reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 43 - PERSONAL HEALTH › Subchapter J - CHILD AND ADULT CARE FOOD PROGRAM › Section .0100 - GENERAL PROVISIONS › Section 43J .0101 - INCORPORATION BY REFERENCE: 7 C.F.R. PART 226

Current through Register Vol. 39, No. 2, July 15, 2024
Title 7, Code of Federal Regulations, Part 226 is hereby
					 incorporated by reference along with all subsequent amendments and editions. A
					 copy of 7 C.F.R. Part 226 is available for inspection at the Department of
					 Health and Human Services, Division of Public Health, Women's and Children's
					 Health Section, Nutrition Services Branch, 5601 Six Forks Road, Raleigh, North
					 Carolina. Copies of 7 C.F.R. Part 226 may be downloaded and printed from the
					 Internet at
					 http://www.fns.usda.gov/cnd/Care/Regs-Policy/CFR226.pdf.
Authority
					 G.S.
					 130A-29;
					 130A-361; S.L. 1995, c. 324, s.
					 17.11; 42 U.S.C.
					 1766;
Temporary Adoption Eff.
					 July 8, 1996;
Eff. August 1, 1998;
Amended Eff. October
					 1, 2012;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. December 6,
					 2016.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 43 - PERSONAL HEALTH › Subchapter K - NEWBORN SCREENING FOR CRITICAL CONGENITAL HEART DEFECTS › Section 43K .0102 - SCREENING REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) All medical
				facilities and attending providers of a neonate or infant shall assure the
				following:
(1) Screening of every neonate for
				critical congenital heart defects (CCHD) using pulse oximetry shall be
				performed at 24 to 48 hours of age using a written protocol developed by the
				provider based upon and in accordance with the most current recommendations
				from the American Academy of Pediatrics and American Heart Association
				(AAP/AHA) which are incorporated by reference including subsequent amendments
				and editions, unless a diagnostic neonatal echocardiogram has been performed. A
				copy of the recommendations is available for inspection at the NC Division of
				Public Health, Women's and Children's Health Section, Children and Youth
				Branch, 5601 Six Forks Road, Raleigh, NC 27609. In addition, the
				recommendations can be accessed at the American Academy of Pediatrics website
				at:
http://pediatrics.aappublications.org/content/128/5/e1259.full.pdf+html?sid=85e81711-f9b8-43d1-a352-479168895a72
.
(2) Screening of a neonate for CCHD who is
				born in a free-standing birthing center or home may occur as early as 6 hours
				of age but shall not occur later than 48 hours of age using the AAP/AHA
				recommendations.
(3) Screening of
				neonates and infants in neonatal intensive care units for critical congenital
				heart defects using pulse oximetry screening shall be performed using a written
				protocol based on the AAP/AHA recommendations as soon as the neonate or infant
				is stable, as determined by the attending provider, and off oxygen and before
				discharge unless a diagnostic echocardiogram is performed on the neonate or
				infant after birth and prior to discharge from the medical facility.
(4) Only U.S. Food and Drug Administration
				approved pulse oximetry equipment is used and maintained to screen the neonate
				or infant for the presence of critical congenital heart defects.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 43 - PERSONAL HEALTH › Subchapter K - NEWBORN SCREENING FOR CRITICAL CONGENITAL HEART DEFECTS › Section 43K .0103 - REPORTING REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) All medical
				facilities and attending providers of neonates or infants performing critical
				congenital heart defect (CCHD) screening shall report the information described
				below about positive screenings to a statewide CCHD database maintained by the
				Perinatal Quality Collaborative of North Carolina (PQCNC).The following
				information must be reported by medical facilities and attending providers
				within 7 days of all positive screenings:
(1)
				date and time of birth of the neonate or infant, gestational age, and the
				medical facility or birth location, and
(2) age in hours at time of screening; all
				pulse oximetry saturation values, including initial, subsequent, and final
				screening results; final diagnosis if known; any known interventions and
				treatment, and any need for transport or transfer; and the location of the
				transfer or transport if known.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 44 - POSTMORTEM MEDICOLEGAL EXAMINATION › Section .0100 - FILING OF REPORTS › Section 44 .0101 - FILING OF MEDICAL EXAMINER'S REPORT

Current through Register Vol. 39, No. 2, July 15, 2024
The local medical examiner shall complete a Report of
				  Investigation Form promptly. He shall provide such additional information with
				  the Report of Investigation Form as is reasonably required to document the case
				  fully. The completed report shall be mailed by the local medical examiner to
				  the state Office of the Chief Medical Examiner within 14 days of the time the
				  local medical examiner assumes jurisdiction of a dead body. Payment of the
				  medical examiner fee shall be authorized only when the report is postmarked
				  within 14 days after the local medical examiner assumed jurisdiction of the
				  dead body, unless the Chief Medical Examiner determines that the delay was
				  beyond the control of the local medical examiner.
Authority
				  G.S.
				  130A-383;
				  130A-387;
				  130A-393;
Eff.
				  February 1, 1976;
Readopted Eff. December 5, 1977;
Amended Eff. November 1, 1978;
Transferred and Recodified from
				  10 NCAC
				  11 .0402 Eff. April 4, 1990;
Amended Eff. September 1, 1990;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. December 23,
				  2017.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 44 - POSTMORTEM MEDICOLEGAL EXAMINATION › Section .0200 - FEES › Section 44 .0201 - MEDICAL EXAMINER FEE

Current through Register Vol. 39, No. 2, July 15, 2024
For each investigation including the making of the required
				  reports, the medical examiner shall receive a fee as established in
				  G.S.
				  130A-387 to be paid by the state unless the
				  decedent is a legal resident of the county in which death or fatal injury
				  occurred, in which event such county shall be responsible for the
				  fee.
Authority
				  G.S.
				  130A-381;
				  130A-387;
				  130A-393;
Eff. July
				  1, 1979;
Transferred and Recodified from
				  10 NCAC
				  11 .0701 Eff. April 4, 1990;
Amended Eff. August 1, 2000;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. December 23,
				  2017.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 44 - POSTMORTEM MEDICOLEGAL EXAMINATION › Section .0200 - FEES › Section 44 .0202 - PATHOLOGY FEE

Current through Register Vol. 39, No. 2, July 15, 2024
For each autopsy ordered by a county medical examiner or the
				  chief medical examiner, the pathologist shall receive a fee as established in
				  G.S.
				  130A-389 when the autopsy report is received
				  at the Office of the Chief Medical Examiner. There will be no fee for reports
				  received after the 180 day period, unless the Chief Medical Examiner determines
				  that the delay was beyond the control of the pathologist. The fee shall be paid
				  by the state unless the decedent is a legal resident of the county in which
				  death or fatal injury occurred, in which event the county of residence shall be
				  responsible for the fee.
Authority
				  G.S.
				  130A-389;
				  130A-393;
Eff. July
				  1, 1979;
Amended Eff. July 1, 1986; July 1, 1984; July 1,
				  1982;
Transferred and Recodified from
				  10 NCAC
				  11 .0702 Eff. April 4, 1990;
Amended Eff. September 1, 1990;
Temporary Amendment Eff. February
				  24, 1999;
Amended Eff. August 1, 2000;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. December 23,
				  2017.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 44 - POSTMORTEM MEDICOLEGAL EXAMINATION › Section .0200 - FEES › Section 44 .0203 - RADIOLOGY FEE

Current through Register Vol. 39, No. 2, July 15, 2024
Radiology services shall be paid for by the state. Rates and
				  methods used in the Medicaid program shall be used in computing the amounts of
				  radiology fees.
Authority
				  G.S.
				  130A-381;
				  130A-393;
Eff. July
				  1, 1979;
Transferred and Recodified from
				  10 NCAC
				  11 .0703 Eff. April 4, 1990;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. December 23,
				  2017.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 44 - POSTMORTEM MEDICOLEGAL EXAMINATION › Section .0200 - FEES › Section 44 .0204 - HOSPITAL FEE

Current through Register Vol. 39, No. 2, July 15, 2024
A fee of forty dollars ($40.00) is paid by the state to a
				  hospital when a county medical examiner orders a body taken to the hospital and
				  later examines the body in that facility. No payment is due a hospital when an
				  autopsy is performed in that facility. No payment is due when the county
				  medical examiner utilizes a hospital emergency room or other hospital facility
				  for examination of a body transported to the hospital for
				  examination.
Authority
				  G.S.
				  130A-381;
				  130A-393;
Eff. July
				  1, 1979;
Amended Eff. January 1, 1984;
Transferred and
				  Recodified from
				  10 NCAC
				  11 .0704 Eff. April 4, 1990;
Amended Eff. August 1, 2000;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. December 23,
				  2017.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 44 - POSTMORTEM MEDICOLEGAL EXAMINATION › Section .0300 - MIGRANT WORKER BODY DISPOSITION › Section 44 .0301 - EXPIRED - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  130A-417;
				  130A-418;
Eff. March
				  31, 1980;
Transferred and Recodified from
				  10 NCAC
				  11 .0801 Eff. April 4, 1990;
Amended Eff. September 1, 1990;
Expired Eff. January 1, 2018
				  pursuant to
				  G.S.
				  150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 44 - POSTMORTEM MEDICOLEGAL EXAMINATION › Section .0300 - MIGRANT WORKER BODY DISPOSITION › Section 44 .0303-.0310 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  130A-417;
				  130A-418;
Eff. March
				  31, 1980;
Transferred and Recodified from
				  10 NCAC
				  11 .0803-11
				  .0810 Eff. April 4, 1990;
Amended Eff.
				  September 1, 1990;
Expired Eff. January 1, 2018 pursuant to
				  G.S.
				  150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 44 - POSTMORTEM MEDICOLEGAL EXAMINATION › Section .0400 - INVESTIGATIONAL PROCEDURES › Section 44 .0401 - UNCLAIMED BODIES

Current through Register Vol. 39, No. 2, July 15, 2024
The chief medical examiner shall retain charge or control of
				  an unclaimed body for a period of ten days. During this period, reasonable
				  effort shall be made to locate relatives of the decedent. After the search for
				  relatives has been completed and the required ten day period has passed, each
				  unclaimed body shall be disposed of by cremation. The ashes shall be retained
				  in the control of the chief medical examiner for a period of three years.
				  During this time appropriate family members of the decedent may claim and
				  receive the ashes. At the end of the three years any unclaimed ashes shall be
				  disposed of in an appropriate manner.
Authority
				  G.S.
				  130A-381;
				  130A-393;
Eff.
				  February 1, 1976;
Readopted Eff. December 5, 1977;
Amended Eff. January 1, 1984;
Transferred and Recodified from
				  10 NCAC
				  11 .0309 Eff. April 4, 1990;
Amended Eff. September 1, 1990;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. December 23,
				  2017.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 44 - POSTMORTEM MEDICOLEGAL EXAMINATION › Section .0500 - MEDICAL EXAMINER'S INVESTIGATION › Section 44 .0501 - INVESTIGATION BEFORE CREMATION OR BURIAL AT SEA

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				Before a dead body may be cremated or buried at sea, a medical examiner must
				certify that the medical examiner has investigated the cause and manner of
				death and determined that no further examination is necessary. Such
				certification is not required if the death falls under one of the exceptions in
				G.S.
				130A-388 or under one of the following
				exceptions:
(1) a death that is medically
				attended, is determined to result from natural disease, and occurs in a nursing
				home or while under the care of a licensed hospice; or
(2) a body that is donated to the Commission
				of Anatomy or to any of the schools of medicine in accordance with
				G.S.
				130A-402 et seq.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0100 - GENERAL PROVISIONS › Section 45A .0101 - GENERAL

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The purpose of
				  this Subchapter is to establish uniform policies and procedures for the
				  administration of all Department of Health and Human Services' payment programs
				  for which the Commission for Public Health has been granted rulemaking
				  authority.
(b) In the event of
				  conflict between the rules in this Subchapter and the rules adopted by the
				  various payment programs, the rules of this Subchapter shall control.
(c) Persons who wish to receive rule-making
				  notices concerning the rules in this Subchapter may send a written request to
				  Purchase of Care Services Unit, Division of Public Health, 1907 Mail Service
				  Center, Raleigh, NC 27699-1907.
Authority
					 G.S.
					 130A-5(3);
					 130A-124;
					 130A-127;
					 130A-129,
					 130A-205;
Eff. July
					 1, 1981;
Amended Eff. July 1, 1983; April 1, 1982; January 1,
					 1982;
Temporary Amendment Eff. August 31, 1983, for a period of 120
					 days to expire on December 29, 1983;
Amended Eff. December 29,
					 1983;
Transferred and Recodified from
					 10 NCAC
					 04C .0101 Eff. April 4, 1990;
Amended Eff. January 1, 2014; April 1, 1999; April 1, 1993, December 1,
					 1990;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. January 13, 2015:
Amended Eff.
					 June 1, 2016.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0100 - GENERAL PROVISIONS › Section 45A .0102 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
The following definitions shall apply throughout this
					 Subchapter:
(1) "Authorization" means
				  agreement by a payment program to pay for a medical or dental service or
				  appliance provided all requirements in this Subchapter are met. An
				  authorization is sent to the provider of service and copy is sent to individual
				  receiving the service.
(2)
				  "Benefits" means the purchase of medical or dental care on a fee-for-service
				  basis. "Benefits" also means the purchase of medical or dental
				  appliances.
(3) "Department" means
				  the Department of Health and Human Services, or its contractor.
"Inpatient services" means medical or dental care
					 administered to a person who has been admitted to a hospital.
(5) "Outpatient services" means medical or
				  dental care administered to a person without admission to a hospital.
(6) "Payment programs" refers to Department
				  program activities involving the purchase of medical or dental care on a
				  fee-for-service basis or the purchase of medical or dental appliances, either
				  through direct payment or through contracts with local health departments,
				  other agencies, or private institutions. Examples of payment programs include:
(a) Early Hearing Detection and
				  Intervention;
(b) HIV Medications
				  Program;
(c) Infant Toddler
				  Program; and
(d) Sickle Cell
				  Program.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0200 - ELIGIBILITY DETERMINATIONS › Section 45A .0201 - RESIDENCY REQUIREMENT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A person must
				  be a permanent resident of North Carolina to be eligible for benefits provided
				  by any of the payment programs, except as provided in Paragraph (d) of this
				  Rule.
(b) For the purposes of this
				  Rule, all determinations of residency shall be governed by the following rules:
(1) In order to be a resident of North
				  Carolina, a person must:
(A) live in this
				  State, except as provided in Subparagraph (b)(6) of this Rule,
(B) pay North Carolina income tax if state
				  income tax liability exists,
(C)
				  have the intention of making his permanent home in this State, and
(D) intend to return to this State whenever
				  absent.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0200 - ELIGIBILITY DETERMINATIONS › Section 45A .0203 - ANNUAL NET FAMILY INCOME

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Annual net
				  family income shall be computed by subtracting the deductions allowed in
				  Paragraph (d) of this Rule, from the gross family income as computed in
				  Paragraph (c) of this Rule.
(b) The
				  time period to be used as the basis for computing annual net family income is
				  the 12-month period immediately preceding the date a patient or his
				  representative makes application for eligibility to a particular payment
				  program. However, if any of the family members were unemployed for at least 30
				  consecutive days during this 12-month period or are currently unemployed at the
				  time the application is completed, that person's portion of the annual net
				  family income shall be computed on the basis of income and deductions for the
				  six month period immediately preceding the date of application plus a
				  projection of income and deductions (excluding medical expenses) for the six
				  month period immediately succeeding the date of application based upon the
				  current employment or benefit situation. Medical expenses from the 12-month
				  period immediately preceding the date of application may be deducted from
				  income.
(c) Gross Family Income:
(1) Gross family income shall mean the
				  combined gross cash income received by the patient's family from the following
				  sources:
(A) Salaries and wages;
(B) Earnings from self-employment;
(C) Investment income, stocks, bonds, savings
				  account interest, rentals, and all other investment income;
(D) Periodic trust fund payments;
(E) Public assistance money;
(F) Unemployment compensation;
(G) Alimony and child support payments
				  received;
(H) Military
				  allotments;
(I) Social Security
				  benefits;
(J) Veteran's
				  Administration benefits;
(K)
				  Retirement and pension payments;
(L) Worker's compensation;
(M) Educational stipends in excess of the
				  cost of tuition and books;
(N)
				  Allowances paid for basic living expenses such as housing and
				  utilities;
(O) Supplemental
				  security income benefits;
(P) All
				  other sources of cash income except those specifically excluded.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0200 - ELIGIBILITY DETERMINATIONS › Section 45A .0204 - DETERMINATION OF FAMILY SIZE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) For the
				  purpose of determining eligibility for benefits provided by any of the payment
				  programs, a patient's family shall be defined as the patient and all
				  individuals living in the same household with the patient who are:
(1) parents, not including step-parents, of
				  the patient, if the patient is unmarried and less than 18 years of
				  age;
(2) siblings or half-siblings
				  of the patient, but not step-siblings, if the siblings are unmarried and less
				  than 18 years of age;
(3) siblings
				  or half-siblings of the patient, but not step-siblings, if the siblings are 18
				  years of age or over and have no income;
(4) the spouse of the patient; and
(5) individuals related to the patient by
				  blood, marriage, or adoption, if the individual has no income, and if no
				  parent(s) or spouse of the individual lives in the same household and has
				  income.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0300 - ELIGIBILITY PROCEDURES › Section 45A .0301 - INCOME DOCUMENTATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Documentation
				  of earned income of the patient's family is required before services can be
				  authorized in the following circumstances:
(1)
				  Whenever the applicant is requesting payment program benefits for inpatient
				  services, even when outpatient services have been previously
				  authorized.
(2) Whenever medical
				  expense deductions from income exceed three thousand dollars
				  ($3,000).
(3) Whenever eligibility
				  personnel have reason to believe information given may be inaccurate.
(4) Whenever the Department requests
				  documentation for quality control purposes.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0300 - ELIGIBILITY PROCEDURES › Section 45A .0302 - AUTHORIZATIONS AND CLAIMS PROCESSING TIME FRAMES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  following time frames shall apply to all payment programs:
(1) An Authorization Request must be received
				  by the Department within one year after the date of service or it will be
				  denied.
(2) The Department shall
				  respond to an Authorization Request within 45 days after receipt.
(3) If the Department requests additional
				  information, this information must be received within one year after the date
				  of service or within 30 days after the date of the Department's request,
				  whichever is later, or the Authorization Request will be denied.
(4) The Department shall approve or deny an
				  Authorization Request within 45 days after receipt of all
				  information.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0300 - ELIGIBILITY PROCEDURES › Section 45A .0304 - APPEALS PROCEDURE

Current through Register Vol. 39, No. 2, July 15, 2024
Appeals concerning the interpretation and enforcement of
					 the rules in this Section shall be made in accordance with G.S.
					 150B.
Authority
					 G.S.
					 130A-5(3);
					 130A-124;
					 130A-127;
					 130A-129;
					 130A-177;
					 130A-205;
Eff.
					 February 1, 1987;
Transferred and Recodified from
					 10 NCAC
					 04C .0305 Eff. April 4, 1990;
Amended Eff. December 1, 1990;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. January 13,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0300 - ELIGIBILITY PROCEDURES › Section 45A .0305 - DISQUALIFICATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A provider
				  shall be disqualified from all Department payment programs upon
				  disqualification from Medicaid, Medicare, or the Child Health Services Block
				  Grant Program (Title V of the Social Security Act).
(b) The period of disqualification shall be
				  equal to the period specified by the federal government for disqualification
				  from Medicaid, Medicare, or the Child Health Services Block Grant Program
				  (Title V of the Social Security Act).
(c) Written notification of disqualification
				  from Department payment programs shall be given to the provider. The
				  notification shall inform the provider of the provider's right to appeal the
				  disqualification.
(d)
				  Authorizations for services provided prior to the date of disqualification from
				  Department programs shall be honored by the Department. Authorizations for
				  services which have not been provided prior to disqualification shall be
				  cancelled unless the provider has made a financial commitment based upon the
				  authorization.
Authority
					 G.S.
					 130A-5(3);
					 130A-124;
					 130A-127;
					 130A-129;
					 130A-177;
					 130A-205;
Eff. March
					 1, 1989;
Transferred and Recodified from
					 10 NCAC
					 04C .0306 Eff. April 4, 1990;
Amended Eff. December 1, 1990;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. January 13,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0400 - REIMBURSEMENT › Section 45A .0401 - GENERAL

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The purpose of
				  this Section is to establish rates of reimbursement for services provided under
				  the Department's payment programs and governed by the Commission for Public
				  Health.
(b) The reimbursement rates
				  established in the rules of this Section shall not apply to perinatal program
				  high risk maternity clinic reimbursement funds, as set forth in
				  10A NCAC
				  43C .0300, or school health funds, as set
				  forth in 10A NCAC 43E .0100. Rates of
				  reimbursement for these programs are individually negotiated with providers by
				  the Department's contractor, usually a local health department. These rates
				  shall be negotiated and established in accordance with guidelines found in the
				  respective program rules, and shall not exceed the Medicaid rate of
				  reimbursement in effect on the date of service.
Authority
					 G.S.
					 130A-5(3);
					 130A-124;
					 130A-127;
					 130A-129;
					 130A-205;
Eff.
					 October 1, 1982;
Amended Eff. July 1, 1983;
Transferred
					 and Recodified from
					 10 NCAC
					 04C .0401 Eff. April 4, 1990;
Amended Eff. January 1, 2014; December 1, 1990;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. January 13,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0400 - REIMBURSEMENT › Section 45A .0402 - REIMBURSEMENT FOR INPATIENT HOSPITALIZATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  The Department shall reimburse providers of authorized inpatient services for
				  payment programs governed by Commission for Public Health at the Medicaid rate
				  in effect on the date of service.
(b) In addition to the requirements of
				  Paragraph (a) of this Rule, in the Cancer Program there shall be a limit on the
				  payment for an inpatient admission of one percent of the program's current
				  annual budget.
Authority
					 G.S.
					 130A-5(3);
					 130A-124;
					 130A-127;
					 130A-129;
					 130A-205;
					 130A-223;
Eff.
					 October 1, 1982;
Temporary Amendment Eff. August 31, 1983, for a
					 Period of 120 Days to Expire on December 29, 1983;
Amended Eff. May
					 1, 1987; July 1, 1986; January 1, 1985;
Transferred and Recodified
					 from 10
					 NCAC 04C .0402 Eff. April 4,
					 1990;
Amended Eff. February 1, 1992; December 1, 1990;
Temporary Amendment Eff. July 6, 1992 for a Period of 180 Days or Until the
					 Permanent Rule is Effective, Whichever is Sooner;
Amended Eff.
					 April 1, 1999; July 1, 1995; October 1, 1992;
Temporary Amendment
					 Eff. August 23, 1999;
Amended Eff. January 1, 2014; August 1,
					 2000;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. January 13,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0400 - REIMBURSEMENT › Section 45A .0403 - REIMBURSEMENT FOR PROFESSIONAL, OUTPATIENT, OTHER SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The Department shall reimburse providers
				  of authorized outpatient services, professional services, and all other
				  services for payment programs governed by the Commission for Public Health not
				  otherwise covered in the rules of this Section at the Medicaid rate in effect
				  on the date of service.
(b) In
				  addition to the reimbursement rate in Paragraph (a) of this Rule, for
				  professional and outpatient services under the Cancer Program, there shall be a
				  per claim payment limit of one percent of the program's current annual
				  budget.
Authority
					 G.S.
					 130A-5(3);
					 130A-124;
					 130A-127;
					 130A-129;
					 130A-205;
					 130A-223;
Eff.
					 February 1, 1976;
Amended Eff. April 22, 1977;
Readopted Eff. December 5, 1977;
Amended Eff. July 1, 1982; January
					 1, 1982;
Temporary Amendment Eff. November 7, 1983, for a period of
					 120 days to expire on March 4, 1984;
Amended Eff. October 1, 1984;
					 March 1, 1984;
Temporary Amendment Eff. October 14, 1988, for a
					 period of 180 days to expire on April 12, 1989;
Temporary Amendment
					 Expired April 12, 1989;
Amended Eff. September 1, 1990;
Temporary Amendment Eff. June 19, 1996;
Temporary Amendment Expired
					 March 11, 1997;
Amended Eff. January 1, 2014; August 1,
					 2000;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. January 13,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0400 - REIMBURSEMENT › Section 45A .0404 - REIMBURSEMENT RATES FOR SERVICES NOT COVERED BY MEDICAID

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The Department shall reimburse providers
				  of authorized mobility systems (including components and accessories),
				  environmental control units, and custom seating systems for which there are no
				  Medicaid reimbursement rates at the manufacturer's catalog price less five
				  percent.
(b) The Department shall
				  reimburse providers of authorized prosthetics and orthotics at the Medicare
				  rate of reimbursement when there is no Medicaid rate of reimbursement for the
				  item. When there is neither a Medicaid rate nor a Medicare rate for the item,
				  the Department shall reimburse at the provider's usual charge to the general
				  public.
(c) The Department shall
				  reimburse providers of authorized equipment repair services for which there are
				  no Medicaid reimbursement rates at forty five dollars ($45.00) per
				  hour.
(d) The Department shall
				  reimburse physicians and dentists for authorized services for which there are
				  no Medicaid rates at the Medicaid rate for a comparable procedure as determined
				  by the program's medical director or at 80 percent of the amount billed,
				  whichever is less.
(e) The
				  Department shall reimburse providers of authorized assistive listening devices
				  and those types of hearing aids for which there are no Medicaid rates at
				  invoice cost plus the Medicaid dispensing fee for a new hearing
				  aid(s).
(f) The Department shall
				  reimburse providers of authorized amplification-related services for which
				  there are no Medicaid rates at the rates paid for audiology services under
				  Medicaid's Independent Practitioner Program.
(g) The Department shall reimburse providers
				  of authorized services not otherwise specified in this Section, for which there
				  are no Medicaid reimbursement rates, at the provider's usual charge to the
				  general public.
Authority
					 G.S.
					 130A-5(3);
					 130A-124;
					 130A-127;
					 130A-129;
					 130A-205;
Eff.
					 October 1, 1982;
Transferred and Recodified from
					 10 NCAC
					 04C .0404 Eff. April 4, 1990;
Amended Eff. December 1, 1990;
RRC Objection Eff. November 17, 1994
					 due to lack of statutory authority;
Amended Eff. January 1, 2014;
					 April 1, 1999; October 1, 1995; February 1, 1995;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. January 13,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0400 - REIMBURSEMENT › Section 45A .0405 - BILLING THE PATIENT PROHIBITED

Current through Register Vol. 39, No. 2, July 15, 2024
If a provider has accepted partial or total payment from
					 the Department for particular services, the Department's reimbursement rate for
					 those services shall be considered payment in full for those authorized
					 services for all payment programs and the provider shall not bill the patient
					 or his family for any amount exceeding the payment received.
Authority
					 G.S.
					 130A-5(3);
					 130A-124;
					 130A-127;
					 130A-129;
					 130A-205;
Eff.
					 October 1, 1982;
Transferred and Recodified from
					 10 NCAC
					 04C .0405 Eff. April 4, 1990;
Amended Eff. January 1, 2014; April 1, 1995; December 1, 1990;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. January 13,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0500 - QUALITY CONTROL › Section 45A .0501 - GENERAL

Current through Register Vol. 39, No. 2, July 15, 2024
The Department screens, reviews and investigates financial
					 eligibility forms in an effort to detect cases where the form contains
					 incorrect information. If the incorrect information is found before any
					 services are authorized based on that financial eligibility form, the
					 Department shall make further investigations before authorizing services. If
					 services have already been authorized based on a financial eligibility form
					 that contains incorrect information that materially affects the person's
					 financial eligibility, the Department may take steps to terminate financial
					 eligibility.
Authority
					 G.S.
					 130A-5(3);
					 130A-124;
					 130A-127;
					 130A-129;
					 130A-177;
					 130A-205;
Eff.
					 October 1, 1983;
Transferred and Recodified from
					 10 NCAC
					 04C .0501 Eff. April 4, 1990;
Amended Eff. December 1, 1990;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. January 13,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0500 - QUALITY CONTROL › Section 45A .0502 - TERMINATION OF ELIGIBILITY

Current through Register Vol. 39, No. 2, July 15, 2024
The Department shall take the following steps in order to
					 terminate a person's eligibility for program benefits which is based on
					 incorrect information or information that has changed since the eligibility
					 applications were completed:
(1)
				  Notice shall be given to the applicant and the eligibility interviewer that:
(a) the Department has determined that
				  eligibility was established based on incorrect information or information that
				  has changed since the program eligibility applications were
				  completed,
(b) the applicant is not
				  eligible for program benefits, and
(c) the Department has made a tentative
				  decision to terminate eligibility.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0500 - QUALITY CONTROL › Section 45A .0503 - EFFECT ON AUTHORIZATIONS AND AUTHORIZATION REQUESTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) All authorizations will be honored by the
				  Department, except that an authorization may be cancelled after a final
				  decision to terminate eligibility if:
(1) The
				  applicant and the provider are notified of the authorization cancellation prior
				  to the provision of the service. Authorizations may be cancelled in part when
				  only some of the services have been provided; and
(2) The provider has not made financial
				  commitments based upon the authorization.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter B - PROCEDURAL RULES › Section 45B .0101 - PETITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Any person
				wishing to request a rule change (adoption, amendment, or repeal) of a rule of
				the Commission for Public Health shall make the request in a petition addressed
				to the State Health Director, Division of Public Health, 1915 Mail Service
				Center, Raleigh, North Carolina 27699-1915.
(b) The petition shall contain the following
				information:
(1) either a draft of the
				proposed rule change or a summary of its contents;
(2) the statutory authority for the agency to
				make the proposed rule change;
(3)
				the reasons for the proposal;
(4)
				the effect of the proposed rule change on existing rules and
				statutes;
(5) any data supporting
				the proposal;
(6) the effect of the
				proposed rule change on existing practices in the area involved, including cost
				factors;
(7) the names and
				addresses, if known, of those most likely to be affected by the proposed rule
				change; and
(8) the name and
				address of the petitioner.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter B - PROCEDURAL RULES › Section 45B .0104 - DECLARATORY RULINGS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The Department
				shall in accordance with
				G.S.
				150B-4 issue declaratory rulings concerning
				rules found in
				15A NCAC
				13,
				15A NCAC
				18, and
				10A NCAC
				39 through 47.
(b) All requests for declaratory rulings
				shall be by written petition and shall be submitted to: Division of Public
				Health, 1915 Mail Service Center, Raleigh, North Carolina 27699-1915.
(c) Every request for a declaratory ruling
				must include the following information:
(1)
				the name and address of the petitioner,
(2) the statute or rule to which the petition
				relates,
(3) a concise statement of
				the manner in which the petitioner is aggrieved by the rule or statute or its
				potential application to him, and
(4) the consequences of a failure to issue a
				declaratory ruling.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter C - PUBLIC HEALTH SERVICES › Section 45C .0101 - REPEALED - ESSENTIAL PUBLIC HEALTH SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  130A-1.1;
Eff. July 1,
				  1992;
Repealed Eff. February 7, 2014 pursuant to
				  G.S.
				  150B-21.7.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 46 - LOCAL STANDARDS › Section .0100 - GENERAL › Section 46 .0101-.0102 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  130A-5(3);
Eff.
				  April 1, 1985;
Amended Eff. October 1, 1985;
Transferred and Recodified from
				  10 NCAC
				  12 .0108 Eff. April 4, 1990;
				  (.0101);
Transferred and Recodified
				  10 NCAC
				  12 .0109 Eff. April 4, 1990
				  (.0102);
Amended Eff. September 1, 1990;
Expired Eff.
				  February 1, 2016 pursuant to
				  G.S.
				  150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 46 - LOCAL STANDARDS › Section .0200 - STANDARDS FOR LOCAL HEALTH DEPARTMENTS › Section 46 .0201 - MANDATED SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
The following is a list of mandated services required to be
				  provided in every county of this state. The local health department shall
				  provide or ensure the provision of these services in accordance with the rules
				  in this Section:
(1) Adult
				Health;
(2) Home Health;
(3) Dental Public Health;
(4) Food, Lodging and Institutional
				Sanitation;
(5) Individual On-Site
				Water Supply;
(6) Sanitary Sewage
				Collection, Treatment and Disposal;
(7) Communicable Disease Control;
(8) Vital Records Registration;
(9) Maternal Health;
(10) Child Health;
(11) Family Planning;
(12) Public Health Laboratory
				Support.
Authority
				  G.S.
				  130A-9;
Eff. July 1,
				  1984;
Transferred and Recodified from
				  10 NCAC
				  12 .0227 Eff. April 4, 1990;
Amended Eff. July 1, 2015;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. January 5,
				  2016.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 46 - LOCAL STANDARDS › Section .0200 - STANDARDS FOR LOCAL HEALTH DEPARTMENTS › Section 46 .0202 - EXPIRED - GENERAL

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  130A-9;
Eff. October 1,
				  1984;
Transferred and Recodified from
				  10 NCAC
				  12 .0228 Eff. April 4, 1990;
Amended Eff. September 1, 1990;
Expired Eff. February 1, 2016
				  pursuant to
				  G.S.
				  150B-21.3A.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 46 - LOCAL STANDARDS › Section .0200 - STANDARDS FOR LOCAL HEALTH DEPARTMENTS › Section 46 .0203 - QUALITY ASSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
A local health department shall establish, implement, and
				  maintain written policies to assure quality in all administrative,
				  environmental, clinical, and educational services and activities mandated by
				  the Commission which are contracted for or provided by the local health
				  department. Policies shall include:
(1) Provisions for a periodic program
				assessment to be conducted at least once per year which shall include:
(a) A review of appropriate clinical and
				non-clinical records.
(b)
				Development of a corrective action time-table for making necessary
				improvements.
(c) Representation in
				the quality assurance program of each discipline involved in service
				provision.
(d) A review of
				appropriate state or local reports and statistics.
(e) Documentation of review
				findings.
(f) Documentation of
				corrective action.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 46 - LOCAL STANDARDS › Section .0200 - STANDARDS FOR LOCAL HEALTH DEPARTMENTS › Section 46 .0204 - CHILD HEALTH

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A local health
				department shall provide, contract for the provision of, or certify the
				availability of child health services for all individuals within the
				jurisdiction of the local health department. A local health department shall
				establish, implement, and maintain written policies which shall include:
(1) A description of the procedures for child
				health services provided by the local health department, a copy of the contract
				for the provision of child health services, or a certification of availability
				of child health services. These child health services shall include:
(A) Child health information, referral,
				immunizations, and hemoglobinopathy screening upon request.
(B) Identification and follow-up of high
				priority infants.
(C) Follow-up of
				infants with PKU or hypothyroidism.
(D) Follow-up of chronically ill and
				handicapped infants and children upon request.
(E) Routine periodic well-child supervision
				to children less than five years of age, not served by another health care
				resource, through one or more of the following mechanisms:
(i) referral to other health care
				providers;
(ii) contracts with
				other health care providers; or
(iii) provision of the following health
				assessment services in a local health department child health clinic:
(I) initial and interim health
				history;
(II) physical assessment
				and laboratory services;
(III)
				developmental evaluation;
(IV)
				nutrition assessment;
(V)
				counseling, including anticipatory guidance; and
(VI) referral for further diagnosis and
				treatment.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 46 - LOCAL STANDARDS › Section .0200 - STANDARDS FOR LOCAL HEALTH DEPARTMENTS › Section 46 .0205 - MATERNAL HEALTH

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A local health
				department shall provide, contract for the provision of, or certify the
				availability of maternal health services for all individuals within the
				jurisdiction of the local health department. A local health department shall
				establish, implement, and maintain written policies which shall include:
(1) A description of the procedures for
				maternal health services provided by the local health department, a copy of the
				contract for the provision of maternal health services, or a certification of
				availability of maternal health services. These maternal health services shall
				include:
(A) Pregnancy testing, information,
				and referral as appropriate;
(B)
				Ongoing prenatal care to all pregnant women, not served by another health care
				resource, through one or more of the following mechanisms:
(i) Referral to other health care
				providers;
(ii) contracts with
				other health care providers; or
(iii) provision of the following prenatal
				services in a local health department maternity clinic:
(I) Initial history, and physical and
				laboratory examinations;
(II)
				assessment of medical, nutritional, and social problems;
(III) weekly assessments by a physician or a
				registered nurse, as medically indicated;
(IV) laboratory, nutrition, and patient
				education follow-up services;
(V)
				high-risk identification and referral; and
(VI) scheduling of postpartum
				visits.