SUBCHAPTER 22l ‑ MANAGED CARE AND PREPAID PLANS

 

SECTION .0100 ‑ MANAGED CARE

 

10A NCAC 22l .0101      PROGRAM DEFINITION

The Division's primary care case management contractor shall contract with primary care physicians in participating counties to deliver and coordinate the health care of certain categories of Medicaid beneficiaries listed in 10A NCAC 22L .0104.

 

History Note:        Authority G.S. 108A‑25(b);

Eff. August 3, 1992;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. August 22, 2015;

Amended Eff. July 1, 2018.

 

10a NCAC 22L .0102      COORDINATION FEE

In addition to normal Medicaid payments, the Division may pay participating physicians a monthly fee to provide case management for providing or coordinating the health care services of enrollees who have selected them as their primary care physician.

 

History Note:        Authority G.S. 108A‑25(b);

Eff. August 3, 1992.

Readopted Eff. July 1, 2018.

 

10A NCAC 22L .0103      ACCESS TO CARE

The Division's primary care case management enrollees shall be eligible to receive health care services that Medicaid beneficiaries are eligible for. Beneficiaries receive services through their primary care physician who either provides or coordinates health care.

 

History Note:        Authority G.S. 108A‑25(b);

Eff. August 3, 1992;

Readopted July 1, 2018.

 

10A NCAC 22L .0104      ENROLLMENT

(a)  All Medicaid beneficiaries in participating counties who are eligible for primary care case management shall enroll. Eligible Medicaid beneficiaries include AFDC-related, MIC, Aged, Blind and Disabled categories, unless exempt due to institutional placement. Institutional placement includes nursing home, mental institutions, and domiciliary care.

(b)  The following beneficiaries have the option to enroll in primary care case management:

(1)           Medicaid for Pregnant Women;

(2)           benefit diversion beneficiaries;

(3)           beneficiaries with end stage renal disease; and

(4)           Native Americans/Alaska Natives.

 

History Note:        Authority G.S. 108A‑25(b);

Eff. August 3, 1992;

Readopted July 1, 2018.

 

10A NCAC 22l .0105      EMERGENCY ROOM CARE

 

History Note:        Authority G.S. 108A‑25(b); Section 93(h) of Chapter 689, 1991 North Carolina Session laws;

Eff. August 3, 1992;

Expired Eff. September 1, 2015 pursuant to G.S. 150B-21.3A.

 

SECTION .0200 ‑ PREPAID PLANS

 

10A NCAC 22L .0201      PROGRAM DEFINITION

 

History Note:        Authority G.S. 108A-25(b);

Eff. August 3, 1992;

Amended Eff. April 1, 1999;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. August 22, 2015;

Repealed Eff. July 1, 2018.

 

10A NCAC 22L .0202      ENROLLMENT

 

History Note:        Authority G.S. 108A-25(b);

Eff. August 3, 1992;

Amended Eff. April 1, 1999;

Expired Eff. September 1, 2015 pursuant to G.S. 150B-21.3A.

 

10A NCAC 22L .0203      ACCESS TO CARE

 

History Note:        Authority G.S. 108A-25(b); 42 U.S.C. 1396u-2(b)(2)(B),(C);

Eff. August 3, 1992;

Amended Eff. April 1, 1999;

Repealed Eff. July 1, 2018.