reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0100 - COVERAGE GROUPS › Section 21B .0102 - OPTIONAL (TRANSFERRED TO 10A NCAC 23D .0102)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0200 - APPLICATION PROCESS › Section 21B .0201 - ACCEPTANCE OF APPLICATION (TRANSFERRED TO 10A NCAC 23C .0101)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0200 - APPLICATION PROCESS › Section 21B .0202 - FACE-TO-FACE INTERVIEW (TRANSFERRED TO 10A NCAC 23C .0102)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0200 - APPLICATION PROCESS › Section 21B .0203 - APPLICATION PROCESSING STANDARDS (TRANSFERRED TO 10A NCAC 23C .0201)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0200 - APPLICATION PROCESS › Section 21B .0204 - EFFECTIVE DATE OF ASSISTANCE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  first month of Medicaid coverage shall be:
(1) the month of application, or for SSI
				  recipients, the month of application for SSI;
(2) as much as three months prior to the
				  month of application when the client received medical services covered by the
				  program and was eligible during the month or months of medical need;
				  or
(3) if the client applies prior
				  to meeting a non-financial requirement, no earlier than the calendar month in
				  which all non-financial requirements are met.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0200 - APPLICATION PROCESS › Section 21B .0205 - RECOMMENDATION FOR DISPOSITION (TRANSFERRED TO 10A NCAC 23C .0103)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0200 - APPLICATION PROCESS › Section 21B .0206 - DISPOSITION (TRANSFERRED TO 10A NCAC 23C .0104)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0200 - APPLICATION PROCESS › Section 21B .0207 - REFERRALS AT A FACE-TO-FACE INTERVIEW (TRANSFERRED TO 10A NCAC 23C .0105)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0200 - APPLICATION PROCESS › Section 21B .0208 - MANDATORY USE OF OUTREACH LOCATIONS (TRANSFERRED TO 10A NCAC 23C .0106)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0200 - APPLICATION PROCESS › Section 21B .0209 - HOURS FOR ACCEPTING FINANCIAL AND MEDICAL ASSISTANCE APPLICATIONS (TRANSFERRED TO 10A NCAC 23C .0107)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0301 - AGE (TRANSFERRED TO 10A NCAC 23E .0101)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0302 - UNITED STATES CITIZEN (TRANSFERRED TO 10A NCAC 23E .0102)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0303 - RESIDENCE (TRANSFERRED TO 10A NCAC 23E .0103)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0304 - DEPRIVATION (TRANSFERRED TO 10A NCAC 23E .0104)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0305 - DISABILITY (TRANSFERRED TO 10A NCAC 23E .0105)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0306 - BLINDNESS (TRANSFERRED TO 10A NCAC 23E .0106)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0307 - CARETAKER RELATIVE (TRANSFERRED TO 10A NCAC 23E .0107)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0308 - INMATE OF PUBLIC INSTITUTION OR PRIVATE PSYCHIATRIC HOSPITAL (TRANSFERRED TO 10A NCAC 23E .0108)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0309 - APPLYING FOR ALL BENEFITS AND ANNUITIES (TRANSFERRED TO 10A NCAC 23E .0201)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0310 - RESERVE (TRANSFERRED TO 10A NCAC 23E .0202)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0311 - REPEALED - TRANSFER OF RESOURCES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-54;
					 108A-58;
					 P.L.
					 100-360;
					 P.L.
					 100-485;
					 42 U.S.C.
					 1396p(c);
					 42 C.F.R. 435.121;
					 42 C.F.R.
					 435.840;
					 42 C.F.R. 435.841;
					 42 C.F.R.
					 435.845; S.L. 2002-126;
Eff.
					 September 1, 1984;
Amended Eff. December 1, 1991; August 1,
					 1990;
Temporary Amendment Eff. April 21, 2003; March 1,
					 2003;
Amended Eff. August 1, 2004;
Repealed Eff. July
					 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0312 - INCOME (TRANSFERRED TO 10A NCAC 23E .0203)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0300 - CONDITIONS FOR ELIGIBILITY › Section 21B .0313 - PERSONAL NEEDS ALLOWANCE (TRANSFERRED TO 10A NCAC 23E .0204)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0401 - BUDGET UNIT MEMBERSHIP (TRANSFERRED TO 10A NCAC 23E .0205)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0402 - FINANCIAL RESPONSIBILITY AND DEEMING (TRANSFERRED TO 10A NCAC 23E .0206)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0403 - RESERVE (TRANSFERRED TO 10A NCAC 23E .0207)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0404 - INCOME (TRANSFERRED TO 10A NCAC 23E .0208)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0405 - CERTIFICATION AND AUTHORIZATION (TRANSFERRED TO 10A NCAC 23G .0101)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0406 - DEDUCTIBLE (TRANSFERRED TO 10A NCAC 23E .0209)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0407 - PATIENT LIABILITY (TRANSFERRED TO 10A NCAC 23E .0210)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0408 - CLASSIFICATION (TRANSFERRED TO 10A NCAC 23D .0201)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0409 - CHANGE IN SITUATION (TRANSFERRED TO 10A NCAC 23G .0304)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0400 - BUDGETING PRINCIPALS › Section 21B .0410 - ALIEN SPONSOR DEEMING (TRANSFERRED TO 10A NCAC 23E .0211)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0500 - REDETERMINATION › Section 21B .0501 - TIME AND CONTENT (TRANSFERRED TO 10A NCAC 23G .0301)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0500 - REDETERMINATION › Section 21B .0502 - INTERVIEW (TRANSFERRED TO 10A NCAC 23G .0302)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter B - ELIGIBILITY DETERMINATION › Section .0500 - REDETERMINATION › Section 21B .0503 - RECOMMENDATION (TRANSFERRED TO 10A NCAC 23G .0303)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter C - BENEFITS › Section .0100 - MEDICAID I.D. CARD › Section 21C .0101 - MEDICAID IDENTIFICATION CARD (TRANSFERRED TO 10A NCAC 23B .0101)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter C - BENEFITS › Section .0100 - MEDICAID I.D. CARD › Section 21C .0102 - ISSUANCE (TRANSFERRED TO 10A NCAC 23B .0102)

Current through Register Vol. 39, No. 2, July 15, 2024
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter C - BENEFITS › Section .0100 - MEDICAID I.D. CARD › Section 21C .0103 - REPEALED - PHARMACY OF RECORD

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-54;
Eff. September 1,
					 1984;
Amended Eff. August 1, 1990;
Repealed Eff. April
					 1, 2010.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter D - ESTATE RECOVERY › Section .0100 - RECIPIENTS SUBJECT TO ESTATE RECOVERY › Section 21D .0101-.0103

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-70.5;
					 42 U.S.C.
					 1396p.;
Temporary Adoption Eff.
					 May 6, 1996 to expire on July 1, 1996, or the last day of the 1996 session of
					 the General Assembly, whichever is later;
Temporary Rule Expired on
					 July 1, 1996;
Eff. July 1, 1996;
Repealed Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter D - ESTATE RECOVERY › Section .0200 - RECONSIDERATION REVIEW › Section 21D .0201 - REPEALED - RECONSIDERATION REVIEW

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-70.5;
					 42 U.S.C.
					 1396p.;
Temporary Adoption Eff.
					 May 6, 1996 to expire on July 1, 1996, or the last day of the 1996 session of
					 the General Assembly, whichever is later;
Temporary Rule Expired on
					 July 1, 1996;
Eff. July 1, 1996;
Repealed Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter D - ESTATE RECOVERY › Section .0300 - MEDICAID PAYMENTS SUBJECT TO RECOVERY › Section 21D .0301-.0302

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-70.5;
					 42 U.S.C.
					 1396p.;
Temporary Adoption Eff.
					 May 6, 1996 to expire on July 1, 1996, or the last day of the 1996 session of
					 the General Assembly, whichever is later;
Temporary Rule Expired on
					 July 1, 1996;
Eff. July 1, 1996;
Repealed Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter D - ESTATE RECOVERY › Section .0400 - FILING AND COLLECTION OF CLAIMS AGAINST ESTATE › Section 21D .0401-.0402

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-70.5;
					 42 U.S.C.
					 1396p.;
Temporary Adoption Eff.
					 May 6, 1996 to expire on July 1, 1996, or the last day of the 1996 session of
					 the General Assembly, whichever is later;
Temporary Rule Expired on
					 July 1, 1996;
Eff. July 1, 1996;
Repealed Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 21 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter D - ESTATE RECOVERY › Section .0500 - WAIVER OF RECOVERY › Section 21D .0501-.0503

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-70.5;
					 42 U.S.C.
					 1396p.;
Temporary Adoption Eff.
					 May 6, 1996 to expire on July 1, 1996, or the last day of the 1996 session of
					 the General Assembly, whichever is later;
Temporary Rule Expired on
					 July 1, 1996;
Eff. July 1, 1996;
Repealed Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter A - IDENTIFYING INFORMATION › Section 22A .0101 - SCOPE

Current through Register Vol. 39, No. 2, July 15, 2024
The Division of Health Benefits shall administer and
				  supervise the administration of medical services under Title XIX of the Social
				  Security Act, commonly referred to as Medicaid. A fiscal agent, under contract
				  to the Department of Health and Human Services, shall process claims for
				  medical services, and conduct utilization control activities. Payment of claims
				  shall be made to the providers. Notwithstanding any other rules in this
				  Chapter, no services shall be covered for which funds have not been allocated
				  by the General Assembly.
Authority
				  G.S.
				  108A-25(b);
				  108A-54;
Eff.
				  February 1, 1976;
Amended Eff. September 30, 1977;
Readopted Eff. October 31, 1977;
Amended Eff. May 1,
				  1990;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. August 22, 2015;
Amended Eff.
				  March 1, 2020.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter B - PROVIDER ISSUES › Section .0100 - GENERAL › Section 22B .0101 - INSTITUTIONAL HEALTH SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
No provider shall be enrolled in the Medicaid Program to
					 provide any new institutional health service for which a Certificate of Need is
					 required under G.S. 131E, Article 9 without first obtaining a Certificate of
					 Need and meeting the conditions imposed by it.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
Eff. March
					 1, 1993;
Recodified from
					 10 NCAC
					 26B .0124 Eff. October 1, 1993;
Recodified from
					 10 NCAC
					 26B .0125 Eff. April 1, 1994;
Recodified from
					 10 NCAC
					 26B .0126 Eff. January 1, 1998;
Readopted Eff. July 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter B - PROVIDER ISSUES › Section .0100 - GENERAL › Section 22B .0102 - COORDINATION WITH TITLE XVIII

Current through Register Vol. 39, No. 2, July 15, 2024
The entire range of benefits under Part B of Title XVIII of
					 the Social Security Act, which is adopted and incorporated by reference with
					 subsequent changes or amendments and available free of charge at
http://uscode.house.gov/
, to
					 Medicare-eligible persons shall be provided through a buy-in agreement with the
					 Secretary of Health and Human Services. This agreement shall cover all persons
					 eligible under the Medicaid State Plan.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
Eff.
					 February 1, 1976;
Readopted Eff. October 31, 1977;
Amended Eff. June 1, 1998;
Readopted Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter B - PROVIDER ISSUES › Section .0100 - GENERAL › Section 22B .0103 - INSTITUTIONAL STANDARDS

Current through Register Vol. 39, No. 2, July 15, 2024
Institutions shall meet standards prescribed for
					 participation in Titles XVIII, XIX, and XXI of the Social Security Act, which
					 is adopted and incorporated by reference with subsequent changes or amendments
					 and available free of charge at
http://uscode.house.gov/
.These standards
					 are set forth in North Carolina licensing law and federal regulations, and are
					 kept on file in the Department of Health and Human Services, Division of Health
					 Services Regulation and available on request.
Authority
					 G.S.
					 108A-25(b);
					 108A-54; 131-E;
					 42 C.F.R.
					 440.10;
					 42 C.F.R. Part 442;
					 42 C.F.R.
					 457.990;
Eff. February 1,
					 1976;
Readopted Eff. October 31, 1977;
Readopted Eff.
					 July 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter B - PROVIDER ISSUES › Section .0100 - GENERAL › Section 22B .0104 - TIME LIMITATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) To receive
				  payment, claims shall be filed either:
(1)
				  within 365 days of the date of service for services other than inpatient
				  hospital, home health, or nursing home services;
(2) within 365 days of the date of discharge
				  for inpatient hospital services and the last date of service in the month for
				  home health and nursing home services, not to exceed the limitations as
				  specified in 42 C.F.R.
				  447.45, which is adopted and incorporated by
				  reference with subsequent changes or amendments and available free of charge at
https://www.ecfr.gov/
; or
(3) within 180 days of the Medicare or other
				  third party payment or final denial, when the date of the third party payment
				  or denial exceeds the filing limits in Subparagraphs (1) or (2) of this
				  Paragraph, if it is shown that:
(A) a claim
				  was filed with a prospective third-party payor within the filing limits in
				  Subparagraph (1) or (2) of this Paragraph;
(B) payment from the third party payor with
				  whom the claim was filed is pending; and
(C) documented efforts were made to achieve
				  either payment or final denial of the third-party claim.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter B - PROVIDER ISSUES › Section .0100 - GENERAL › Section 22B .0105 - REPEALED - OVERUTILIZER IDENTIFICATION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
Eff.
					 January 1, 1978;
Amended Eff. May 1, 1990; October 4,
					 1979;
Repealed Eff. July 1, 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter B - PROVIDER ISSUES › Section .0200 - MANUALS AND FORMS › Section 22B .0201 - MANUALS

Current through Register Vol. 39, No. 2, July 15, 2024
Manuals and bulletins explaining Medicaid procedures are
					 available through the private contractor mentioned in
					 10A NCAC
					 22A .0101.
Authority
					 G.S.
					 108A-25(b);
Eff.
					 February 1, 1976;
Readopted Eff. October 31, 1977;
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 B - PROVIDER ISSUES › Section .0200 - MANUALS AND FORMS › Section 22B .0202 - FORMS

Current through Register Vol. 39, No. 2, July 15, 2024
All forms are available through the private contractor
					 mentioned in
					 10A NCAC
					 22A .0101.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 143B-10;
Eff.
					 February 1, 1976;
Readopted Eff. October 31, 1977;
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 C - AMOUNT: DURATION: AND SCOPE OF ASSISTANCE › Section 22C .0101-.0103

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  108A-25(b); S.L. 1985, c.
				  479, s. 86; 34 C.F.R.
				  447.50;
				  42 C.F.R. 440.210;
				  42 C.F.R.
				  440.220;
				  42 C.F.R. 440.240;
Eff. February 1, 1976;
Readopted Eff. October 31, 1977;
Amended Eff. May 1, 1990;
Repealed Eff. July 1,
				  2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter C - AMOUNT: DURATION: AND SCOPE OF ASSISTANCE › Section 22C .0104 - EXPIRED - HEALTH INSURING ORGANIZATIONS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  108A-25(b);
				  34 C.F.R.
				  434.14;
Eff. February 1,
				  1976;
Readopted Eff. October 31, 1977;
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 D - RECIPIENT ISSUES › Section 22D .0101 - REPEALED - CO PAYMENT

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  108A-25(b); S.L. 1985, c.
				  479, s. 86; 42 C.F.R.
				  440.230(d);
Tax
				  Equity and Fiscal Responsibility Act of 1982, Subtitle B; Section 95 of Chapter
				  689, 1991 Session Laws;
Eff. January 1, 1984;
Temporary
				  Amendment Eff. August 15, 1991 For a Period of 180 Days to Expire on February
				  15, 1992;
Amended Eff. February 1, 1992;
Temporary
				  Amendment Eff. September 15, 1992 For a Period of 180 Days or Until the
				  Permanent Rule Becomes Effective, Whichever is Sooner;
Amended Eff.
				  February 1, 1993;
Temporary Amendment Eff. January 1,
				  2002;
Amended Eff. April 1, 2003;
Repealed Eff. July 1,
				  2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter E - COOPERATIVE AGREEMENTS › Section 22E .0101 - EXPIRED - DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  108A-25(b);
				  143B-10;
Eff.
				  February 1, 1976;
Readopted Eff. October 31, 1977;
Amended Eff. August 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 E - COOPERATIVE AGREEMENTS › Section 22E .0102 - VOCATIONAL REHABILITATION

Current through Register Vol. 39, No. 2, July 15, 2024
The cooperative agreements between the Divisions of Medical
				  Assistance and Vocational Rehabilitation, Department of Health and Human
				  Services, shall commit the Divisions to their responsibilities with regard to
				  social services and medical services.
Authority
				  G.S.
				  108A-25(b);
				  143B-10;
				  143B-138;
Eff.
				  February 1, 1976;
Readopted Eff. October 31, 1977;
Amended Eff. August 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 E - COOPERATIVE AGREEMENTS › Section 22E .0103 - MENTAL HEALTH, DEVELOP/DISABILITIES/SUBSTANCE ABUSE SVCS

Current through Register Vol. 39, No. 2, July 15, 2024
The cooperative agreements between the Divisions of Health
				  Benefits and Mental Health, Developmental Disabilities and Substance Abuse
				  Services, Department of Health and Human Services, shall commit the Divisions
				  to their responsibilities with regard to social services.
Authority
				  G.S.
				  108A-25(b);
				  143B-10;
				  143B-138;
Eff.
				  February 1, 1976;
Readopted Eff. October 31, 1977;
Amended Eff. August 1, 1990;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. August 22, 2015;
Amended Eff.
				  March 1, 2020.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter E - COOPERATIVE AGREEMENTS › Section 22E .0104-.0105 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  108A-25(b);
				  143B-10;
Eff.
				  November 1, 1977;
Amended Eff. August 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 F - PROGRAM INTEGRITY › Section .0100 - GENERAL › Section 22F .0101 - SCOPE

Current through Register Vol. 39, No. 2, July 15, 2024
This Subchapter shall provide methods and procedures to
					 ensure the integrity of the Medicaid program. Nothing in these procedures is
					 intended, nor shall be construed, to grant any provider any right to
					 participate in the Medicaid program not granted by federal law or
					 regulations.
Authority
					 G.S.
					 108A-25(b);
					 108A-63;
					 108A-64;
					 42 C.F.R.
					 455.1;
Eff. April 15,
					 1977;
Readopted Eff. October 31, 1977;
Amended Eff. May
					 1, 1990; 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 .0100 - GENERAL › Section 22F .0102 - ORGANIZATION

Current through Register Vol. 39, No. 2, July 15, 2024
The North Carolina Department of Health and Human Services,
					 Division of Health Benefits shall perform the duties required by this
					 Subchapter. The Department or Division may enter into contracts with other
					 persons for the purpose of performing these duties.
Authority
					 G.S.
					 108A-25(b); 42 C.F.R. Part
					 455;
Eff. April 15, 1977;
Readopted Eff. October 31,
					 1977;
Amended Eff. May 1, 1984;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. August 22, 2015;
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 .0100 - GENERAL › Section 22F .0103 - FUNCTIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The Division
				  shall develop, implement and maintain methods and procedures for preventing,
				  detecting, investigating, reviewing, hearing, referring, reporting, and
				  disposing of cases involving fraud, abuse, error, overutilization or the use of
				  medically unnecessary or medically inappropriate services.
(b) The Division shall institute methods and
				  procedures to:
(1) receive and process
				  complaints and allegations of provider and recipient aberrant
				  practices;
(2) perform preliminary
				  and full investigations to collect facts, data, and information;
(3) analyze and evaluate data and information
				  to establish facts and conclusions concerning provider and recipient
				  practices;
(4) make administrative
				  decisions affecting providers, including but not limited to suspension from the
				  Medicaid program;
(5) recoup
				  improperly paid claims;
(6)
				  establish remedial measures including but not limited to monitoring
				  programs;
(7) conduct
				  administrative review or, when legally necessary, hearings except as provided
				  in Subparagraph (b)(8) of this Rule;
(8) refer for provider peer review those
				  cases involving questions of professional practice.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0100 - GENERAL › Section 22F .0104 - PREVENTION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Provider
				  Education. Upon the request of a provider, the Division may conduct on-site
				  educational visits to assist a provider in complying with requirements of the
				  Medicaid Program.
(b) Provider
				  Manuals. The Division shall prepare and make available a provider manual
				  containing at least the following information:
(1) amount, duration, and scope of
				  assistance;
(2) participation
				  standards;
(3) penalties;
(4) reimbursement rules; and
(5) claims filing instructions.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0100 - GENERAL › Section 22F .0105 - REPEALED - DETECTION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-63;
					 108A-64; 42 C.F.R. Part 455;
					 42 C.F.R.
					 455.12-23;
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 .0100 - GENERAL › Section 22F .0106 - CONFIDENTIALITY

Current through Register Vol. 39, No. 2, July 15, 2024
All investigations by the Division concerning allegations
					 of provider fraud, abuse, over-utilization, or inadequate quality of care shall
					 be confidential, and the information contained in the files of such
					 investigations shall be confidential, except as permitted by State or Federal
					 law or regulation.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-54.1B;
					 132-1.4; 42 C.F.R. Part 455;
					 42 C.F.R.
					 455.21;
Eff. May 1,
					 1984;
Amended Eff. May 1, 1990;
Readopted Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0100 - GENERAL › Section 22F .0107 - RECORD RETENTION

Current through Register Vol. 39, No. 2, July 15, 2024
All Title XIX and Title XXI providers shall keep and
					 maintain all Medicaid and NC Health Choice financial, medical, or other records
					 necessary to disclose the nature and extent of services furnished to Medicaid
					 and NC Health Choice recipients and claimed for reimbursement. These records
					 shall be retained for a period of not less than five full years from the date
					 of service, unless a longer retention period is required by applicable federal
					 or state law, regulations, or data retention agreements. Upon notification of
					 an audit or upon receipt of a request for records, all records related to the
					 audit or records request shall be retained until notification that the
					 investigation has been concluded.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-63;
					 108A-64; 42 C.F.R. Part 455;
					 42 C.F.R.
					 455.12-
					 23;
					 42 C.F.R. 431.107;
Eff. April 1, 1988;
Readopted Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0200 - PROVIDER FRAUD AND PHYSICAL ABUSE OF RECIPIENTS › Section 22F .0201 - REPEALED - DEFINITION OF PROVIDER FRAUD

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 108A-63;
					 150B-21.6;
					 42 U.S.C.
					 1396(b) et seq.; 42 C.F.R.
					 Part 455;
Eff. April 15, 1977;
Readopted Eff. October
					 31, 1977;
Amended Eff. May 1, 1990; 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 .0200 - PROVIDER FRAUD AND PHYSICAL ABUSE OF RECIPIENTS › Section 22F .0202 - INVESTIGATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The Division
				  shall conduct a preliminary investigation of all complaints received or
				  allegations of fraud, waste, abuse, error, or practices not conforming to state
				  and federal Medicaid laws and regulations, clinical coverage policies, or the
				  Medicaid State Plan until it is determined:
(1) whether there are sufficient findings to
				  warrant a full investigation, as set out in Paragraph (b) of this
				  Rule;
(2) whether there is
				  sufficient evidence to warrant referring the case for civil fraud
				  investigation, criminal fraud investigation, or both; or
(3) whether there is insufficient evidence to
				  support the allegation(s) and the case may be closed.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0200 - PROVIDER FRAUD AND PHYSICAL ABUSE OF RECIPIENTS › Section 22F .0203 - REFERRAL TO LAW ENFORCEMENT AGENCY

Current through Register Vol. 39, No. 2, July 15, 2024
The Division shall refer credible allegations of provider
					 fraud, defined as provided by
					 42 C.F.R.
					 455.2, which is adopted and incorporated by
					 reference with subsequent changes or amendments and available free of charge at
https://www.ecfr.gov/
, or suspected
					 physical abuse of recipients to the State Medicaid Fraud Control Unit or other
					 law enforcement agency.
Authority
					 G.S.
					 108A-25(b);
					 108A-63;
					 P.L.
					 95-142;
					 42 C.F.R.
					 455.2;
					 42 C.F.R. 455.14;
					 42 C.F.R.
					 455.15;
Eff. April 15,
					 1977;
Readopted Eff. October 31, 1977;
Amended Eff. May
					 1, 1984;
Readopted Eff. July 1,
					 2018.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0300 - PROVIDER ABUSE › Section 22F .0301 - DEFINITION OF PROGRAM ABUSE BY PROVIDERS

Current through Register Vol. 39, No. 2, July 15, 2024
Program abuse by providers as used in this Chapter consists
					 of incidents, services, or practices inconsistent with accepted fiscal or
					 medical practices which cause financial loss to the Medicaid program or its
					 beneficiaries, or which are not reasonable or which are not necessary,
					 including:
(1) billing for care or
				  services at a frequency or amount that is not medically necessary, as defined
				  by 10A
				  NCAC 25A .0201;
(2) separate billing for care and services
				  that are:
(a) part of an all-inclusive
				  procedure; or
(b) included in the
				  daily per-diem rate;
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0300 - PROVIDER ABUSE › Section 22F .0302 - INVESTIGATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Fraud, waste,
				  abuse, error, or practices not conforming to state and federal Medicaid laws
				  and regulations, clinical coverage policies, or the Medicaid State Plan shall
				  be investigated according to the provisions of Rule .0202 of this
				  Subchapter.
(b) A Provider Summary
				  Report shall be prepared by the Division furnishing the full investigative
				  findings of fact, conclusions, and recommendations.
(c) The Division shall review the findings,
				  conclusions, and recommendations and make a tentative decision for disposition
				  of the case. The Division shall seek full restitution of any improper provider
				  payments as required by
				  10A NCAC
				  22F .0601. In addition, upon determination
				  that program abuse has occurred and based on the factors set out in Rule
				  .0602(b) of this Subchapter, the Division may also take one or more
				  administrative actions pursuant to Rule .0602 of this Subchapter.
(d) The tentative decision shall be subject
				  to the review procedures described in Section .0400 of this
				  Subchapter.
(e) If the
				  investigative findings show that the provider is not licensed or certified as
				  required by federal and State law, then the provider shall not participate in
				  the North Carolina State Medical Assistance Program (Medicaid). The Division is
				  required to verify provider licensure pursuant to
				  42 C.F.R.
				  455.412, which is adopted and incorporated by
				  reference with subsequent changes or amendments and available free of charge at
https://www.ecfr.gov/
.
Authority
					 G.S.
					 108A-25(b);
					 108A-54;
					 108A-54.1B;
					 108A-63;
					 108C-5;
					 108C-7;
					 42 C.F.R.
					 455, Subpart A;
					 42 CFR
					 455.412;
Eff. April 15,
					 1977;
Readopted Eff. October 31, 1977;
Amended Eff.
					 July 1, 1988; May 1, 1984;
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 .0400 - AGENCY RECONSIDERATION REVIEW › Section 22F .0401 - REPEALED - PURPOSE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 42 C.F.R.
					 456;
Eff. December 1,
					 1982;
Transferred and Recodified from
					 10 NCAC
					 26I .0201 Eff. July 1, 1995;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. August 22, 2015;
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 .0400 - AGENCY RECONSIDERATION REVIEW › Section 22F .0402 - RECONSIDERATION REVIEW FOR PROGRAM ABUSE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  Division shall notify the provider in writing by certified mail of the
				  tentative decision made pursuant to Rule .0302 of this subchapter and the
				  opportunity for a reconsideration of the tentative decision.
(b) The provider shall be instructed to
				  submit to the Division in writing a request for a Reconsideration Review within
				  30 business days from the date of receipt of the notice. Failure to request a
				  Reconsideration Review in the specified time shall result in the implementation
				  of the tentative decision as the Division's final decision.
(c) The Notice of Reconsideration Review
				  shall be sent to the provider within 30 business days from receipt of the
				  request. The provider shall be notified in writing to appear at a specified
				  day, time, and place. The provider may be accompanied by legal counsel if the
				  provider so desires.
(d) The
				  provider shall provide a written statement to the Hearing Unit prior to the
				  Reconsideration Review identifying any claims that the provider wishes to
				  dispute and setting forth the provider's specific reasons for disputing the
				  determination on those claims.
(e)
				  The purpose of the Reconsideration Review includes:
(1) clarification formulation, and
				  simplification of issues;
(2)
				  exchange and full disclosure of information and materials;
(3) review of the investigative
				  findings;
(4) resolution of matters
				  in controversy;
(5) consideration
				  of mitigating and extenuating circumstances;
(6) reconsideration of the administrative
				  measures to be imposed; and
(7)
				  reconsideration of the restitution of overpayments.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 22 - MEDICAL ASSISTANCE ELIGIBILITY › Subchapter F - PROGRAM INTEGRITY › Section .0400 - AGENCY RECONSIDERATION REVIEW › Section 22F .0403 - EXPIRED - PROCESS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 42 C.F.R.
					 456;
Eff. December 1,
					 1982;
Amended Eff. January 1, 1988; January 1, 1986;
Transferred and Recodified from
					 10 NCAC
					 26I .0202 Eff. July 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 F - PROGRAM INTEGRITY › Section .0500 - PEER REVIEW › Section 22F .0501-.0505 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 150B-11; 42 C.F.R. Part 455; 42
					 C.F.R. Part 456;
Eff. April 15, 1977;
Readopted Eff.
					 October 31, 1977;
Amended Eff. May 1, 1990; January 1, 1987;
					 January 1, 1986; 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 .0500 - PEER REVIEW › Section 22F .0506-.0510 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 108A-25(b);
					 150B-11; 42 C.F.R. Part 455; 42
					 C.F.R. Part 456;
Eff. May 1, 1984;
Amended Eff. May 1,
					 1990; September 1, 1988; January 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 F - PROGRAM INTEGRITY › Section .0600 - ADMINISTRATIVE SANCTIONS AND RECOUPMENT › Section 22F .0601 - RECOUPMENT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  ­Division shall seek full restitution of improper payments, as defined
				  by 42 C.F.R.
				  431.958, which is adopted and incorporated by
				  reference with subsequent changes or amendments and available free of charge at
https://www.ecfr.gov/
, made to
				  providers by the Medicaid Program. Recovery may be by lump sum payment, by a
				  negotiated payment schedule, or by withholding from the provider's pending
				  claims the total or a portion of the recoupment amount.
(b) A provider may seek reconsideration
				  review of a recoupment imposed by the division under Rule .0402 of this
				  Subchapter.
Authority
					 G.S.
					 108A-25(b);
					 108C-5(g); 42
					 C.F.R. Part 431, Subpart Q; 42 C.F.R. Part 455, Subpart F; 42 C.F.R. Part
					 456;
Eff. February 1, 1982;
Amended Eff. May 1,
					 1984;
Readopted Eff. July 1,
					 2018.