SUBCHAPTER 22k ‑ QUALIFIED PROVIDERS

 

10A NCAC 22k .0101       DEFINITION

A provider qualified to make presumptive determinations of Medicaid eligibility for pregnant women must meet the conditions required by the Social Security Act as amended by P.L. 99‑509 and sign a written agreement with the Division of Medical Assistance (DMA).

 

History Note:        Authority G.S. 108A‑25(b); 1987 Session Laws, c. 738; P.L. 99‑509;

Eff. June 1, 1988.

10A NCAC 22K .0102       AGREEMENT

(a)  The provider must agree to participate in training offered by the Division of Medical Assistance (DMA) or its agents and to make presumptive eligibility determinations based on the procedures and guidelines issued by the DMA.

(b)  The DMA may terminate the provider's agreement and authority to make presumptive determinations if the provider fails to make required referrals within five days or fails to follow procedures and guidelines resulting in eligibility denials for a majority of the provider's referrals.

(c)  Termination of the agreement will occur 30 calendar days following notification when termination is initiated by the DMA.

 

History Note:        Authority G.S. 108A‑25(b); 1987 Session Laws, c. 738; P.L. 99‑509;

Eff. June 1, 1988.

 

10A NCAC 22K .0103       PRESUMPTIVE DETERMINATIONS

(a)  Presumptive determinations of eligibility shall apply only to pregnant women whose family income does not exceed the federal poverty guidelines as revised annually.

(b)  Only one presumptive determination of eligibility during a single pregnancy may be made by the same qualified provider.

(c)  A presumptive determination of eligibility may be made by a different qualified provider if the provider has no knowledge of a prior determination.

 

History Note:        Authority G.S. 108A‑25(b); 1987 Session Laws, c. 738; P.L. 99‑509;

Eff. June 1, 1988.