR)

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-64; 42 C.F.R. Part 431; 42
					 C.F.R. Part 455; 42 C.F.R. Part 456;
Eff. May 1, 1984;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0700 - RECIPIENT FRAUD AND ABUSE › Section 22F .0706 - RECOUPMENT OF RECIPIENT OVERPAYMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
The Division requires that:
(1) counties recover recipient responsible
				  overpayments as a debt to the participating local governments;
(2) counties accept payments from each
				  recipient and give the recipient a receipt for each transaction;
(3) counties keep a separate accounting for
				  Medicaid repayments on each recipient;
(4) repayments shall be forwarded to the
				  Division of Health Benefits utilizing the DMA 7050 form. This shall be done on
				  a monthly basis;
(5) the recoupment
				  monies that are apportioned to the repayment of federal, State, and county
				  funds shall be made by the State;
(6) Medical Assistance overpayments shall not
				  be recouped through the reduction of Temporary Assistance for Needy Families
				  (TANF) checks; and
(7) the Division
				  receives its prorated share of recoupments of recipient overpayments involving
				  multiple programs.
Authority
					 G.S.
					 108A-25(b);
					 108A-64; 42 C.F.R. Part 431; 42
					 C.F.R. Part 455; 42 C.F.R. Part 456;
Eff. May 1, 1984;
Readopted Eff. July 1, 2018;
Amended Eff. March 1,
					 2020.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0700 - RECIPIENT FRAUD AND ABUSE › Section 22F .0707 - EXPIRED - REPORTS AND REVIEWS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-64; 42 C.F.R. Part 431; 42
					 C.F.R. Part 455; 42 C.F.R. Part 456;
Eff. May 1, 1984;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0101 - EXPIRED - REIMBURSEMENT PRINCIPLES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 447, Subpart C;
Eff. January 1,
					 1978;
Amended Eff. March 22, 1978;
Emergency Amendment
					 [(a), (b), (c), (g), (m), (o), (p), (q)] Eff. April 1, 1978 for a Period of 120
					 Days to Expire on July 30, 1978;
Emergency Amendment [(a), (b),
					 (c), (g), (m), (o), (p), (q)] Expired Eff. July 30, 1978;
Amended
					 Eff. August 1, 1982;
Temporary Amendment Eff. October 1, 1984 for a
					 Period of 120 Days to Expire on January 28, 1985;
Amended Eff.
					 April 1, 1992; October 1, 1991; January 28, 1985;
Temporary
					 Amendment Eff. June 26, 2003;
Temporary Amendment Expired April 27,
					 2004;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0102 - EXPIRED - RATE SETTING METHODS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 29 C.F.R.
					 1910, Subpart Z;
					 42 C.F.R.
					 447, Subpart C; S.L. 1991, c. 689, s.
					 95;
Eff. January 1, 1978;
Temporary Amendment Eff.
					 October 1, 1984 for a Period of 120 Days to Expire on January 28,
					 1985;
Temporary Amendment Eff. October 1, 1991 for a Period of 180
					 Days to Expire on March 31, 1992;
Amended Eff. April 1,
					 1992;
Temporary Amendment Eff. July 1, 1992 for a Period of 180
					 Days to Expire on December 31, 1992;
Amended Eff. May 1, 1995;
					 February 1, 1993; January 1, 1993;
Temporary Amendment Eff. January
					 22, 1998;
Amended Eff. April 1, 1999;
Temporary
					 Amendment Eff. November 9, 2001;
Temporary Amendment Expired August
					 30, 2002;
Amended Eff. April 1, 2003;
Temporary
					 Amendment Eff. August 3, 2004;
Amended Eff. January 1,
					 2005;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0103 - EXPIRED - REASONABLE AND NON ALLOWABLE COSTS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 447, Subpart C;
Eff. January 1,
					 1978;
Temporary Amendment Eff. October 1, 1984 for a Period of 120
					 Days to Expire on January 28, 1985;
Amended Eff. January 4, 1993;
					 October 1, 1991; November 1, 1988; January 28, 1985;
Temporary
					 Amendment Eff. August 3, 2004;
Amended January 1, 2005;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0104 - EXPIRED - COST REPORTING: AUDITING

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447, Subpart C;
Eff. January 1,
					 1978;
Amended Eff. March 22, 1978;
Emergency Amendment
					 [(a), (h)] Eff. April 1, 1978 for a period of 120 days to expire on July 30,
					 1978;
Emergency Amendment [(a), (h)] Expired Eff. July 30,
					 1978;
Temporary Amendment Eff. October 1, 1984 for a period of 120
					 days to expire on January 28, 1985;
Amended Eff. August 1, 1998;
					 June 1, 1995; January 4, 1993; October 1, 1991; December 1, 1988;
Temporary Amendment Eff. August 3, 2004;
Amended Eff. January 1,
					 2005;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0105 - EXPIRED - CASE-MIX INDEX CALCULATION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S. L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 447, Subpart C;
Eff. January 1,
					 1978;
Amended Eff. March 25, 1980;
Temporary Amendment
					 Eff. October 1, 1984 for a Period of 120 Days to Expire on January 28,
					 1985;
Amended Eff. March 1, 1994; April 1, 1988; January 28,
					 1985;
Temporary Amendment Eff. August 3, 2004;
Amended
					 Eff. January 1, 2005;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0106 - EXPIRED - RECONSIDERATION REVIEWS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 447, Subpart C;
Eff. January 1,
					 1978;
Temporary Amendment Eff. October 1, 1984 for a Period of 120
					 Days to Expire on January 28, 1985;
Amended Eff. January 4, 1993;
					 November 1, 1991; May 1, 1990; June 1, 1989;
Temporary Amendment
					 Eff. August 3, 2004;
Amended Eff. February 1, 2005;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0107 - EXPIRED - PAYMENT ASSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; Section 95 of Chapter 689, 1991 Session Laws;
					 42 C.F.R.
					 447, Subpart C;
Temporary Rule
					 Eff. October 1, 1984 for a Period of 120 Days to Expire on January 28,
					 1985;
Eff. January 28, 1985;
Amended Eff. December 1,
					 1988;
Temporary Amendment Eff. August 1, 1991 For a Period of 180
					 Days to Expire on January 31, 1992;
Amended Eff. February 1, 1992;
					 October 1, 1991;
Temporary Amendment Eff. August 3,
					 2004;
Amended Eff. January 1, 2005;
Expired Eff.
					 September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0108 - REIMBURSEMENT METHODS FOR STATE OPERATED FACILITIES

Current through Register Vol. 39, No. 2, July 15, 2024
The Division's reimbursement methodology is set forth in
					 the Medicaid State Plan. Any payments in excess of costs shall be refunded to
					 the Division. Any costs in excess of payments shall be paid to the
					 provider.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 447, Subpart C;
Eff. January 1,
					 1992;
Temporary Amendment Eff. August 3, 2004;
Amended
					 Eff. January 1, 2005;
Readopted Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0109 - NURSING HOME PROVIDER ASSESSMENT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) In
				  accordance with 42 USC
				  1396b(w) and
				  42 CFR, Part 433, Subpart B, which
				  are adopted and incorporated by reference with subsequent changes or
				  amendments; and consistent with the CMS Federal Waiver approved April 5, 2004
				  with an effective date of October 1, 2003, which is adopted and incorporated by
				  reference with subsequent changes or amendments, a monthly nursing facility
				  assessment based on all occupied nursing facility bed days of service shall be
				  imposed on all nursing bed days in licensed nursing facilities, except:
(1) any nursing facility bed day of service
				  provided by a Continuing Care Retirement Community (CCRC), as defined by
				  G.S.
				  58-64 and licensed by the North Carolina
				  Department of Insurance; or
(2) any
				  nursing facility bed day of service paid for under the Medicare program
				  established under Title XVIII of the Social Security Act.
A copy of the CMS Federal Waiver may be obtained by
					 contacting the Division of Health Benefits, 2501 Mail Service Center, Raleigh,
					 North Carolina 27699-2501, (919) 855-4000. Copies of
					 42 USC
					 1396b(w) and
					 42 CFR, Part 433, Subpart B are
					 available free of charge at
http://uscode.house.gov/
and
https://www.ecfr.gov/
,
					 respectively.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0100 - REIMBURSEMENT FOR NURSING FACILITY SERVICES › Section 22G .0110 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
"Public nursing facility", as used in
					 10A NCAC
					 22G, means any nursing facility that
					 is:
(1) Owned or operated by the State
				  or any department or instrumentality of the State or by county, city, hospital
				  district, or hospital authority; or
(2) Is operated by a nonprofit corporation or
				  association, a majority of whose board of directors or trustees are appointed
				  by the State or any department or instrumentality of the State or by the
				  governing body of a county, city, hospital district, or hospital authority;
				  or
(3) Is operated by a hospital
				  that is a "public hospital" under
				  G.S.
				  159-39(a); or
(4) Is operated by a hospital that has
				  verified its status by certifying State, local, hospital district or authority
				  governmental control on the most recent version of the Form CMS 1514;
				  or
(5) Is a facility to which the
				  State or any department or instrumentality of the State or a city or a county
				  makes current appropriations (other than appropriations for the cost of medical
				  care to prisoners or indigents).
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 159-39(a);
Temporary Adoption Eff. August 3, 2004;
Eff. January 1,
					 2005;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. August 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0200 - HOSPITAL INPATIENT REIMBURSEMENT PLAN › Section 22G .0201 - EXPIRED - REIMBURSEMENT PRINCIPLES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447, Subpart C;
Eff. February 1,
					 1995;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0200 - HOSPITAL INPATIENT REIMBURSEMENT PLAN › Section 22G .0202 - EXPIRED - DRG RATE SETTING METHODOLOGY

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447, Subpart C;
Eff. March 1,
					 1995;
Temporary Amendment Eff. January 22, 1998;
Amended Eff. April 1, 1999;
Temporary Amendment Eff. November 9,
					 2001;
Temporary Amendment Expired August 30, 2002;
Amended Eff. August 1, 2004;
Expired Eff. September 1, 2015
					 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0200 - HOSPITAL INPATIENT REIMBURSEMENT PLAN › Section 22G .0203 - EXPIRED - EXCEPTIONS TO DRG REIMBURSEMENT

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55(c);
					 42 C.F.R.
					 447, Subpart C;
					 42 C.F.R.
					 447.321;
Eff. February 1,
					 1995;
Temporary Amendment Eff. September 15, 1995, for a period of
					 180 days or until the permanent rule becomes effective, whichever is
					 sooner;
Amended Eff. January 1, 1996;
Temporary
					 Amendment Eff. September 25, 1996;
Temporary Amendment Eff.
					 September 30, 1997;
Temporary Amendment Expired July 31,
					 1998;
Temporary Amendment Eff. September 16, 1998;
Temporary Amendment Expired June 13, 1999;
Temporary Amendment Eff.
					 September 22, 1999;
Temporary Amendment Expired July 11,
					 2000;
Temporary Amendment Eff. June 13, 2001; September 21,
					 2000;
Temporary Amendment Eff. May 15, 2002;
Amended
					 Eff. April 1, 2003;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0200 - HOSPITAL INPATIENT REIMBURSEMENT PLAN › Section 22G .0204 - EXPIRED - DISPROPORTIONATE SHARE HOSPITALS (DSH)

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447, Subpart C;
Eff. February 1,
					 1995;
Amended Eff. July 1, 1995;
Temporary Amendment
					 Eff. September 15, 1995, for a period of 180 days or until the permanent rule
					 becomes effective, whichever is sooner;
Temporary Amendment Eff.
					 September 29, 1995, for a period of 180 days or until the permanent rule
					 becomes effective, whichever is sooner;
Amended Eff. January 1,
					 1996;
Temporary Amendment Eff. September 16, 1998; September 30,
					 1997; April 15, 1997; September 25, 1996;
Temporary Amendment
					 Expired on June 13, 1999;
Temporary Amendment Eff. September 22,
					 1999;
Temporary Amendment Expired on July 11, 2000;
Temporary Amendment Eff. May 15, 2002; June 1, 2001; December 10, 2001;
					 September 21, 2000;
Amended Eff. August 1, 2004; April 1,
					 2003;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0200 - HOSPITAL INPATIENT REIMBURSEMENT PLAN › Section 22G .0205 - EXPIRED - OUT OF STATE HOSPITALS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447, Subpart C;
Eff. February 1,
					 1995;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0200 - HOSPITAL INPATIENT REIMBURSEMENT PLAN › Section 22G .0206 - EXPIRED - SPECIAL SITUATION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447 Subpart C;
Eff. February 1,
					 1995;
Temporary Amendment Eff. December 10, 2001;
Temporary Amendment Expired September 29, 2002;
Amended Eff. August
					 1, 2004;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0200 - HOSPITAL INPATIENT REIMBURSEMENT PLAN › Section 22G .0207 - EXPIRED - COST REPORTING AND AUDITS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447, Subpart C;
Eff. February 1,
					 1995;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0200 - HOSPITAL INPATIENT REIMBURSEMENT PLAN › Section 22G .0208 - REPEALED - ADMINISTRATIVE RECONSIDERATION REVIEWS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447, Subpart C;
Eff. February 1,
					 1995;
Repealed Eff. July 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0200 - HOSPITAL INPATIENT REIMBURSEMENT PLAN › Section 22G .0209-.0213 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447, Subpart C;
Eff. February 1,
					 1995;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0300 - ICF MR PROSPECTIVE RATE PLAN › Section 22G .0301 - EXPIRED - PAYMENT FOR SERVS PROSPECTIVE REIMBURSEMENT PLAN ICF MR FACILITIES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 447, Subpart C;
Eff. January 1,
					 1982;
Temporary Amendment Eff. July 8, 1993 for a period of 180
					 days or until the permanent rule becomes effective, whichever is
					 sooner;
Amended Eff. November 1, 1993;
Expired Eff.
					 September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0300 - ICF MR PROSPECTIVE RATE PLAN › Section 22G .0302 - EXPIRED - REPORTING REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Temporary Amendment
					 Eff. July 8, 1993, for a period of 180 days or until the permanent rule becomes
					 effective, whichever is sooner.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 42 C.F.R.
					 447, Subpart C;
Eff. January 1,
					 1982;
Amended Eff. August 1, 1995; November 1, 1993; May 1, 1990;
					 April 1, 1988;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0300 - ICF MR PROSPECTIVE RATE PLAN › Section 22G .0303 - EXPIRED - REQUIREMENTS FOR FINANCIAL RECORDS

Current through Register Vol. 39, No. 2, July 15, 2024
Temporary Amendment
					 Eff. July 8, 1993, for a period of 180 days or until the permanent rule becomes
					 effective, whichever is sooner;
Temporary Amendment Eff. July 1,
					 1992 for a period of 180 days to expire on
December 31,
					 1992;
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R. Part 447, Subpart C;
Eff. January 1,
					 1982;
Amended Eff. November 1, 1993; January 4, 1993; January 1,
					 1993; December 1, 1989;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0300 - ICF MR PROSPECTIVE RATE PLAN › Section 22G .0304 - EXPIRED - RATE SETTING METHOD FOR NON-STATE FACILITIES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; 42 C.F.R. Part 447,
					 Subpart C;
Eff. December 1, 1984;
Amended Eff. March 1,
					 1988; January 1, 1987;
Temporary Amendment Eff. July 8, 1993 for a
					 period of 180 days or until the permanent rule becomes effective, whichever is
					 sooner;
Amended Eff. August 1, 1995; November 1, 1993;
Temporary Amendment Eff. September 8, 1999; August 7, 1998;
Amended
					 Eff. March 19, 2001; August 1, 2000;
Temporary Amendment Eff.
					 December 10, 2001;
Temporary Amendment Expired September 29,
					 2002;
Amended Eff. August 1, 2004;
Expired Eff.
					 September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0300 - ICF MR PROSPECTIVE RATE PLAN › Section 22G .0305-.0309 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 447, Subpart C;
Temporary
					 Adoption Eff. July 8, 1993 for a period of 180 days or until the permanent rule
					 becomes effective, whichever is sooner;
Eff. November 1,
					 1993;
Amended Eff. August 1, 1995;
Temporary Amendment
					 Eff. June 26, 2003;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0400 - PROVIDER FEE SCHEDULES › Section 22G .0401 - EXPIRED - PHYSICIAN'S FEE SCHEDULE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
Eff.
					 October 1, 1982;
Amended Eff. July 1, 1997; July 1, 1995; January
					 4, 1993; June 1, 1990; December 1, 1988;
Temporary Amendment Eff.
					 July 22, 1998; January 22, 1998;
Amended Eff. April 1,
					 1999;
Temporary Amendment Eff. January 1, 2000 (This temporary
					 amendment amends and replaces a permanent rulemaking originally proposed to be
					 effective August 2000);
Amended Eff. March 19, 2001;
Temporary Amendment Eff. September 10, 2001;
Temporary Amendment
					 Expired June 28, 2002;
Amended Eff. April 1, 2003;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0400 - PROVIDER FEE SCHEDULES › Section 22G .0402 - EXPIRED - OTHER SERVICES PERFORMED BY PHYSICIANS AND OTHER PRACTITIONERS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b); S.L. 1985, c.
					 479, s. 86;
Eff. January 4, 1993;
Temporary Amendment
					 Eff. March 7, 2002;
Temporary Amendment Expired December 27,
					 2002;
Amended Eff. August 1, 2004;
Expired Eff.
					 September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A;
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0501 - EXPIRED - CLINIC SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b); S.L. 1985, c.
					 479, s. 86;
Eff. February 1, 1984;
Temporary Amendment
					 Eff. November 9, 2001;
Temporary Amendment Expired August 30,
					 2002;
Amended Eff. April 1, 2003;
Expired Eff.
					 September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0502 - REPEALED - MENTAL HEALTH CLINIC SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b); S.L. 1985, c.
					 479, s. 86;
Eff. February 1, 1984;
Repealed Eff. July
					 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0503 - EXPIRED - INPATIENT HOSPITAL: INAPPROPRIATE LEVEL OF CARE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 42 C.F.R.
					 447.253; S.L. 1985, c. 479, s.
					 86;
Eff. May 1, 1984;
Expired Eff. September 1, 2015
					 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0504 - HEALTH MAINTENANCE ORGANIZATIONS AND PREPAID HEALTH PLANS

Current through Register Vol. 39, No. 2, July 15, 2024
Reimbursement to Health Maintenance Organizations and
					 Prepaid Health Plans for services rendered shall be paid as a monthly
					 capitation fee developed by the Division and set out in contract with the
					 Health Maintenance Organization or Prepaid Health Plan.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R. Part 434; 42 C.F.R. Part 438.6;
Eff. August 1,
					 1984;
Amended Eff. February 1, 1985;
Readopted Eff.
					 July 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0505 - EXPIRED - PERSONAL CARE SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 131D-4.1;
					 131D-4.2; S.L. 1995 c. 507, s.
					 23.10; 42 C.F.R.
					 440.170(f);
Eff.
					 January 1, 1986;
Temporary Amendment Eff. April 22, 1996; January
					 9, 1997;
Amended Eff. August 1, 1998;
Temporary
					 Amendment Eff. January 1, 2000;
Temporary Amendment Expired on
					 October 28, 2000;
Temporary Amendment Eff. July 1,
					 2002;
Amended Eff. August 1, 2002;
Temporary Amendment
					 Eff. January 13, 2003;
Amended Eff. August 1, 2004;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0506 - EXPIRED - INDEPENDENT LABORATORY SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55;
					 P.L.
					 93-369;
					 P.L.
					 99-272;
					 42 C.F.R.
					 447.10;
					 42 C.F.R. 447.342;
Eff. March 1, 1987;
Amended Eff. September 1, 1991;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0507 - EXPIRED - DURABLE MEDICAL EQUIPMENT AND RELATED SUPPLIES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 42 C.F.R.
					 447, Subpart D; 1991 S.L, s. 95, c.
					 689;
Eff. March 1, 1990;
Temporary Amendment Eff.
					 August 1, 1991 for a period of 180 days to expire on
January 31,
					 1992;
Amended Eff. December 1, 1995; February 1, 1992;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0508 - EXPIRED - PRIVATE DUTY NURSING

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 42 C.F.R.
					 440.80;
Eff. January 1,
					 1994;
Temporary Amendment Eff. December 20, 2002; July 1,
					 2002;
Temporary Amendment Expired November 28, 2003;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0509 - REPEALED - REIMBURSEMENT PRINCIPLES, HEARING AIDS/ACCESSORIES/BATTERIES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
Eff.
					 January 4, 1993;
Recodified from
					 10 NCAC
					 26H .0509 Eff. January 1, 1994;
Repealed Eff. July 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0500 - REIMBURSEMENT FOR SERVICES › Section 22G .0510 - EXPIRED - CASE MANAGEMENT SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54; 1915 (g) of the Social
					 Security Act;
Eff. April 1, 1994;
Expired Eff.
					 September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0600 - HOME HEALTH PROSPECTIVE REIMBURSEMENT › Section 22G .0601 - EXPIRED - REIMBURSEMENT PRINCIPLES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 440.70;
Eff. October 1,
					 1987;
Amended Eff. October 1, 1992;
Temporary Amendment
					 Eff. August 1, 1991 for a period of 180 days to expire on
January
					 31, 1992;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0600 - HOME HEALTH PROSPECTIVE REIMBURSEMENT › Section 22G .0602 - EXPIRED - REIMBURSEMENT METHODS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c.479, s.
					 86; 42 C.F.R.
					 440.70;
Eff. October 1,
					 1987;
Amended Eff. October 1, 1992; May 1, 1990;
Temporary Amendment Eff. October 4, 1996;
Amended Eff. April 1,
					 1997;
Temporary Amendment Eff. July 25, 1997;
Amended
					 Eff. August 1, 1998;
Temporary Amendment Eff. November 9,
					 2001;
Temporary Amendment Expired August 30, 2002;
Amended Eff. April 1, 2003;
Expired Eff. September 1, 2015 pursuant
					 to G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0600 - HOME HEALTH PROSPECTIVE REIMBURSEMENT › Section 22G .0603 - EXPIRED - APPEALS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985. c. 479, s.
					 86; 42 C.F.R.
					 440.70;
Eff. October 1,
					 1987;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0600 - HOME HEALTH PROSPECTIVE REIMBURSEMENT › Section 22G .0604 - EXPIRED - COST REPORTING AND AUDITING

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S.L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 440.70;
Eff. October 1,
					 1987;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter G - REIMBURSEMENT PLANS › Section .0600 - HOME HEALTH PROSPECTIVE REIMBURSEMENT › Section 22G .0605 - EXPIRED - PAYMENT ASSURANCES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-55; S. L. 1985, c. 479, s.
					 86; 42 C.F.R.
					 440.70;
Eff. October 1,
					 1987;
Amended Eff. October 1, 1992; May 1, 1990;
Expired Eff. September 1, 2015 pursuant to
					 G.S.
					 150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter H - APPEALS PROCEDURES › Section .0100 - BENEFICIARY APPEALS FOR DENIAL, TERMINATION, SUSPENSION, OR REDUCTION OF A MEDICAID SERVICE OR AN AUTHORIZATION FOR A MEDICAID SERVICE › Section 22H .0101 - APPEALS BY MEDICAID BENEFICIARIES

Current through Register Vol. 39, No. 2, July 15, 2024
Appeals by Medicaid beneficiaries of determinations by the
					 Division to deny, terminate, suspend, or reduce a Medicaid service or an
					 authorization for a Medicaid service are governed by
					 G.S.
					 108A-70.9A and
					 G.S.
					 108A-70.9B.
Authority
					 G.S.
					 108A-25(b);
					 108A-70.9A;
					 108A-70.9B;
					 42 C.F.R.
					 431;
					 42 C.F.R. 456;
Eff.
					 April 13, 1979;
Amended Eff. May 1, 1990; November 1, 1983; October
					 4, 1979;
RRC objection due to lack of Authority and ambiguity Eff.
					 October 18, 1995;
Amended Eff. December 11, 1995;
Readopted Eff. July 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter H - APPEALS PROCEDURES › Section .0100 - BENEFICIARY APPEALS FOR DENIAL, TERMINATION, SUSPENSION, OR REDUCTION OF A MEDICAID SERVICE OR AN AUTHORIZATION FOR A MEDICAID SERVICE › Section 22H .0102-.0103

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 42 C.F.R.
					 431;
					 42 C.F.R. 456;
Eff.
					 April 13, 1979;
Amended Eff. December 1, 1995; May 1, 1990;
					 November 1, 1983; October 4, 1979;
RRC objection to Rule .0103 due
					 to lack of Authority and ambiguity Eff. October 18, 1995;
Amended
					 Eff. December 11, 1995;
Repealed Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter H - APPEALS PROCEDURES › Section .0100 - BENEFICIARY APPEALS FOR DENIAL, TERMINATION, SUSPENSION, OR REDUCTION OF A MEDICAID SERVICE OR AN AUTHORIZATION FOR A MEDICAID SERVICE › Section 22H .0104 - PAYMENT PENDING APPEALS

Current through Register Vol. 39, No. 2, July 15, 2024
If a final decision rendered in accordance with
					 G.S.
					 108A-70.9B(g) upholds the
					 adverse determination, as defined in
					 G.S.
					 108A-70.9A(a), the Division
					 may institute recovery procedures against the beneficiary to recoup the cost of
					 any services furnished resulting from the appeal process.
Authority
					 G.S.
					 108A-25(b);
					 108A-70.9A;
					 108A-70.9B;
					 42 C.F.R.
					 431.230(b);
Eff.
					 April 13, 1979;
Amended Eff. December 1, 1995; October 4,
					 1979;
Readopted Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter H - APPEALS PROCEDURES › Section .0100 - BENEFICIARY APPEALS FOR DENIAL, TERMINATION, SUSPENSION, OR REDUCTION OF A MEDICAID SERVICE OR AN AUTHORIZATION FOR A MEDICAID SERVICE › Section 22H .0105 - REPEALED - DISMISSAL OF APPEAL

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b); 42 C.F.R. Part
					 431;
Eff. April 13, 1979;
Amended Eff. December 1,
					 1995; May 1, 1990;
Repealed Eff. July 1,
					 2018.