10A NCAC 22G .0501. CLINIC SERVICES

(a)  Payments for clinic services shall be based on negotiated fee, not to exceed reasonable cost:

(1)           For services provided by or through the memorandum of understanding between the Division of Medical Assistance and the Division of Public Health, a supplemental payment shall be made between September 20, 1995 and September 30, 1995, in an amount which represents the difference between the estimated cost of services for the 12-month period ending September 30, 1995, and the estimate of payments made by the Division of Medical Assistance for these services. The amount of the supplement payment shall be set by the Director of the Division of Medical Assistance and will not exceed fifteen million dollars ($15,000,000). Effective with dates of services for the fiscal period beginning October 1, 1995, and for subsequent periods beginning October 1 an interim payment for services shall be made by the Division of Medical Assistance.

(2)           To assure payments do not exceed the upper payment limits set forth at 42 CFR 447.321, the payments made by this Paragraph shall be cost settled on a statewide average per service to determine the difference between the reasonable cost of services provided as determined by the Division of Medical Assistance and the amount of payment made for the services for each fiscal period corresponding to the payment periods specified. Cost settlements for the September 30, 1995, and September 30, 1996, fiscal period shall occur within six months after the approval date of the initial state plan amendment.  Subsequent fiscal periods shall be cost settled within six months of the end of each fiscal period.

(b)  This cost methodology does not apply to the reimbursement of services that are billed by health departments for physicians, nurse midwives, and nurse practitioners who are not salaried employees of a health department and whose compensation is not included in the service cost of a health department. These services are reimbursed in accordance with the fees established in 10A NCAC 22G .0401 and 10A NCAC 22G .0402.

(c)  Effective October 1, 2001 the cost settlement period shall be the 12 months ended June 30.  The first settlement period after the change shall be short period from October 1, 2001 to June 30, 2002.  Subsequent cost settlement periods shall be the 12 months ended June 30.

(d)  Effective July 1, 2001, the cost settlement shall occur within nine months of the end of the settlement period.

 

History Note:        Authority G.S. 108A‑25(b); S.L. 1985, c. 479, s. 86;

Eff. February 1, 1984;

Temporary Amendment Eff. November 9, 2001;

Temporary Amendment Expired August 30, 2002;

Amended Eff. April 1, 2003.