SECTION .0300 - MEDICAID PAYMENTS SUBJECT TO RECOVERY

 

10A NCAC 21D .0301       PERMANENTLY INSTITUTIONALIZED

(a)  For permanently institutionalized individuals recovery shall be claimed for all Medicaid payments, including cost sharing charges for Medicare services and Medicare premiums, made on behalf of individuals for the period of time the individual received care in a medical institution, including the period of time prior to the date the recipient is determined permanently institutionalized whether or not such periods were consecutive.  The amount of recovery shall be limited to the amount of Medicaid payments for services and benefits described herein.

(b)  No recovery shall be claimed for any period of time the recipient was discharged from a medical institution and lived in the community for a period of 30 or more consecutive days.

(c)  No recovery shall be claimed if the recipient is survived by one or more of the relatives listed in Section .0100 of this Subchapter.

(d)  No recovery shall be claimed if the Division of Medical Assistance determines under provisions of Section .0500 of this Subchapter that it is not cost effective or if recovery would create undue hardship to a survivor.

 

History Note:        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.