Adult Medicaid Manual 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. confidentiality of information received from the social security administration

IX. Confidentiality of eligibility information system (EIS) Data

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

MA-400: INTRODUCTION TO MEDICAID

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

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 RECIPIENTS

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

UNLESS OTHERWISE NOTED BELOW, THE SAME REQUIREMENTS AND PROCEDURES APPLY TO M-WD AND MQB-Q.

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

I. INTRODUCTION AND OVERVIEW

II. ALWAYS EVALUATE FOR FPW

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-2221: Figure 1 – Transfer Letter

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

MA-2231: COMMUNITY SPOUSE RESOURCE PROTECTION

II. PROCEDURES FOR SPOUSAL RESOURCE PROTECTION

III. CHANGES AFFECTING SPOUSAL RESOURCE PROTECTION

community spouse resource protection worksheet

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

MA-2241 – TRANSITION POLICY FOR IN-HOME HEALTH SERVICES & SUPPLIES

I. Introduction

II. Evaluation of Transfers of Resources for Purposes of Eligibility for In-Home Health Services and Supplies from November 1, 2007 through October 31, 2010

III. The week-end of November 3, 2007, EIS changed sanction periods ending 12/9999 to an ending date of 11/30/2010 for those recipients who did not respond.

IV. Transfers Occurring on or After November 1, 2007

MA-2242 – 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/R’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 COVERAGE GROUPS

II. RESOURCE RESPONSIBILITY

III. RESERVE DEEMING PROCEDURES AND COMPUTATIONS

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

V. INCOME TABLE

VI. RESERVE TABLE

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/R 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. PACE recipients are not issued Medicaid Cards. A PACE enrollment card is issued by the PACE organization. If the PACE recipient is enrolled in Medicare, a PACE identification sticker is placed on the Medicare card by the PACE organization.

XIV. XPTR REPORT

XV. AUTOMATED AND MANUAL NOTICES FOR PACE SERVICES

XVI. PACE APPLICATION REPORT

XVII. PACE SERVICES – INTERNAL APPEAL PROCESS

XVIII. 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. CAP-MR/DD

VIII. MONEY FOLLOWS THE PERSON

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. 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

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

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

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. REQUIREMENTS FOR COOPERATION OF THE CARETAKER

IV. DETERMINING GOOD CAUSE FOR NOT COOPERATING WITH IV-D

V. MAKING A REFERRAL TO IV-D

VI. AUTOMATED REFERRAL PROCESS

VII. PENALTY FOR FAILURE TO COOPERATE

IX. 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. COUNTY CORRECTIVE ACTIONS

III. OVERRIDE OF THE CLAIMS FILING TIME LIMIT

IV. DMA CORRECTIVE ACTIONSDMA is responsible for making corrections in the following:

V. FINANCIAL RESPONSIBILITY

VI. PROCEDURES

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

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. NOTICE PROCEDURES

IV. 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

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

(V.)

VI. DOCUMENTATION

MA-2500: AGE/NAME/MARITAL STATUS

I. POLICY RULE

II. VERIFICATION PROCEDURES

MA-2504 CITIZEN/ALIEN REQUIREMENTS

I. INTRODUCTION

II. PRINCIPLE

III. United States Citizen

IV. QUALIFIED ALIENS

V. Iraqi and Afghanistan Special Immigrants

VI. Immigrants - Refugee Code, Date, Alien ID and Citizenship/Identity Codes

VII. Trafficking Victims

VIII. Battered Alien (Violence Against Women Act)

IX. Public Charge

X. Sponsor deeming

XI. Verifying 40 qualifying Quarters

XII. Non-Qualified Aliens

XIII. COVERAGE FOR EMERGENCY MEDICAL SERVICES

XIV. PROCEDURES TO OBTAIN USCIS VERIFICATION

MA-2505 CITIZENSHIP/IDENTITY DATA MATCH

I. INTRODUCTION

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

MA-2510: LIVING ARRANGEMENT

I. OVERVIEW OF LIVING ARRANGEMENT

II. SPECIFIC TYPES OF INSTITUTIONS/FACILITIES

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 RECIPIENT WITH SSA/SSI TERMINATION OR DENIAL

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

X. MAB/MAD Recipients 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-2530 - BLindness M-SB

I. Policy Rules Applicable To Special Assistance For The Blind (SAB) Recipient

II. SAB Authorization (DSB-7209)

III. Authorizing Medicaid For An SAB Recipient

IV. Authorization Of Medicaid Prior To SAB Authorization

V. Changes In Situation

VI. Termination Of SAB And Medicaid

MA-2531 – BLINDNESS - MAB

I. INTRODUCTION

II. POLICY PRINCIPLES

III. WHEN A DETERMINATION OF BLINDNESS IS NOT REQUIRED

IV. WHEN A DETERMINATION OF BLINDNESS IS REQUIRED

V. REDETERMINATION AND RECIPIENTS 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 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. PERSONAL CARE SERVICES (PCS)

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 and Child service coordination

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 MEDICINE 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

MA-2910 - MEDICAID TRANSPORTATION

I. BACKGROUND

II. POLICY Principles

III. EXCLUSIONS

IV. eligibility AND ASSESSMENT OF NEED FOR ASSISTANCE

V. Arranging Transportation

VI. methods of transportation and covered costs

viI. sTAFFING

VIII. Safety and Risk Management

IX. Coordination of Transportation Services

X. Reimbursement

XI. Reporting Medically Related Transportation Costs

For questions or clarification on any of the policy contained in these manuals, please contact your local county office.