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

MA-200

DEFINITIONS

REVISED 03/01/11 – CHANGE NO. 03-11 (III.) Non-qualified Alien --- An alien who does not meet the alien requirements to receive full Medicaid coverage. Non-qualified aliens potentially are eligible for emergency services only. Non-qualified aliens include illegal aliens, non-immigrants legally admitted to the U.S. but only for a temporary or specified period of time, and/or aliens admitted legally to the U.S. but who do not fall into one of the specified qualified alien categories.

North Carolina Health Choice for Children (NCHC)--- A health insurance program for uninsured children under the age of 19 who do not qualify for Medicaid and have family income under 200% of the Federal Poverty Limit. Funding for this program is capped. This program is known as Children’s Health Insurance Program (CHIP) at the national level.

Nursing Facility --- A nursing facility is a licensed skilled nursing facility (SNF) or intermediate care facility (ICF-MR).

Old Bills --- Outstanding medical bills that were incurred prior to the current certification period that have not been considered in establishing previous authorization.

Overissuance/Overpayment --- Benefits that are in excess of the amount for which the recipient was eligible.

Overstated PML --- Recipient paid too much toward cost of care due to PML being calculated incorrectly.

Partial Payment --- Assistance paid for a portion of the month. (N/A to Medicaid.)

Pass Along --- The disregard of Social Security benefits when determining eligibility for Medical Assistance.

Patient Monthly Liability (PML) --- The portion of his cost of care that a patient in long-term care is expected to pay.

Payee --- The person in whose name the assistance is made.

Payment month --- The month for which a client receives payment. (N/A to Medicaid.)

Payment Schedule --- A list mailed to the county department by the central office showing checks that will be mailed the subsequent month. (N/A to Medicaid.)

Penalty Period --- The period of time in which an a/r could be ineligible for Medicaid payment of nursing home cost of care, CAP, or in-home health services and supplies due to a transfer of resources. The penalty period is also referred to as a sanction period.

Perinatal---The period immediately before and after birth.

Perjury --- The voluntary violation of an oath or vow by swearing to what is untrue or by omission to do what was promised under oath. A signed application is a signed oath.

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Official source

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

MA-200

DEFINITIONS

Nursing Facility --- A nursing facility is a licensed skilled nursing facility (SNF) or intermediate care facility (ICF-MR).

Old Bills --- Outstanding medical bills that were incurred prior to the current certification period that have not been considered in establishing previous authorization.

Overissuance/Overpayment --- Benefits that are in excess of the amount for which the recipient was eligible.

Overstated PML --- Recipient paid too much toward cost of care due to PML being calculated incorrectly.

Partial Payment --- Assistance paid for a portion of the month. (N/A to Medicaid.)

Pass Along --- The disregard of Social Security benefits when determining eligibility for Medical Assistance.

Patient Monthly Liability (PML) --- The portion of his cost of care that a patient in long-term care is expected to pay.

Payee --- The person in whose name the assistance is made.

Payment month --- The month for which a client receives payment. (N/A to Medicaid.)

Payment Schedule --- A list mailed to the county department by the central office showing checks that will be mailed the subsequent month. (N/A to Medicaid.)

Perinatal---The period immediately before and after birth.

Perjury --- The voluntary violation of an oath or vow by swearing to what is untrue or by omission to do what was promised under oath. A signed application is a signed oath.