North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 27 - MENTAL HEALTH, COMMUNITY FACILITIES AND SERVICES › Subchapter G - RULES FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES, AND SUBSTANCE ABUSE FACILITIES AND SERVICES › Section .7000 - LOCAL MANAGEMENT ENTITY RESPONSE TO COMPLAINTS › Section 27G .7003 - REQUIREMENTS FOR LOCAL MANAGEMENT ENTITY COMPLAINT INVESTIGATIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The Local Management Entity shall follow
				  these procedures when investigating providers according to
				  10A NCAC
				  27G .0606:
(1) The Local Management Entity shall make
				  contact with the provider when investigating a complaint. The Local Management
				  Entity shall state the purpose of the contact and inform the provider that the
				  Local Management Entity is in receipt of a complaint concerning the provider
				  and the general nature of the complaint.
(2) The Local Management Entity shall
				  complete the complaint investigation within 30 calendar days of the date of the
				  receipt of the complaint.
(3) Upon
				  completion of the complaint investigation, the Local Management Entity shall
				  submit a report of investigation findings to the complainant, the provider and
				  client's home Local Management Entity, if different. The report shall be
				  submitted within 15 calendar days of the date of completion of the
				  investigation. The complaint investigation report shall include:
(A) statements of the allegations or
				  complaints lodged;
(B) steps taken
				  and information reviewed to reach conclusions about each allegation or
				  complaint;
(C) conclusions reached
				  regarding each allegation or complaint;
(D) citations of statutes and rules pertinent
				  to each allegation or complaint; and
(E) required action regarding each allegation
				  or complaint.
(4) The
				  provider shall submit a plan of correction to the Local Management Entity for
				  each issue requiring correction identified in the report in a letter dated 15
				  calendar days from the date the provider receives the complaint investigation
				  report.
(5) The Local Management
				  Entity shall review and respond in writing to the provider's plan of correction
				  with approval or a description of additional required information. The Local
				  Management Entity shall respond to the provider in a letter dated 15 calendar
				  days of receipt of the plan of correction.
(6) The provider shall implement a plan of
				  correction within 60 calendar days from the date of the complaint investigation
				  report.
(7) The complainant or
				  provider who disagrees with the results of the Local Management Entity actions
				  may file an appeal regarding the investigation that is received by the Local
				  Management Entity within 21 calendar days from the receipt of the Local
				  Management Entity investigation report. The Local Management Entity shall
				  provide notification of the appeal to the complainant or provider to inform
				  them of this appeal. The appeal is limited to items identified in the original
				  complaint record and the investigation report.
(8) The Local Management Entity shall convene
				  a review committee to review the appeal as specified in
				  10A NCAC
				  27G
				  .7002(b)(3)(J).
(9) The Local Management Entity Director
				  shall issue a written decision based on the appeal committee's decision to
				  uphold or overturn the findings of the investigation. The decision letter shall
				  be dated within 28 calendar days from receipt of the appeal.
(10) The Local Management Entity shall
				  follow-up on issues requiring correction in the investigation report no later
				  than 60 calendar days from the date the plan of correction is
				  approved.
(11) When a complaint
				  investigation involving a category B provider identifies an issue which if
				  substantiated by the Division of Mental Health, Developmental Disabilities and
				  Substance Abuse Services could result in a revocation or suspension of the
				  provider's funding pursuant to
				  10A NCAC
				  26C .0501 through
				  26C .0504, the LME shall document
				  the issue or issues creating the concern and notify the Division of Mental
				  Health, Developmental Disabilities and Substance Abuse Services of the issue
				  within 24 hours. The Division of Mental Health, Developmental Disabilities and
				  Substance Abuse Services shall consult with the Local Management Entity and
				  then shall determine which agency will lead the investigation and which
				  agencies need to be involved. Separate complaint investigations shall not be
				  performed.
(12) Local Management
				  Entity shall provide information regarding the disposition of the complaint to
				  the complainant and the client's home Local Management Entity, if different, as
				  soon as the investigation is concluded.