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North Carolina Department of Health and Human Services AGED, BLIND, AND DISABLED MEDICAID MANUAL

MA-200

DEFINITIONS

10 REISSUED 03/01/11 – CHANGE NO. 03-11 (III.) Actual Time Report Card --- A report card that shows individual county/DDS average processing time and the percentage processed timely counting actual days to complete applications in a month. The actual processing time excludes no days and does not adjust the 45th/90th day.

Add-on --- Any individual added to an active case.

Adequate Notice --- A notice that must be received before the effective date of the change that informs the a/r of action taken.

Adjusted Payment --- A payment to the recipient to correct an underpayment and/or other upward adjustments that are needed

Adjusted Application Report Card --- A report card that shows the individual county/DDS average processing time and percentage processed timely excluding days allowable by policy to complete applications.

Adult Care Home --- Licensed group care facility.

Affidavit of Support --- This is a statement of a sponsor’s income, resources, and willingness to support an alien. It is filed with the BCIS by a U.S. resident who sponsors an alien seeking admission to the U.S. as a permanent resident.

Alien --- An alien is an individual who lives in the U.S. but is not a citizen.

Appeal --- An appeal is a request of an applicant/recipient or his representative for a review of the action taken on his case. An SSI Medicaid recipient will appeal through SSA. A non-SSI Medicaid recipient will request an appeal through his county income maintenance caseworker. An appeal of the level of care is requested through the North Carolina Division of Medical Assistance.

Applicant --- A person who signs under penalty of perjury a written application for MA or on whose behalf a written application is made and signed by an authorized representative.

Application --- An application for MA signed by the applicant or his authorized representative.

Application Process --- A series of actions leading to a determination of eligibility or ineligibility for MA.

Approved Amount --- In Medicare claims, the portion of the medical charge that Medicare approves as reasonable. Medicare pays 80% of the approved amount.

Approved Level of Care --- The level of care recommended by the patient's attending physician that meets level of care criteria and is approved by the Prior Approval Unit. See FL-2/MR-2.

Assessment --- The procedure for determining the community spouse's share of resources owned by the couple at the time of institutionalization.

Asset – For purposes of transfer of assets, is resources and income.