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Adult Medicaid Manual Table of Contents

AGED, BLIND, AND DISABLED MEDICAID TABLE OF CONTENTS

MA-200 DEFINITIONS

I. ACRONYMS

II. PROGRAMS

III. DEFINITIONS

MA-300 CONFIDENTIALITY

I. INTRODUCTION

II. REQUIREMENTS

III. DEFINITIONS

IV. OWNERSHIP OF RECORDS

V. CLIENT ACCESS AND RELEASE OF INFORMATION

VI. RELEASE OF INFORMATION TO OTHER SOURCES WITHOUT CONSENT

VII. RELEASE OF INFORMATION TO Federal, State and county Law Enforcement

VIII. RELEASE OF INFORMATION WITHOUT CLIENT CONSENT CHART

IX. confidentiality of information received from the social security administration

X. Confidentiality of eligibility information system (EIS) Data

XI. confidentiality of information received from the EMPLOYMENT SECURITY COMMISSION (ESC)

MA-400 INTRODUCTION TO MEDICAID

I. Introduction to Medicaid

II. Background

III. Requirements

MA-500 CLASSIFICATION

I. AGED, BLIND, AND DISABLED MEDICAID CLASSIFICATIONS

II. COVERAGE OF MEDICARE BENEFICIARIES

III. SUMMARY OF DIFFERENCES IN CLASSIFICATIONS

IV. DETERMINATION OF THE CORRECT CLASSIFICATION

V. CLASSIFICATION TABLE

MA-1000 SSI MEDICAID AUTOMATED PROCESS

I. INTRODUCTION TO SSI MEDICAID

II. POLICY PRINCIPLES FOR SSI MEDICAID

III. AUTOMATION OVERVIEW

IV. SSI APPROVAL

V. LIMITATIONS TO MEDICAID ELIGIBILITY FOR SSI RECIPIENTS

VI. SSI DENIAL

VII. SSI TERMINATIONS

VIII. SSI OPEN/SHUTS

MA-1100 SSI MEDICAID-COUNTY DSS RESPONSIBILITY

I. COUNTY DSS RESPONSIBILITY FOR SSI APPROVALS

II. COUNTY DSS RESPONSIBILITY FOR RETROACTIVE SSI MEDICAID

III. COUNTY DSS RESPONSIBILITY FOR SSI APPLICANTS WHO DIE PRIOR TO DISPOSITION

IV. COUNTY DSS RESPONSIBILITY when AN SSI RECIPIENT enters LONG TERM CARE (LTC)

V. COUNTY DSS RESPONSIBILITY WHEN SSI TERMINATES FOR INDIVIDUALS IN LTC

VI. COMMUNITY ALTERNATIVES PROGRAM (CAP

VII. IN-HOME HEALTH SERVICES AND SUPPLIES

VIII. EMERGENCY CERTIFICATION FOR MEDICAID

IX. COUNTY DSS RESPONSIBILITY FOR AN SSI CHILD IN HSF

X. NON-ELIGIBILITY RELATED MEDICAID PROCEDURES

MA-2000 NON-SSI ELIGIBILITY REGULATIONS

I. INTRODUCTION TO NON-SSI MEDICAID ELIGIBILITY DETERMINED BY DSS

II. CATEGORICAL REQUIREMENTS FOR NON-SSI MEDICAID COVERAGE GROUPS

III. NON-FINANCIAL REQUIREMENTS APPLICABLE TO ADULT MEDICAID COVERAGE GROUPS

IV. FINANCIAL REQUIREMENTS APPLICABLE TO ADULT MEDICAID COVERAGE GROUPS

V. NON-SSI AGED, BLIND, AND DISABLED COVERAGE GROUPS BY CLASSIFICATION

MA-2100 CATEGORICALLY NEEDY-NO MONEY PAYMENT

I. INTRODUCTION TO CATEGORICALLY NEEDY - NO MONEY PAYMENT (N)

II. POLICY RULES FOR CATEGORICALLY NEEDY

MA-2110 PASSALONG

I. INTRODUCTION TO PASSALONG

II. COLA PASSALONG PICKLE AMENDMENT GROUP

III. DAC PASSALONG

IV. WIDOW(ER)S (INCLUDING SOME SURVIVING, DIVORCED SPOUSES) NOT RECEIVING MEDICARE

V. WIDOW(ER)S (INCLUDING SOME UNMARRIED, DIVORCED SPOUSES) WHO LOST SSI IN 1984

MA-2120 MEDICALLY NEEDY REGULATIONS

I. INTRODUCTION TO MEDICALLY NEEDY (M)

II. POLICY RULES FOR MEDICALLY NEEDY

MA-2130 QUALIFIED MEDICARE BENEFICIARIES-Q

I. INTRODUCTION TO MQB-Q

II. MQB-Q ELIGIBILITY REGULATIONS FOR NON-SSI BENEFICIARIES

III. MQB-Q SPECIAL PROGRAM REQUIREMENTS

MA-2140 QUALIFIED MEDICARE BENEFICIARIES-B

I. introduction to mqb-b

II. MQB-B ELIGIBILITY REQUIREMENTS

III. mQB-B SPECIAL PROGRAM REQUIREMENTS

MA-2150 MEDICAID-WORKING DISABLED

I INTRODUCTION TO M-WD

II. MWD ELIGIBILITY REQUIREMENTS

III. M-WD SPECIAL REQUIREMENTS

MA-2160 QUALIFYING INDIVIDUALS 1 (QI1/MQB-E)

I. INTRODUCTION TO QUALIFYING INDIVIDUALS

II. QUALIFYING INDIVIDUALS POLICY FUNDAMENTALS

III. PROCEDURES

IV. RE-ENROLLMENT

MA-2170 MEDICAID FAMILY PLANNING WAIVER

Issued 10/1/05 – Change No. 22-05

I. INTRODUCTION AND OVERVIEW

II. ALWAYS EVALUATE FOR THE FAMILY PLANNING PROGRAM

MA-2180 HEALTH COVERAGE FOR WORKERS WITH DISABILITIES

I. Introduction to Health Coverage for Workers with Disabilities

II. Background

III. COVERAGE GROUPS

IV. Eligibility Requirements

V. Redeterminations

VI. Terminations/Deletions

MA-2220 STATE RESIDENCE

I. pRINCIPLE

II. Requirements

III. Procedures

IV. INDICATING INTENT

V. INDIVIDUAL MOVING TO NC WAS PREVIOUSLY ELIGIBLE IN ANOTHER STATE

VI. INDIVIDUAL PREVIOUSLY ELIGIBLE IN NC MOVES TO ANOTHER STATE

VII. MEDICAL CARE PROVIDED OUTSIDE OF NC

MA-2221 COUNTY RESIDENCE

I. POLICY RULES

II. DETERMINING COUNTY RESIDENCE

III. VERIFYING THE COUNTY OF RESIDENCE

IV. APPLICANT MOVes FROM ONE COUNTY TO ANOTHER

V. COUNTY REASSIGNMENT OF ONGOING CASES

Vi. Transfers keyed to wrong County

MA-2230 FINANCIAL RESOURCES

I. POLICY PRINCIPLES

II. FINANCIAL RESOURCE PROCEDURES

III. WHOSE RESOURCES TO COUNT

IV. AVAILABILITY OF RESOURCES

V. RESULTING TRUSTS/LEGALLY BINDING AGREEMENTS

VI. INCOMPETENCY

VII. REAL PROPERTY ASSETS

VIII. PERSONAL PROPERTY ASSETS

IX. INCOME PRODUCING REAL/PERSONAL PROPERTY

X. LIQUID ASSETS

XI. TRUST FUNDS

XII. LIFE INSURANCE AND ANNUITIES

XIII. BURIAL EXCLUSION

XIV. A/B IS A BENEFICIARY OF A TRUST

MA-2231 COMMUNITY SPOUSE RESOURCE PROTECTION

II. PROCEDURES FOR SPOUSAL RESOURCE PROTECTION

III. CHANGES AFFECTING SPOUSAL RESOURCE PROTECTION

MA-2240 TRANSFER OF ASSETS

I. Introduction

II. POLICY Principle

IiI. DEFINITION OF TERMS RELATED TO TRANSFER POLICY

IV. TRANSFER OF ASSET RULES

V. LOOKBACK date

VI. Exploring transfer of assets

VII. ALLOWABLE TRANSFERS (NON-TRUSTS

VIII. ALLOWABLE TRANSFERS TO A TRUST

IX. Transfers THAT MAY OR MAY NOT BE ALLOWED

X. ADDITIONAL EXCEPTIONS TO APPLYING TRANSFER SANCTION

XI. NON-ALLOWABLE TRANSFERS

XiI. TRANSFER Sanction

XIII. REBUTTAL

XiV. DECISION AND NOTIFICATION procedures (dENIAL/REBUTTAL/UNDUE HARDSHIP)

XV. Tracking Transfer of Assets Sanction Period

HOME EQUITY VALUE & ELIGIBILITY FOR INSTITUTIONAL SERVICES

I. INTRODUCTION

II. LIMITATION ONLY ON PAYMENT FOR INSTITUTIONAL SERVICES

III. DETERMINING HOME EQUITY VALUE

IV. DEMONSTRATED HARDSHIP

MA-2245 UNDUE HARDSHIP WAIVER FOR TRANSFER OF ASSETS

I. Undue Hardship

II. Policy RULES

III. Procedures For Requesting Undue Hardship Determination and Documentation

IV. INFORMATION AND DOCUMENTATION TO SUPPORT CLAIM FOR UNDUE HARDSHIP

V. UNDUE HARDSHIP DECISION

MA-2250 INCOME

I. POLICY RULEs

II. A/B’S RESPONSIBILITIES

III. DOCUMENTATION

IV. BASE PERIOD

V. CHANGES AND/OR TERMINATED INCOME

VI. NON-COUNTABLE INCOME

VII. COUNTABLE EARNED INCOME

VIII. COUNTABLE UNEARNED INCOME

IX. COMPUTATION

X. APPEAL REVERSALS

MA-2260 FINANCIAL ELIGIBILITY REGULATIONS-PLA

I. FINANCIAL AND RESOURCE RESPONSIBILITY FOR ALL M-AABD and MQB COVERAGE GROUPS

II. Financial Responsibility

III. MAABD and MQB SSI Budgeting methodology and definitions

IV. INCOME COMPUTATIONS (BASED ON COMPLETION OF DMA'S BUDGET SHEETS)

V. MQB Family size budgeting

VI. RESOURCE RESPONSIBILITY

VII. INCOME TABLE

VIII. RESERVE TABLE (effective 01/14)

MA-2261 1/3 REDUCTION

I. RULES FOR USE OF FULL INCOME LEVEL OR 1/3 REDUCTION

II. 1/3 REDUCTION

MA-2262 SPONSOR DEEMING

I. Introduction

II. Definitions

III. policy principles

IV. Aliens exempt from sponsor deeming

V. immigrants affected by alien sponsor deeming

VI. Battered Alien Exemption

VII. Indigent alien Exemption

VIII. Sponsorship Verification and documentation

IX. Income policy

X. resources

XI. time limit for sponsor deeming

MA-2270 LONG TERM CARE NEED AND BUDGETING

I. INTRODUCTION

II. WHEN TO USE LTC BUDGETING

III. EXCEPTIONS TO LTC BUDGETING

IV. DETERMINING ELIGIBILITY FOR The months prior to Long-term care budgeting

V. LONG TERM CARE BUDGETING COMPUTATION

VI. THE COMMUNITY SPOUSE INCOME ALLOWANCE (SPOUSE IN PLA)

VII. THE DEPENDENT FAMILY MEMBER ALLOWANCE

VIII. UNMET MEDICAL NEEDS ALLOWANCE

IX. REPORTING PATIENT MONTHLY LIABILITY ON DMA-5016

X. HOSPITAL LEVEL OF CARE CHANGE AND DECERTIFIED FACILITY PROCEDURES

XI. CHANGE IN SITUATION

XII. Procedures For Other Medicaid Covered Services Only (STEP III)

XIII. PLA Procedures When The A/B Is Ineligible For Cost of Care For Reasons Not Related to Income

XIV. MEDICARE COVERAGE

XV. PRIOR APPROVALS (FL-2 AND MR-2)

XVI. LONG TERM CARE OMBUDSMEN

MA-2275 PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)

I. BACKGROUND

II. INTRODUCTION

III. PACE AND MEDICAID REFERRAL PROCEDURES

IV. Eligibility Documentation for PACE

V. POLICY PRINCIPLES

VI. PACE BUDGETING

VII. ALLOWABLE DEDUCTIONS

VIII. MEDICAID AUTHORIZATION FOR PACE SERVICES

IX. MEDICAID CERTIFICATION AND AUTHORIZATION FOR PACE

X. REDETERMINATION OF ELIGIBILITY/REVIEW

XI. CHANGE IN SITUATION

XII. ELIGIBILITY INFORMATION SYSTEM (EIS)

XIII. XPTR REPORT

XIV. AUTOMATED AND MANUAL NOTICES FOR PACE SERVICES

XV. PACE APPLICATION REPORT

XVI. PACE SERVICES – INTERNAL APPEAL PROCESS

XVII. MEDICAID APPEAL PROCESS

MA-2280 COMMUNITY ALTERNATIVES PROGRAM (CAP)

I. INTRODUCTION

II. POLICY PRINCIPLES - APPLICABLE TO ALL PROGRAMS

III. PROCEDURES - APPLICABLE TO ALL PROGRAMS

IV. CAP/C

V. CAP/DA

VI. CAP/CHOICE

VII. MONEY FOLLOWS THE PERSON

MA-2285 – ESTATE RECOVERY

I. BACKGROUND

II. POLICY PRINCIPLES

III. PROCEDURES

IV. ESTATE RECOVERY PROCEDURES WHEN A RECIPIENT DIES

V. WAIVER OF ESTATE RECOVERY

VI. CLAIM OF UNDUE HARDSHIP

MA-2290 Managed Care Organizations for Behavioral Health

I. BACKGROUND

II. POLICY PRINCIPLES

III. Affected populations

IV. EIS AND POLICY PROCEDURES

V. NOTICE PROCEDURES

VI. PRIOR APPROVAL AND REVIEW PROCESS

VII. COUNTY RESPONSIBILITIES

VIII. BENEFICIARY CONTACT INFORMATION FOR THE LOCAL MANAGEMENT ENTITY-MANAGED CARE ORGANIZATIONS (LME-MCO).

MA-2300 INITIAL CONTACT

I. INTRODUCTION

II. POLICY PRINCIPLES

III. TYPES OF CONTACT

IV. DISCOURAGEMENT

V. EXCEPTIONS TO THE RIGHT TO BE INTERVIEWED THE SAME DAY THE INDIVIDUAL APPEARS IN THE AGENCY

MA-2301 CONDUCTING A FACE-TO-FACE INTAKE INTERVIEW

I. PRINCIPLE

II. WHO MAY APPLY

III. INFORMATION REGARDING THE MEDICAID PROGRAM

IV. RIGHTS AND RESPONSIBILITIES

V. TAKING THE APPLICATION

VI. EXPLAINING THE AVAILABLE SERVICES

MA-2302: RECEIVING MAIL-IN APPLICATIONS

I. Introduction

II. policy principles

III. Procedures

MA-2303 VERIFICATION REQUIREMENTS FOR APPLICATIONS

I. INTRODUCTION

II. POLICY PRINCIPLES

III. PROCEDURES

MA-2304 - PROCESSING THE APPLICATION

I. INTRODUCTION

II. POLICY PRINCIPLES

III. PROCEDURES

IV. pROCEDURES FOR APPLICATIONS RECEIVED FROM PRISONERS WITH INPATIENT HOSPITALIZATIONS

V. REOPENED DENIALS, WITHDRAWALS, APPROVALS OR INQUIRIES

MA-2305 EVALUATING COUNTY/DDS PERFORMANCE

I. INTRODUCTION

II. POLICY PRINCIPLES

III. DEFINITIONS

IV. APPLICATION PROCESSING REQUIREMENTS

V. MONITORING TOOLS

VI. REPORTS

MA-2306 APPLICATION PROCESSING – CORRECTIVE ACTION PROCEDURES

I. PRINCIPLES

II. REPORT CARD FAILURES

III. WAIVER REQUESTS FOR FAILING THE ADJUSTED APPLICATION REPORT CARD

IV. MONITORING

V. LOCAL CORRECTIVE ACTION PROCEDURES FOR COUNTY DSS NON- COMPLIANCE

VI. TRACKING AND NOTIFICATION OF NON-COMPLIANCE

VII. STATE CORRECTIVE ACTION TEAM

MA-2309 LIS APPLICATION FOR MEDICAID

I. Introduction

II. policy principles

III. Automated Overview

IV. County Procedures

V. Special Situations

MA-2310 TAKING THE LIS APPLICATION

I. Introduction and overview

II. Definitions

III. Policy principles

IV. Who May Apply for the LIS

V. Completing the LIS Application For Submission to SSA

VI. APPLICANT INSISTS THAT DSS PROCESS THE lis APPLICATION

MA-2311 LIS PROCESSING AND MAINTENANCE

I. INTRODUCTION

II. DEFINITIONS

III. POLICY PRINCIPLES

IV. INCOME

V. RESOURCES

VI. DETERMINING ELIGIBILITY FOR THE LIS

VII. APPLICATION OUTCOMES

VIII. CASE MAINTENANCE

IX. LIS Income Limits

MA-2312 MEDICARE PRESCRIPTION DRUG BENEFIT

i. introduction TO The Medicare Modernization Act of 2003

ii. Policy Principles

iii. enrollment

iV. OTHER PROGRAM AREAS

V. other drug coverage

VI. EXCLUDED and NON COVERED-DRUGS

VII. MEDICAID ID CARD

VIII. EIS

IX. NOTICES AND APPEALS

X. Other Places to contact for Medicare Information

MA-2320 REDETERMINATION OF ELIGIBILITY

I. POLICY RULES

II. ITEMS TO BE VERIFIED AT REDETERMINATION

III. THE REDETERMINATION INTERVIEw

IV. COOPERATING WITH THE COUNTY DSS

V. ENUMERATION REQUIREMENT

VI. U.S. Citizenship and identity DOCUMENTATION

VII. INFORMING THE RECIPIENT/REPRESENTATIVE OF HIS RIGHTS AND RESPONSIBILITIES

VIII. TRANSFER OF RESOURCES

IX. PROTECTION AGAINST DISCRIMINATION

X. FAMILY PLANNING WAIVER (fpw)

XI. HEALTH CHECK PROGRAM

XII. Community care of north carolina/carolina access (ccnc/ca)

XIII. MEDICAL TRANSPORTATION

XIV. EXPLAIN THE FOOD AND NUTRITIon SERVICES PROGRAM

XV. EXPLAIN THE WOMEN, INFANTS AND CHILDREN (WIC) PROGRAM

XVI. OTHER AVAILABLE SERVICES

XVII. REDETERMINATION/VERIFICATION FORMS

Xviii. COLLATERAL CONTACTS

XIX. HOME VISIT

XX. ACTIONS REQUIRED AT THE END OF CERTIFICATION PERIOD

XXI. REDETERMINATION ALTERNATIVES

XXII. REVIEW CHARTS

MA-2340 CHANGE IN SITUATION

I. GENERAL INSTRUCTIONS APPLICABLE TO ANY CHANGE IN SITUATION

II. TYPES OF CHANGES

MA-2350 CERTIFICATION AND AUTHORIZATION

I. POLICY PRINCIPLES

II. LENGTH OF CERTIFICATION PERIODS

III. SPECIAL SITUATIONS

IV. AUTHORIZATION

MA-2352 TERMINATIONS/DELETIONS/EX PARTES

I. POLICY PRINCIPLES

II. WHEN MEDICAID TERMINATES

III. EXCEPTIONS TO CONTINUING MEDICAID WHEN MEDICAID, INCLUDING WORK FIRST TERMINATES.

MA-2355 MAABD/MQB PROGRAM TRANSFERS

I. POLICY RULES

II. TRANSFERS FROM M-QB TO M-AABD

III. TRANSFERS FROM M-AABD TO MQB-Q or B

MA-2360 MEDICAID DEDUCTIBLE

I. POLICY RULE

II. COMPUTING A DEDUCTIBLE

III. HOW TO MEET A DEDUCTIBLE

IV. ALLOWABLE CHARGES

V. THIRD PARTY RESPONSIBILITY

VI. DOCUMENTATION AND VERIFICATION

VII. AUTHORIZATION AND REPORTING OF DEDUCTIBLE BALANCE

VII. APPLYING DRG POLICY

MA-2370 RETROACTIVE COVERAGE

I. POLICY RULES

II. PROCEDURES

III. DISPOSITIONS

MA-2375 CHILD SUPPORT

I. INTRODUCTION

II. REQUIREMENTS FOR REFERRING CHILDREN TO THE CHILD SUPPORT ENFORCEMENT AGENCY

III. Caretaker responsibilities where cooperation is required

IV. DETERMINING GOOD CAUSE FOR NOT COOPERATING WITH Child Support Enforcement

V. MAKING A REFERRAL TO IV-D

VI. AUTOMATED REFERRAL PROCESS

VII. PENALTY FOR FAILURE TO COOPERATE

VIII. REPORTING CHANGES TO IV-D

MA-2380 MEDICAID IDENTIFICATION CARD

I. Introduction

II. PROCEDURES

MA-2395 CORRECTIVE ACTION AND RESPONSIBILITY FOR ERRORS

I. Background

II. REQUIREMENTS

III. PROCEDURES

IV. FINANCIAL RESPONSIBILITY

MA-2400 THIRD PARTY RECOVERY

I. POLICY RULES

II. PROCEDURES

III. TYPES OF THIRD PARTY RESOURCES

IV. INTERVIEW QUESTIONS FOR DETERMINING TYPES OF THIRD PARTY RESOURCES

V. MEDICAID AS PAYER OF LAST RESORT OR AS PRIMARY PAYER

VI. THIRD PARTY RECOVERY NON COMPLIANCE

VII. third party insurance for nchc and bccm

MA-2410 MEDICARE ENROLLMENT & BUY-IN

I. INTRODUCTION

II. WHO IS ENTITLED TO MEDICARE?

III. POLICY PRINCIPLES

IV. OVERVIEW OF MEDICARE COVERAGE

V. OVERVIEW OF MEDICARE BUY-IN

VI. EFFECTIVE DATE OF BUY-IN COVERAGE

VII. RECIPIENT ENROLLMENT IN BUY-IN

VIII. COUNTY RESPONSIBILITY TO ASSIST WITH MEDICARE APPLICATION

IX. CHARGEBACKS FOR COUNTY ERRORS

X. PROCEDURES FOR ALIENS

XI. INFORMATIONAL MATERIALS SENT TO COUNTIES

MA-2420 NOTICE AND HEARINGS PROCESS

I. INTRODUCTION

II. POLICY PRINCIPLES

III. Authorized Representatives Entitled to notice.

Iv. NOTICE PROCEDURES

V. HEARING PROCESS

MA-2425 COMMUNITY CARE OF NORTH CAROLINA/CAROLINA ACCESS

I. Background

II. Policy Principles

III. DMA RESPONSIBILITY

IV. COUNTY DSS RESPONSIBILITIES

V. CCNC/CA CONTACT PERSON and Back-Up Person

VI. CCNC/CA PROVIDER (PRIMARY DOCTOR/MEDICAL HOME) DIRECTORY

VII. ENROLLMENT

VIII. ASSIGNMENT PROTOCOLS FOR MEDICAID AND NORTH CAROLINA HEALTH CHOICE (NCHC) RECIPIENTS

IX. RECIPIENT EDUCATION

X. INFORMATION AND REFERRAL RESPONSIBILITY

MA-2430: AUTOMATED INQUIRY AND MATCH PROCEDURES

i. introduction

II. POLICY PRINCIPLES

III. MATCHES REQUIRED BY IEVS

IV. OTHER MATCHES

V. FRR RESOURCE TYPES AND DESCRIPTIONS

MA-2440 AUTOMATED SOLQ PROCEDURES

I. INTRODUCTION

II. BENEFIT VERIFICATION

III. MANUAL VERIFICATION OF BENEFITS

IV. THE SOLQ/TPQY SYSTEM

MA-2450 ENUMERATION PROCEDURES

I. Policy Principles

II. ENUMERATION REQUIREMENTS

III. ENUMERATION PROCEDURES

IV. UPDATING OF SOCIAL SECURITY ID NUMBER

V. SOCIAL SECURITY NUMBER VALIDATION

VI. DOCUMENTATION

MA-2500 AGE/NAME/MARITAL STATUS

I. POLICY RULE

II. VERIFICATION PROCEDURES

MA-2504 – ALIEN REQUIREMENTS

I. INTRODUCTION

II. PRINCIPLE

III. GLOSSARY OF USCIS TERMS

IV. QUALIFIED ALIENS

V. Public Charge

VI. Sponsor deeming

VII. Verifying 40 qualifying Quarters

VIII. Non-Qualified Aliens

IX. Pregnant Women and Children Under Age 19 Lawfully Residing in the US

X. COVERAGE FOR EMERGENCY MEDICAL SERVICES

XI. PROCEDURES TO OBTAIN USCIS VERIFICATION

MA-2505 CITIZENSHIP/IDENTITY SSA DATA MATCH

I. INTRODUCTION

II. Procedures to Verify Citizenship and Identity using SSA Data Match

MA-2506 US CITIZENSHIP REQUIREMENTS

I. INTRODUCTION

II. PRINCIPLE

III. United States Citizen

IV. Citizenship and Identity REQUIREMENTS AT APPLICATION

V. Citizenship and Identity REQUIREMENTS at Redetermination

VI. CITIZENSHIP AND IDENTITY DOCUMENTATION

VII. Hierarchy Charts: Acceptable Documentation of Citizenship and Identity

VIII. Collective Naturalization

MA-2510 LIVING ARRANGEMENT

I. OVERVIEW OF LIVING ARRANGEMENT

II. SPECIFIC TYPES OF INSTITUTIONS/FACILITIES

III. Medicaid Suspension/Termination for Incarcerated Beneficiaries and Beneficiaries Who Enter an Institution for Mental Disease (IMD)

MA-2525 DISABILITY

I. INTRODUCTION

II. DEFINITIONS

III. POLICY principles

IV. APPLICATIONS/REAPPLICATIONS - DISABILITY NOT ESTABLISHED

V. APPLICATIONS/REAPPLICATIONS - DISABILITY ALREADY ESTABLISHED

VI. APPLICATIONS/REAPPLICATIONS - DISABILITY ESTABLISHED BY SSA - PRIOR MAD DISABILITY DENIAL

VII. APPEAL REVERSAL OF MAD DISABILITY DENIAL

VIII. ACTIVE MAD BENEFICIARY WITH SSA/SSI TERMINATION OR DENIAL

IX. ACTIVE MAD BENEFICIARY APPEALS MEDICAID TERMINATION OF DISABILITY THROUGH THE STATE HEARING PROCESS

X. MAB/MAD beneficiaries who are working and terminated from rsdi/ssi

XI. PROTECTED MEDICAID STATUS FOR NON-SSI CHILDREN

XII. REDETERMINATIONS OF DISABILITY FOR NON-SSI MAD CHILDREN UNDER AGE 18

XIII. REDETERMINATIONS OF Continued DISABILITY FOR NON-SSI ADULTS OVER AGE 18

XIV. TRANSPORTATION FOR MAD APPLICANTS To Establish DIsability

MA-2531 BLINDNESS - MAB

I. INTRODUCTION

II. POLICY PRINCIPLES

III. WHEN A DETERMINATION OF BLINDNESS IS NOT REQUIRED

V. REDETERMINATION AND BENEFICIARIES NEEDING AN INITIAL BLINDNESS DETERMINATION

VI. SUBMITTAL PROCEDURES FOR DSB-2202 "REPORT OF EYE EXAMINATION"

VII. SPECIAL PROCEDURES FOR REAPPLICATIONS

MA-2900 RECIPIENT FRAUD AND ABUSE POLICY AND PROCEDURES

I. PURPOSE

II. LEGAL RESPONSIBILITY AND REFERENCES

III. NORTH CAROLINA GENERAL STATUTES

IV. FRAUD VS. MISREPRESENTATION

V. Prevention

VI. DETECTION

VII. INVESTIGATIONS

VIII. CALCULATING OVERPAYMENTS

IX. CONCLUSIONS AND RECOMMENDATIONS

X. NOTICES & APPEALS

Xi. Administrative Collection Procedures

XII. BankruptcY

XIII. Distribution of Cash Repayment

XIV. EPICS Reporting Requirements

XV. NC Debt Setoff (Tax Intercept) Criteria for Medicaid Claims

XVI. North Carolina Title XIX Medicaid Recipient/NCHC Profiles

XVII. CITATIONS AND REFERENCES

MA-2905- MEDICAID COVERED SERVICES

I. Introduction

ii. Policy Principles

iiI. PHYSICIAN SERVICES

Iv. CLINIC SERVICES

V. HOSPITAL INPATIENT SERVICES

Vi. HOSPITAL OUTPATIENT SERVICES

VIi. NURSING FACILITY SERVICES

ViIi. PSYCHIATRIC AND PSYCHOLOGICAL SERVICES

iX. RESIDENTIAL SERVICES

X. MENTAL HEALTH CENTERS

Xi. STATE AND PRIVATE MENTAL HOSPITALS

XIi. NORTH CAROLINA SPECIALTY HOSPITALS

XIii. DENTAL SERVICES

Xiv. CHIROPRACTORS

Xv. PODIATRISTS

XVi. HOSPICE

XVIi. DURABLE MEDICAL EQUIPMENT (DME)

Xviii. HOME HEALTH SERVICES

Xix. In-Home Care for Adults (IHCA) and In-Home Care for Children (IHCC)

Xx. HOME INFUSION THERAPY (HIT)

XXi. PRIVATE DUTY NURSING (PDN)

XXIi. PRESCRIPTION DRUGS

XXIii. HEARING AID SERVICES

XXiv. Optical services

xxv. LABORATORY SERVICES

XXVi. RADIOLOGICAL (X-RAY) SERVICES

xxvii. Outpatient specialized therapies

xxviii. health related services provided by independent practitioners

xxix. Health related services provided in public schools

xxx. Anesthesiology Services

XXXi.FAMILY PLANNING SERVICES

XXXII. Ob/Gyn Services

xxxiii. Sterilizations/hysterectomies/abortions

XXXiV. Baby Love

XXXV. Medicaid for Pregnant women

XXXVI. NURSE-MIDWIFE SERVICES

XXxvII. Nurse practitioners

XXXviiI. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) and health check

Xil. PREVENTIVE Medical SERVICES

XL. Refugee health assessments provided in health Departments

XLI. DIALYSIS SERVICES

XlIi. COMMUNITY ALTERNATIVES PROGRAMS (CAP)

Xliii. Case Management for adults and children at risk of abuse, neglect, and exploitation (At-risk case management)

XLiV. CASE MANAGEMENT FOR HIV

XLV. Medical Transportation

XLVI. BUY-IN PROGRAM

XLVII. MISCELLANEOUS NON-COVERED ITEMS

A-2910 MEDICAID TRANSPORTATION

I. ACRONYMS

II. DEFINITIONS

III. BACKGROUND

IV. POLICY PRINCIPLES

V. Beneficiary’s Rights and Responsibilities

VI. County’s Responsibilities (also see IX Safety and Risk Management)

VII. Procedure

VIII. ARRANGING TRANSPORTATION TO MEDICAL CARE

IX. Safety and Risk Management

X. Reimbursement

XI. REPORTING TRANSPORTATION COST

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