10A NCAC 39A .0902. DEFINITIONS

The following definitions shall apply throughout this Section:

(1)           "Care Consortium" is an association of one or more public, and one or more nonprofit private health care and support services providers or community based organizations operating within areas determined by the RWCP to be most affected by HIV disease.

(2)           "Essential Health Services" means services such as case management services; medical, nursing, and dental care; diagnostics; monitoring; medical follow‑up services; mental health; developmental and rehabilitation services; home health; and hospice care.

(3)           "Essential Support Services" means services such as transportation services; attendant care; homemaker services; day or respite care; benefits advocacy; advocacy services provided through public and nonprofit private entities; nutrition services; housing referral services; child welfare and family services (including foster care and adoption services); and provision of information and counseling on living with HIV disease.

(4)           "Lead Agency" means the agency, organization, institution or other entity which will assume administrative and fiscal responsibility for RWCP Care Consortium Funds.

(5)           "RWCP Reimbursement Rate" is the:

(a)           maximum Medicaid rate, if one exists, for essential health services and essential support ser­vic­es other than those set out in Paragraph (5)(b) and (c) of this Rule;

(b)           interim Medicare rate for medical social services; or

(c)           schedule of payments that shall be developed by the Division of Public Health for essential health services and essential support services other than those set out in Paragraph (5)(a) and (b) of this Rule.

(6)           "Third Party Payor" is any person or entity that is or may be indirectly liable for the cost of services furnished to an eligible person.  Third party payors include, without limitation, Medicaid, Medicare, and private insurance.

 

History Note:        Authority G.S. 130A‑223;

Eff. December 1, 1991.