§ 108A-55. Payments. - North Carolina Statutes

§ 108A‑55. Payments.

(a)        The Department may authorize, within appropriations made forthis purpose, payments of all or part of the cost of medical and other remedialcare for any eligible person when it is essential to the health and welfare ofsuch person that such care be provided, and when the total resources of suchperson are not sufficient to provide the necessary care. When determiningwhether a person has sufficient resources to provide necessary medical care,there shall be excluded from consideration the person's primary place ofresidence and the land on which it is situated, and in addition there shall beexcluded real property contiguous with the person's primary place of residencein which the property tax value is less than twelve thousand dollars ($12,000).

(b)        Payments shall be made only to intermediate care facilities,hospitals and nursing homes licensed and approved under the laws of the Stateof North Carolina or under the laws of another state, or to pharmacies,physicians, dentists, optometrists or other providers of health‑relatedservices authorized by the Department. Payments may also be made to such fiscalintermediaries and to the capitation or prepaid health service contractors asmay be authorized by the Department. Arrangements under which payments are madeto capitation or prepaid health services contracts are not subject to theprovisions of Chapter 58 of the General Statutes or of Article 3 of Chapter 143of the General Statutes.

(c)        The Department shall reimburse providers of services,equipment, or supplies under the Medical Assistance Program in the followingamounts:

(1)        The amount approved by the Health Care FinancingAdministration of the United States Department of Health and Human Services, ifthat Administration approves an exact reimbursement amount;

(2)        The amount determined by application of a method approved bythe Health Care Financing Administration of the United States Department ofHealth and Human Services, if that Administration approves the method by whicha reimbursement amount is determined, and not the exact amount.

The Department shall establish the methods by which reimbursementamounts are determined in accordance with Chapter 150B of the General Statutes.A change in a reimbursement amount becomes effective as of the date for whichthe change is approved by the Health Care Financing Administration of theUnited States Department of Health and Human Services. The Department shallreport to the Fiscal Research Division of the Legislative Services Office andto the Senate Appropriations Committee on Human Resources and the House ofRepresentatives Appropriations Subcommittee on Human Resources or the JointLegislative Commission on Health Care Oversight on any change in areimbursement amount at the same time as it sends out public notice of thischange prior to presentation to the Health Care Financing Administration.

(d)        No payments shall be made for the care of any person in anursing home or intermediate care home which is owned or operated in whole or inpart by a member of the Social Services Commission, of any county board ofsocial services, or of any board of county commissioners, or by an official oremployee of the Department or of any county department of social services or bya spouse of any such person. (1965, c. 1173, s. 1; 1969, c. 546, s. 1; 1971, c. 435; 1973, c. 476,s. 138; c. 644; 1975, c. 123, ss. 1, 2; 1977, 2nd Sess., c. 1219, c. 25; 1979,c. 702, s. 7; 1981, c. 275, s. 1; c. 849, s. 2; 1991, c. 388, s. 1; 1993, c.529, s. 7.3; 1998‑212, s. 12.12B(c).)