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Review of Emergency Services Provided to Aliens
CCME conducts day-by-day, ex post facto reviews of the emergency medical care provided to undocumented aliens, and legal aliens who do not qualify for full Medicaid benefits. The reviews to determine whether the subject's medical conditions meet the federal definition of “medical emergency” to qualify for Medicaid reimbursement. Under federal law, non-qualified aliens, and qualified aliens who have resided in the United States for less than five (5) years, do not qualify for full Medicaid assistance, but do qualify for medical emergency services. Each medical emergency must be reviewed on a day-by-day basis to determine whether the subject qualifies for emergency services and Medicaid eligibility.
The definition of a medical emergency for the purposes of review is:
- Labor and delivery, including delivery by caesarean section
- Treatment after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical condition could reasonably be expected to result in:
- a. Placing the patient’s health in serious jeopardy.
- b. Serious impairment to bodily functions.
- c. Serious dysfunction of any bodily organ or part.
To initiate a review determination, the county Department of Social Services (DSS) must submit to CCME a MA-2504/3330 Figure 7 and accompanying medical records for the requested service dates. The requests can be submitted via:
Fax: 866-932-5926
Mail:
The Carolinas Center for Medical Excellence
ATTN: Alien Emergency Services Review
100 Regency Forest Drive
Suite 200
Cary, NC 27518-9860
For questions or additional information about the review process, contact Vicky Conen at 919-380-9860, ext. 2319, or vconen@thecarolinascenter.org.
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