North Carolina General Statutes 108C-2. Definitions
The following definitions apply in this Chapter:
(1) Adverse determination. – A final decision by the Department to deny, terminate, suspend, reduce, or recoup a Medicaid payment or to deny, terminate, or suspend a provider’s or applicant’s participation in the Medical Assistance Program.
Terms Used In North Carolina General Statutes 108C-2
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- following: when used by way of reference to any section of a statute, shall be construed to mean the section next preceding or next following that in which such reference is made; unless when some other section is expressly designated in such reference. See North Carolina General Statutes 12-3
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
- state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories, so called; and the words "United States" shall be construed to include the said district and territories and all dependencies. See North Carolina General Statutes 12-3
- United States: shall be construed to include the said district and territories and all dependencies. See North Carolina General Statutes 12-3
(2) Applicant. – An individual, partnership, group, association, corporation, institution, or entity that applies to the Department for enrollment as a provider in the North Carolina Medicaid program.
(3) Department. – The North Carolina Department of Health and Human Services, its legally authorized agents, contractors, or vendors who acting within the scope of their authorized activities, assess, authorize, manage, review, audit, monitor, or provide services pursuant to Title XIX or XXI of the Social Security Act, the North Carolina State Plan of Medical Assistance, or any waivers of the federal Medicaid Act granted by the United States Department of Health and Human Services.
(4) Division. – The Division of Health Benefits of the Department.
(5) Final overpayment, assessment, or fine. – The amount the provider owes after appeal rights have been exhausted, which shall not include any agency decision that is being contested at the Department or the Office of Administrative Hearings or in Superior Court, provided that the Superior Court has entered a stay pursuant to the provisions of N.C. Gen. Stat. § 150B-48
(6) Repealed by Session Laws 2022-74, s. 9D.15(k).
(7) Managing employee. – As defined in 42 C.F.R. § 455.101.
(8) Medicaid. – The Medical Assistance program authorized by N.C. Gen. Stat. § 108A-54 and as set forth in the North Carolina State Plan of Medical Assistance.
(9) Owner and/or operator. – As defined in 42 C.F.R. § 455.101.
(10) Provider. – An individual, partnership, group, association, corporation, institution, or entity required to enroll in the North Carolina Medicaid program to provide services, goods, supplies, or merchandise to a Medicaid recipient.
(11) Revalidation. – The reenrollment of a provider in the Medicaid program as required under federal law.
(12) Secretary. – The Secretary of the Department of Health and Human Services. (2011-399, s. 1; 2018-5, s. 11H.12(b); 2019-81, s. 15(a); 2022-74, s. 9D.15(k).)