North Carolina Administrative Code

10A NCAC 22O .0210 DRUGS (Transferred to 10a NCAC 25H .0305)

10a NCAC 22O .0211 PRIOR APPROVAL (Transferred To 10A NCAC 25H .0206)

section .0300 – Amount, duration, and scope of assistance 10A NCAC 22O .0301 MEDICAL SERVICES (Transferred to 10A NCAC 25A .0201)

section .0400 – limitation of amount, duration, and scope of assistance 10A NCAC 22O .0401 INPATIENT HOSPITAL SERVICES (Paragraphs (a)-(d) Transferred to 10A NCAC 25M .0201 and paragraph (e) transferred to 10A NCAC 25P .0201))

10a NCAC 22O .0402 OUTPATIENT HOSPITAL SERVICES (transferred to 10A NCAC 25P .0301)

10A NCAC 22O .0403 SKILLED NURSING FACILITY SERVICES (transferred to 10A NCAC 25M .0401(d))

10A NCAC 22O .0404 PHYSICIAN SERVICES (transferred to 10A NCAC 25P .0401)

10A NCAC 22O .0405 PODIATRIST SERVICES (transferred to 10A NCAC 25P .0404)

10A NCAC 22O .0406 HOME HEALTH SERVICES (Transferred to 10A NCAC 25O .0201(b)-(e))

10A NCAC 22O .0407 PRESCRIBED DRUGS History Note: Authority G.S. 108A-25(b); 143B-10; S.L. 1985, c. 479, s. 86; 42 C.F.R. 440.120; 42 C.F.R. 440.230(d) Eff. February 1, 1976 Amended Eff. October 1, 1977; Readopted Eff. October 31, 1977 Amended Eff. May 1, 1990; August 1, 1983; Ap…

10A NCAC 22O .0408 INTERMEDIATE CARE FACILITIES (transferred to 10A NCAC 25D .0201(c)-(j))

10A NCAC 22O .0409 Therapeutic Leave (Transferred to 10A NCAC 25m .0501)

10A ncac 22o .0410 personal care services (transferred to 10a ncac 25o .0202(c)-(e))

SECTION .0100 – GENERAL INFORMATION 10A NCAC 22P .0101 PURPOSE AND SCOPE History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

SECTION .0200 – DEFINITIONS 10A NCAC 22P .0201 DEFINITIONS History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

SECTION .0300 – MEDICAL SERVICE REQUIREMENTS 10A NCAC 22P .0301 SERVICE DELIVERY History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0302 ACCESS TO CARE History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0303 COORDINATION OF BENEFITS History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

SECTION .0400 – CERTIFICATION AND STAFFING REQUIREMENTS 10A NCAC 22P .0401 CERTIFICATION REQUIREMENTS History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired Oc…

10A NCAC 22P .0402 GOOD STANDING History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0403 MEDICAL DIRECTOR REQUIREMENTS History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0404 CLINICAL DIRECTOR History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0405 QUALITY MANAGEMENT DIRECTOR History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0406 TRAINING DIRECTOR History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0407 EXCEPTION PROCESS History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0408 MEDICAL SCHOOL/ TEACHING HOSPITAL EXCEPTION History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

SECTION .0500 – CERTIFICATION PROCEDURES 10A NCAC 22P .0501 LETTER OF ATTESTATION AND DESK REVIEW History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired Octobe…

10A NCAC 22P .0502 INTERVIEW History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0503 VERIFICATION REVIEW History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0504 EXISTING CRITICAL ACCESS BEHAVIORAL HEALTH AGENCIES History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

SECTION .0600 – MONITORING, DECERTIFICATION AND APPEAL PROCEDURES 10A NCAC 22P .0601 MONITORING History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October …

10A NCAC 22P .0602 DECERTIFICATION AND SUSPENSION History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

10A NCAC 22P .0603 APPEAL PROCEDURES History Note: Authority G.S. 108A-54; 42 U.S.C. 1396a; 42 C.F.R. 431.51; S.L. 2009-451, Section 10.58(d); Temporary Adoption Eff. December 28, 2010; Temporary Adoption Expired October 15, 2011.

SUBCHAPTER 22Q - DISTRIBUTION OF FEDERAL DISPROPORTIONATE SHARE ADJUSTMENT RECEIPTS ARISING FROM CERTIFIED PUBLIC EXPENDITURES 10A NCAC 22Q .0101 SCOPE This Subchapter establishes the requirements for the distribution of federal disproportionate share adjustment receipts as estab…

10A NCAC 22Q .0102 DEFINITIONS (a) "Certifying Hospital" means an institution that meets all of the following criteria: (1) meets the definition in G.S. 131E-176(13); (2) is licensed by the State of North Carolina; and (3) certifies as a public agency that its expenditures are el…

10A NCAC 22Q .0103 DISTRIBUTIONS After distributions are made pursuant to an act appropriating funds for the operation of the North Carolina Medicaid Program and the "Basic Disproportionate Share Hospital (DSH) Payment" section of the North Carolina Medicaid State Plan, Attachmen…

10A NCAC 22Q .0104 CERTIFYING HOSPITAL DISTRIBUTION The Department shall distribute available funds to certifying hospitals in two parts: (1) An amount equal to 10 percent of expenditures certified by the hospital pursuant to 42 CFR 433.51; and (2) An amount equal to the hospital…

10A NCAC 22q .0105 Certifying hospitals' outpatient costs (a) A certifying hospital's outpatient costs for uninsured patients will be determined by multiplying the hospital's outpatient cost-to-charge ratio in Rule .0104(2)(c) of this Section by the hospital's outpatient charges …

10A NCAC 22q .0106 Certifying hospital's proportionate share The Department shall calculate the certifying hospital's proportionate share of outpatient costs as follows: (1) Adding the certifying hospitals' outpatient costs and each of the eligible hospitals' as defined in 10A NC…

SUBCHAPTER 22R - distribution of Hospital Uncompensated Care Fund 10A NCAC 22R .0101 SCOPE This Subchapter establishes the requirements for the distribution of funds allocated to the Hospital Uncompensated Care Fund pursuant to G.S. 143C-9-9 after distributions of available funds…

10A NCAC 22R .0102 DEFINITIONS (a) "Department" means the North Carolina Department of Health and Human Services. (b) "Eligible hospital" means an institution that meets the requirements of Rule .0103 of this Section. (c) "Eligible hospital cost" means the values calculated pursu…

10A NCAC 22R .0103 ELIGIBLE HOSPITAL An institution licensed by the State of North Carolina that meets the definition in G.S. 131E-176 (13) is eligible for reimbursement from the Hospital Uncompensated Care Fund if it: (1) is not a public agency qualified to certify expenditures …

10A NCAC 22R .0104 ELIGIBLE OUTPATIENT COSTS (a) An eligible hospital's eligible outpatient costs for uninsured patients will be determined by multiplying the hospital's outpatient cost-to-charge ratio in Rule .0103(3)(c) of this Section by the hospital's outpatient charges for u…

10A NCAC 22R .0105 DISTRIBUTION OF AVAILABLE FUNDS (a) An eligible hospital satisfying the requirements of Rule .0103 of this Section shall be eligible for a payment from funds available under this Subchapter. In a payment period, an eligible hospital shall receive a proportional…

CHAPTER 23 - MEDICAL ASSISTANCE ADMINISTRATION SUBCHAPTER 23A - GENERAL PROGRAM ADMINISTRATION SECTION .0100 - GENERAL 10A NCAC 23A .0101 SUPERVISION History Note: Authority G.S. 108A-25(b); 108A-54; Eff. September 1, 1984; Amended Eff. August 1, 1990; January 1, 1986; Transferre…

10A NCAC 23A .0102 DEFINITIONS For purposes of this Chapter, the following definitions apply: (1) "M-AA" means a program of medical assistance to persons 65 years of age and older, and also means the assistance itself. (2) "M-AB" means a program of medical assistance to blind per…

10A NCAC 23A .0103 QUALITY ASSURANCE (a) County department of social services eligibility actions on active and negative cases, as defined by 42 C.F.R. 431.804, which is incorporated by reference including subsequent amendments and editions, and available free of charge at https:…

10A NCAC 23A .0104 AVAILABILITY OF MANUALS (a) One copy of the Medicaid Eligibility Manual and other policy issuances affecting the public is maintained in each county department of social services and each DSS Regional Office for examination by the public on regular work days du…

SUBCHAPTER 23B - BENEFITS SECTION .0100 - GENERAL 10A NCAC 23B .0101 MEDICAID IDENTIFICATION CARD The card shall be proof to medical providers of the client's Medicaid eligibility for a specified time. History Note: Authority G.S. 108A-54; Eff. September 1, 1984; Amended Eff. Aug…

10A NCAC 23B .0102 ISSUANCE (a) Cards shall be issued by the State at any time of the month for: (1) Approved applications; (2) Cases authorized after meeting a deductible; (3) Change in primary care provider; or (4) Change in LME/MCO catchment area. (b) Cards shall be requested …