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NCAC > Title 10A - Health and Human Services > Chapter 22 - Medical Assistance Eligibility
Chapter 22 (consolidated)Medical Assistance EligibilityHTML | DOC
Subchapter AHTML | DOC
10A NCAC 22A .0101SCOPEHTML | DOC
10A NCAC 22A .0102reserved for future codificationHTML | DOC
 
Subchapter BHTML | DOC
10A NCAC 22B .0101INSTITUTIONAL HEALTH SERVICESHTML | DOC
10A NCAC 22B .0102COORDINATION WITH TITLE XVIIIHTML | DOC
10A NCAC 22B .0103INSTITUTIONAL STANDARDSHTML | DOC
10A NCAC 22B .0104TIME LIMITATIONHTML | DOC
10A NCAC 22B .0105REPEALED - OVERUTILIZER IDENTIFICATIONHTML | DOC
10A NCAC 22B .0201MANUALSHTML | DOC
10A NCAC 22B .0202FORMSHTML | DOC
 
Subchapter CHTML | DOC
10A NCAC 22C .0101-.0103REPEALEDHTML | DOC
10A NCAC 22C .0104EXPIRED - HEALTH INSURING ORGANIZATIONSHTML | DOC
 
Subchapter DHTML | DOC
10A NCAC 22D .0101REPEALED - CO-PAYMENTHTML | DOC
 
Subchapter EHTML | DOC
10A NCAC 22E .0101EXPIRED - department of ENVIRONMENT AND NATURAL RESOURCESHTML | DOC
10A NCAC 22E .0102-.0103EXPIREDHTML | DOC
10A NCAC 22E .0104-.0105EXPIREDHTML | DOC
 
Subchapter FHTML | DOC
10A NCAC 22F .0101SCOPEHTML | DOC
10A NCAC 22F .0102a> ORGANIZATIONHTML | DOC
10A NCAC 22F .0103FUNCTIONSHTML | DOC
10A NCAC 22F .0104PREVENTIONHTML | DOC
10A NCAC 22F .0105REPEALED - DETECTIONHTML | DOC
10A NCAC 22F .0106CONFIDENTIALITYHTML | DOC
10A NCAC 22F .0107RECORD RETENTIONHTML | DOC
10A NCAC 22F .0201REPEALED - DEFINITION OF PROVIDER FRAUDHTML | DOC
10A NCAC 22F .0202INVESTIGATIONHTML | DOC
10A NCAC 22F .0203REFERRAL TO LAW ENFORCEMENT AGENCYHTML | DOC
10A NCAC 22F .0301DEFINITION OF program ABUSE by providersHTML | DOC
10A NCAC 22F .0302INVESTIGATIONHTML | DOC
10A NCAC 22F .0401REPEALED - PURPOSEHTML | DOC
10A NCAC 22F .0402RECONSIDERATION REVIEW FOR PROGRAM ABUSEHTML | DOC
10A NCAC 22F .0403EXPIRED - PROCESSHTML | DOC
10A NCAC 22F .0501-.0505EXPIREDHTML | DOC
10A NCAC 22F .0506-.0510EXPIREDHTML | DOC
10A NCAC 22F .0601RECOUPMENTHTML | DOC
10A NCAC 22F .0602ADMINISTRATIVE ACTIONSHTML | DOC
10A NCAC 22F .0603PROVIDER LOCK-OUTHTML | DOC
10A NCAC 22F .0604REPEALED - WITHHOLDING OF MEDICAID PAYMENTSHTML | DOC
10A NCAC 22F .0605REPEALED - TERMINATIONHTML | DOC
10A NCAC 22F .0606REPEALED - TECHNIQUE FOR PROJECTING MEDICAID OVERPAYMENTSHTML | DOC
10A NCAC 22F .0701DEFINITION OF FRAUD AND ABUSEHTML | DOC
10A NCAC 22F .0702GENERALHTML | DOC
10A NCAC 22F .0703EXPIRED - WARNING NOTIFICATIONHTML | DOC
10A NCAC 22F .0704RECIPIENT MANAGEMENT LOCK-IN SYSTEMHTML | DOC
10A NCAC 22F .0705EXPIRED - OVERUTILIZATION SURVEILLANCE (SUR INDICATOR)HTML | DOC
10A NCAC 22F .0706EXPIRED - RECOUPMENT OF RECIPIENT OVERPAYMENTSHTML | DOC
10A NCAC 22F .0707EXPIRED - REPORTS AND REVIEWSHTML | DOC
 
Subchapter GHTML | DOC
10A NCAC 22G .0101EXPIRED - REIMBURSEMENT PRINCIPLESHTML | DOC
10A NCAC 22G .0102EXPIRED - RATE SETTING METHODSHTML | DOC
10A NCAC 22G .0103EXPIRED - REASONABLE AND NON-ALLOWABLE COSTSHTML | DOC
10A NCAC 22G .0104EXPIRED - COST REPORTING: AUDITINGHTML | DOC
10A NCAC 22G .0105EXPIRED - case-mix index calculationHTML | DOC
10A NCAC 22G .0106EXPIRED - RECONSIDERATION REVIEWSHTML | DOC
10A NCAC 22G .0107EXPIRED - PAYMENT ASSURANCEHTML | DOC
10A NCAC 22G .0108REIMBURSEMENT METHODS FOR STATE-OPERATED FACILITIESHTML | DOC
10A NCAC 22G .0109NURSING HOME PROVIDER ASSESSMENTHTML | DOC
10A NCAC 22G .0110DEFINITIONSHTML | DOC
10A NCAC 22G .0201EXPIRED - REIMBURSEMENT PRINCIPLESHTML | DOC
10A NCAC 22G .0202EXPIRED - DRG RATE SETTING METHODOLOGYHTML | DOC
10A NCAC 22G .0203EXPIRED - EXCEPTIONS TO DRG REIMBURSEMENTHTML | DOC
10A NCAC 22G .0204EXPIRED - DISPROPORTIONATE SHARE HOSPITALS (DSH)HTML | DOC
10A NCAC 22G .0205EXPIRED - OUT OF STATE HOSPITALSHTML | DOC
10A NCAC 22G .0206EXPIRED - SPECIAL SITUATIONHTML | DOC
10A NCAC 22G .0207EXPIRED - COST REPORTING AND AUDITSHTML | DOC
10A NCAC 22G .0208REPEALED - ADMINISTRATIVE RECONSIDERATION REVIEWSHTML | DOC
10A NCAC 22G .0209-.0213EXPIREDHTML | DOC
10A NCAC 22G .0301EXPIRED - PAYMENT FOR SERVS-PROSPECTIVE REIMBURSEMENT PLAN ICF-MR FACILITIESHTML | DOC
10A NCAC 22G .0302EXPIRED - REPORTING REQUIREMENTSHTML | DOC
10A NCAC 22G .0303EXPIRED - REQUIREMENTS FOR FINANCIAL RECORDSHTML | DOC
10A NCAC 22G .0304EXPIRED - RATE SETTING METHOD FOR NON-STATE FACILITIESHTML | DOC
10A NCAC 22G .0305-.0309EXPIREDHTML | DOC
10A NCAC 22G .0401EXPIRED - PHYSICIAN’S FEE SCHEDULEHTML | DOC
10A NCAC 22G .0402EXPIRED - OTHER SERVICES PERFORMED BY PHYSICIANS AND OTHER PRACTITIONERSHTML | DOC
10A NCAC 22G .0501EXPIRED - CLINIC SERVICESHTML | DOC
10A NCAC 22G .0502REPEALED - MENTAL HEALTH CLINIC SERVICESHTML | DOC
10A NCAC 22G .0503EXPIRED - INPATIENT HOSPITAL: INAPPROPRIATE LEVEL OF CAREHTML | DOC
10A NCAC 22G .0504EXPIRED - HEALTH MAINTENANCE ORGANIZATIONS AND PREPAID HEALTH PLANSHTML | DOC
10A NCAC 22G .0505EXPIRED - PERSONAL CARE SERVICESHTML | DOC
10A NCAC 22G .0506EXPIRED - INDEPENDENT LABORATORY SERVICESHTML | DOC
10A NCAC 22G .0507EXPIRED - DURABLE MEDICAL EQUIPMENT AND RELATED SUPPLIESHTML | DOC
10A NCAC 22G .0508EXPIRED - PRIVATE DUTY NURSINGHTML | DOC
10A NCAC 22G .0509REPEALED - REIMBURSEMENT PRINCIPLES, HEARING AIDS/ACCESSORIES/BATTERIESHTML | DOC
10A NCAC 22G .0510EXPIRED - CASE MANAGEMENT SERVICESHTML | DOC
10A NCAC 22G .0601EXPIRED - REIMBURSEMENT PRINCIPLESHTML | DOC
10A NCAC 22G .0602EXPIRED - REIMBURSEMENT METHODSHTML | DOC
10A NCAC 22G .0603EXPIRED - APPEALSHTML | DOC
10A NCAC 22G .0604EXPIRED - COST REPORTING AND AUDITINGHTML | DOC
10A NCAC 22G .0605EXPIRED - PAYMENT ASSURANCESHTML | DOC
 
Subchapter HHTML | DOC
10A NCAC 22H .0101EXPIRED - APPEALS BY MEDICAID BENEFICIARIESHTML | DOC
10A NCAC 22H .0102-.0103REPEALEDHTML | DOC
10A NCAC 22H .0104EXPIRED - PAYMENT PENDING APPEALSHTML | DOC
10A NCAC 22H .0105REPEALED - DISMISSAL OF APPEALHTML | DOC
10A NCAC 22H .0201DEFINITIONSHTML | DOC
10A NCAC 22H .0202TRANSFER AND DISCHARGE REQUIREMENTSHTML | DOC
10A NCAC 22H .0203INITIATING A HEARINGHTML | DOC
10A NCAC 22H .0204HEARING PROCEDURESHTML | DOC
10A NCAC 22H .0205HEARING OFFICER'S FINAL DECISIONHTML | DOC
10A NCAC 22H .0301DEFINITIONSHTML | DOC
10A NCAC 22H .0302PASRR REQUIREMENTSHTML | DOC
10A NCAC 22H .0303INITIATING A HEARINGHTML | DOC
10A NCAC 22H .0304HEARING PROCEDURESHTML | DOC
10A NCAC 22H .0305HEARING OFFICER'S FINAL DECISIONHTML | DOC
 
Subchapter IHTML | DOC
10A NCAC 22I .0101AUDIT TO BE CONDUCTEDHTML | DOC
10A NCAC 22I .0102EXIT CONFERENCEHTML | DOC
10A NCAC 22I .0103NOTICE OF PROGRAM REIMBURSEMENTHTML | DOC
10A NCAC 22I .0104REPEALED - RECONSIDERATION REVIEWHTML | DOC
 
Subchapter JHTML | DOC
10A NCAC 22J .0101PURPOSE AND SCOPEHTML | DOC
10A NCAC 22J .0102PETITION FOR RECONSIDERATION REVIEWHTML | DOC
10A NCAC 22J .0103RECONSIDERATION REVIEW PROCESSHTML | DOC
10A NCAC 22J .0104PETITION FOR A CONTESTED CASE HEARINGHTML | DOC
10A NCAC 22J .0105REPEALED - PAYMENT STATUSHTML | DOC
10A NCAC 22J .0106PROVIDER BILLING OF PATIENTS WHO ARE MEDICAID RECIPIENTSHTML | DOC
 
Subchapter KHTML | DOC
10A NCAC 22K .0101DEFINITIONHTML | DOC
10A NCAC 22K .0102AGREEMENTHTML | DOC
10A NCAC 22K .0103PRESUMPTIVE DETERMINATIONSHTML | DOC
 
Subchapter LHTML | DOC
10A NCAC 22L .0101-.0104EXPIREDHTML | DOC
10A NCAC 22L .0105EXPIRED - EMERGENCY ROOM CAREHTML | DOC
10A NCAC 22L .0201REPEALED - PROGRAM DEFINITIONHTML | DOC
10A NCAC 22L .0202EXPIRED - ENROLLMENTHTML | DOC
10A NCAC 22L .0203REPEALED - ACCESS TO CAREHTML | DOC
 
Subchapter MHTML | DOC
10A NCAC 22M .0101ESTABLISHMENT (transferred to 10A NCAC 25K .0301)HTML | DOC
10A NCAC 22M .0102MEMBERSHIPS (transferred to 10A NCAc 25K .0302)HTML | DOC
10A NCAC 22M .0103CHAIRMEN (Transferred to 10A NCAC 25K .0303)HTML | DOC
10A NCAC 22M .0104ACTIVITIES (transferred to 10A NCAC 25K .0304)HTML | DOC
10A NCAC 22M .0201PATIENT COUNSELING (Transferred to 10A NCAC 25K .0401)HTML | DOC
10A NCAC 22M .0301RETROSPECTIVE DRUG USE REVIEW (DUR) (Transferred to 10A NCAC 25K .0501)HTML | DOC
10A NCAC 22M .0302SCREENING AND PATTERN ANALYSIS (Transferred to 10A NCAC 25K .0502)HTML | DOC
10A NCAC 22M .0303INTERVENTIONS (Transferred to 10A NCAC 25K .0503)HTML | DOC
10A NCAC 22M .0304COMPLIANCE MONITORING (Transferred to 10A NCAc 25K .0504)HTML | DOC
 
Subchapter NHTML | DOC
10A NCAC 22N .0101DEFINITIONSHTML | DOC
10A NCAC 22N .0102SIGNED AGREEMENTSHTML | DOC
10A NCAC 22N .0201REPEALED - DEFINITIONSHTML | DOC
10A NCAC 22N .0202DISCLOSURE OF OWNERSHIPHTML | DOC
10A NCAC 22N .0203ENROLLMENT RESTRICTIONSHTML | DOC
10A NCAC 22N .0301REPEALED - DEFINITIONSHTML | DOC
10A NCAC 22N .0302-.0303REPEALEDHTML | DOC
 
Subchapter OHTML | DOC
10A NCAC 22O .0101EXPIRED - HOSPITAL INPATIENTHTML | DOC
10A NCAC 22O .0102HOSPITAL OUTPATIENT (Transferred to 10A NCAC 25M .0301)HTML | DOC
10A NCAC 22O .0103HOME HEALTH SERVICES (transferred to 10a ncac 25O .0201(a))HTML | DOC
10A NCAC 22O .0104LABORATORY AND X-RAY SERVICES (Items (1)-(3) transferred to 10A NCAC 25P .0406 andHTML | DOC
10A NCAC 22O .0105EYEGLASSES AND OPTOMETRIC SERVICES (transferred to 10A NCAC 25N .0301)HTML | DOC
10A NCAC 22O .0106CHIROPRACTIC SERVICES (Transferred to 10A NCAC 25P .0403)HTML | DOC
10A NCAC 22O .0107MENTAL HEALTH CENTER SERVICES (transferred to 10A NCAC 25C .0201)HTML | DOC
10A NCAC 22O .0108INTERMEDIATE CARE FACILITIES (transferred to 10A NCAC 25D .0201(HTML | DOC
10A NCAC 22O .0109HEARING AID SERVICES (TRANSFERRED TO 10A NCAC 25N .0201)HTML | DOC
10A NCAC 22O .0110AMBULANCE SERVICES (transferred to 10A ncac 25w .0201)HTML | DOC
10A NCAC 22O .0111INPATIENT PSYCHIATRIC HOSPITAL SERVICES (Transferred to 10A NCAC 25C .0301)HTML | DOC
10A NCAC 22O .0112REPEALED - PSYCHIATRIC ADMISSION CRITERIA/MEDICAID BENEFICIARIES UNDER AGE 21HTML | DOC
10A NCAC 22O .0113NC MEDICAID CRITERIA FOR CONTINUED ACUTE STAY IN AN INPATIENT PSYCHIATRIC FACILITY (Transferred to 10A NCAC 25C .0302)HTML | DOC
10A NCAC 22O .0114NORTH CAROLINA SPECIALTY HOSPITAL SERVICES (Transferred to 25M .0201(HTML | DOC
10A NCAC 22O .0115CLINIC SERVICES (transferred to 10A NCAC 25P .0402)HTML | DOC
10A NCAC 22O .0116skilled nursing facility (transferred to 10a ncac 25m .0401(a)-(HTML | DOC
10A NCAC 22O .0117ABORTION (Transferred to 10A NCAC 25P .0405)HTML | DOC
10A NCAC 22O .0118PHARMACY SERVICES (transferred to 10A NCAc 25K .0201)HTML | DOC
10A NCAC 22O .0119OUT-OF-STATE SERVICES (transferred to 10A NCAc 25S .0201)HTML | DOC
10A NCAC 22O .0120PERSONAL CARE SERVICES (transferred to 10A NCAC 25O .0202(a)-(HTML | DOC
10A NCAC 22O .0121REPEALED - DURABLE MEDICAL EQUIPMENTHTML | DOC
10A NCAC 22O .0122PRIVATE DUTY NURSING (transferred to 10A NCAC 25O .0204)HTML | DOC
10A NCAC 22O .0123Case MGMT SVCS/Adults/Children AT-Risk/abuse/neglect/expoitation (transferred to 10a ncac 25f .0201)HTML | DOC
10A NCAC 22O .0124HIV CASE MANAGEMENT (Transferred to 10A NCAC 25F .0301)HTML | DOC
10A NCAC 22O .0125HOME INFUSION THERAPY (transferred to 10A NCAC 25O .0203)HTML | DOC
10A NCAC 22O .0201DEFINITIONS (transferred to 10A NCAC 25H .0201)HTML | DOC
10A NCAC 22O .0202STANDARDS FOR PARTICIPATION (Transferred to 10A NCAC 25H .0203)HTML | DOC
10A NCAC 22O .0203ELIGIBILITY (Transferred to 10A NCAC 25H .0202)HTML | DOC
10A NCAC 22O .0204AMOUNT: DURATION: AND SCOPE OF SERVICES (Transferred to 10A NCAC 25H .0204)HTML | DOC
10A NCAC 22O .0205RESTRICTIONS AND PRIOR APPROVAL (Transferred to 10a NCAC 25H .0205)HTML | DOC
10A NCAC 22O .0206GUIDELINES ON SERVICES (Transferred to 10A NCAC 25H .0301)HTML | DOC
10A NCAC 22O .0207SPECIFIC GUIDELINES (Transferred to 10a NCAC 25H .0302)HTML | DOC
10A NCAC 22O .0208ANESTHESIA (Transferred to 10A NCAC 25H .0303)HTML | DOC
10A NCAC 22O .0209ANALGESIA (Transferred to 10A NCAC 25H .0304)HTML | DOC
10A NCAC 22O .0210DRUGS (Transferred to 10a NCAC 25H .0305)HTML | DOC
10A NCAC 22O .0211PRIOR APPROVAL (Transferred To 10A NCAC 25H .0206)HTML | DOC
10A NCAC 22O .0301MEDICAL SERVICES (Transferred to 10A NCAC 25A .0201)HTML | DOC
10A NCAC 22O .0401INPATIENT HOSPITAL SERVICES (Paragraphs (a)-(HTML | DOC
10A NCAC 22O .0402OUTPATIENT HOSPITAL SERVICES (transferred to 10A NCAC 25P .0301)HTML | DOC
10A NCAC 22O .0403SKILLED NURSING FACILITY SERVICES (transferred to 10A NCAC 25M .0401(HTML | DOC
10A NCAC 22O .0404PHYSICIAN SERVICES (transferred to 10A NCAC 25P .0401)HTML | DOC
10A NCAC 22O .0405PODIATRIST SERVICES (transferred to 10A NCAC 25P .0404)HTML | DOC
10A NCAC 22O .0406HOME HEALTH SERVICES (Transferred to 10A NCAC 25O .0201(b)-(HTML | DOC
10A NCAC 22O .0407REPEALED - PRESCRIBED DRUGSHTML | DOC
10A NCAC 22O .0408INTERMEDIATE CARE FACILITIES (transferred to 10A NCAC 25D .0201(HTML | DOC
10A NCAC 22O .0409Therapeutic Leave (Transferred to 10A NCAC 25m .0501)HTML | DOC
10A NCAC 22O .0410personal care services (transferred to 10a ncac 25o .0202(c)-(HTML | DOC
 
Subchapter PHTML | DOC
10A NCAC 22P .0101PURPOSE AND SCOPEHTML | DOC
10A NCAC 22P .0201DEFINITIONSHTML | DOC
10A NCAC 22P .0301SERVICE DELIVERYHTML | DOC
10A NCAC 22P .0302ACCESS TO CAREHTML | DOC
10A NCAC 22P .0303COORDINATION OF BENEFITSHTML | DOC
10A NCAC 22P .0401CERTIFICATION REQUIREMENTSHTML | DOC
10A NCAC 22P .0402GOOD STANDINGHTML | DOC
10A NCAC 22P .0403MEDICAL DIRECTOR REQUIREMENTSHTML | DOC
10A NCAC 22P .0404CLINICAL DIRECTORHTML | DOC
10A NCAC 22P .0405QUALITY MANAGEMENT DIRECTORHTML | DOC
10A NCAC 22P .0406TRAINING DIRECTORHTML | DOC
10A NCAC 22P .0407EXCEPTION PROCESSHTML | DOC
10A NCAC 22P .0408MEDICAL SCHOOL/ TEACHING HOSPITAL EXCEPTIONHTML | DOC
10A NCAC 22P .0501LETTER OF ATTESTATION AND DESK REVIEWHTML | DOC
10A NCAC 22P .0502INTERVIEWHTML | DOC
10A NCAC 22P .0503VERIFICATION REVIEWHTML | DOC
10A NCAC 22P .0504EXISTING CRITICAL ACCESS BEHAVIORAL HEALTH AGENCIESHTML | DOC
10A NCAC 22P .0601MONITORINGHTML | DOC
10A NCAC 22P .0602DECERTIFICATION AND SUSPENSIONHTML | DOC
10A NCAC 22P .0603APPEAL PROCEDURESHTML | DOC
 
Subchapter QHTML | DOC
10A NCAC 22Q .0101SCOPEHTML | DOC
10A NCAC 22Q .0102DEFINITIONSHTML | DOC
10A NCAC 22Q .0103DISTRIBUTIONSHTML | DOC
10A NCAC 22Q .0104CERTIFYING HOSPITAL DISTRIBUTIONHTML | DOC
10A NCAC 22Q .0105Certifying hospitals' outpatient costsHTML | DOC
10A NCAC 22Q .0106Certifying hospital's proportionate shareHTML | DOC
 
Subchapter RHTML | DOC
10A NCAC 22R .0101SCOPEHTML | DOC
10A NCAC 22R .0102DEFINITIONSHTML | DOC
10A NCAC 22R .0103ELIGIBLE HOSPITALHTML | DOC
10A NCAC 22R .0104ELIGIBLE OUTPATIENT COSTSHTML | DOC
10A NCAC 22R .0105DISTRIBUTION OF AVAILABLE FUNDSHTML | DOC
 
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