North Carolina Administrative Code

10a NCAC 27a .0203 EARLY INTERVENTION - STATE AND FEDERAL FUNDS History Note: Authority G.S. 122C-112(a)(6); 122C-131; 122C-150; U.S.C. 1471 Part HIDEA; Eff. February 1, 1976; Amended Eff. February 1, 1996; April 1, 1988; February 1, 1986; July 1, 1985; Expired Eff. July 1, 2016 …

10a NCAC 27A .0204 DIVISION FUNDS FOR CAPITAL PROJECTS (a) When capital funds are specifically appropriated by the General Assembly, the Division shall allocate funds for area program capital projects. Such allocations shall be in accordance with the language and intent of the ap…

10a NCAC 27a .0205 FUNDING ALCOHOL AND DRUG EDUCATION TRAFFIC SCHOOLS (a) Pursuant to G.S. 20-179.2 the Department of Health and Human Services shall have the authority to approve programs, budgets and contracts with public and private governmental and non-governmental bodies for…

10a NCAC 27a .0206 FUNDS FOR MULTIDISCIPLINARY EVALUATIONS: GUARDIANSHIP History Note: Authority G.S. 122C-147.1; 143B-10; Eff. July 1, 1981; Amended Eff. February 1, 1996; April 1, 1990; Expired Eff. July 1, 2016 pursuant to G.S. 150B-21.3A.

10a NCAC 27a .0207 FUNDS FOR FORENSIC SCREENING: CAPACITY TO PROCEED TO TRIAL (a) To the extent state funds are available, the division shall provide reimbursement for court-ordered screening and evaluation of persons to determine their capacity to proceed to trial. (b) The scree…

10a NCAC 27a .0208 FUNDING DRUG EDUCATION SCHOOLS (a) Pursuant to G.S. 90-96.01 the Department of Health and Human Services shall have the authority to approve programs, budgets and contracts with public and private governmental and nongovernmental bodies for drug education schoo…

10a NCAC 27a .0209 COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT (a) The Division shall administer a grant program for the federal Community Mental Health Services Block Grant which is made available to the Division under the authority of Public Law 102-321. (b) The appropriate po…

10a NCAC 27a .0210 PATH-HOMELESS GRANT (a) The Division shall administer a program of grants for children and adults to area programs called Path-Homeless Grant. (b) These funds shall be used to provide comprehensive services for homeless individuals who have chronic mental illne…

10a NCAC 27a .0213 COMMUNICABLE DISEASE RISK/SERVICES TO INTRAVENOUS (IV) DRUG USERS (a) The Division shall administer a program for substance abuse services to adolescents or adults who inject controlled substances; or have sexual contact with partners who inject controlled subs…

10a NCAC 27a .0214 TREATMENT ALTERNATIVES FOR WOMEN (a) The Division shall administer a program to provide comprehensive services to substance abusing pregnant women or substance abusing women with dependent children. (b) Services may include primary medical, prenatal and pediatr…

10a NCAC 27a .0215 UNIT COST REIMBURSEMENT (UCR) CHILD AND ADULT (a) The Division shall administer a system of reimbursement of state, federal and other funds to area programs for eligible children and adult clients based on the provision of eligible mental health, developmental …

10a NCAC 27a .0216 SUBSTANCE ABUSE PREVENTION AND TREATMENT BLOCK GRANT (a) The Division shall administer a grant program for the federal Substance Abuse Prevention and Treatment Block Grant which is made available to the Division under the authority of Public Law 102-321 Subpart…

10a NCAC 27a .0217 NON-UNIT COST REIMBURSEMENT (a) The Division may provide specific purpose funding with state, federal or other sources for activities authorized by the division and the granting agency and disburse these funds on a basis other than unit cost reimbursement. (b) …

10a NCAC 27a .0218 TRAUMATIC BRAIN INJURY (a) The Division shall administer a program to provide periodic, day/night and 24 hour community based services to children and adults with traumatic brain injury. (b) Eligible recipients are individuals who have a traumatic brain injury …

10a NCAC 27a .0219 REVOLVING LOAN (a) The Division may, upon authorization from the Office of State Budget and Management, make available funds for loans to provide for the implementation of new community based programs and services. (b) Authorization shall be based on written ju…

10a NCAC 27a .0220 DOMICILIARY CARE History Note: Authority G.S. 122C-112; 122C-143.1; Eff. February 1, 1996; Expired Eff. July 1, 2016 pursuant to G.S. 150B-21.3A.

10a NCAC 27a .0221 USE OF DIVISION FUNDS FOR INPATIENT SERVICES (a) Inpatient funding for the purchase of services from local inpatient providers and medical doctors shall meet the following requirements: (1) Program Requirements (A) Division funds may be used by area programs fo…

SECTION .0300 – CLEAN CLAIMS 10A NCAC 27A .0301 SCOPE This Section governs the requirements that constitute a clean claim for purposes of billing. These Rules are applicable to local management entities (LMEs) and public and private providers who seek to provide services that are…

10A NCAC 27A .0302 definitions (a) "Claim" means an itemized statement with standardized elements that is submitted for payment by a provider to the authorizing LME. (b) "Clean Claim" means an itemized statement with standardized elements, completed in its entirety in a format as…

10A NCAC 27A .0303 clean claim format requirements (a) A provider of a service that is payable from funds administered by an LME shall submit a claim for payment to the authorizing LME. The provider shall submit the claim in one of the formats listed as follows: (1) HIPAA complia…

10A Ncac 27A .0304 claims review procedures (a) The LME shall review the claim to determine if it is clean. The determination shall be based on whether the claim is submitted as follows: (1) the claim is submitted in one of the formats as set forth in Rule .0303 of this Section; …

SECTION .0400 - Payment, Reporting and Settlement for Local Management Entities Systems Management 10A NCAC 27A .0401 SCOPE The purpose of this Section is to set forth procedures for the payment, reporting and settlement of Local Management Entities System Management (LME SM) fun…

10A NCAC 27A .0402 DEFINITIONS (a) "Systems Management Funding" when used in this Section means funding provided, pursuant to the LME SM Cost Model, to Local Management Entities (LMEs) to enable LMEs to carry out system management responsibilities set forth in G.S. 122C-115.4. (b…

10A NCAC 27A .0403 MONTHLY PAYMENTS AND MONTHLY REPORTING (a) Prior to the Division making any LME SM payments to an LME, the LME and Department shall sign a memorandum of agreement (MOA), as required in G.S. 122C-115.2(d), and the MOA shall be in place for the period of time for…

10A NCAC 27A .0404 SETTLEMENT OF LME SYSTEMS MANAGEMENT PAYMENTS (a) LME SM payments shall be settled annually for each LME individually taking into consideration actual LME SM expenditures, the earning of Medicaid administrative funds and the retention of up to the lesser of 15 …

SUBCHAPTER 27B - RULES GOVERNING AREA PROGRAMS AND CONTRACTED PROGRAMS UTILIZING SOCIAL SERVICES BLOCK GRANT (TITLE XX) FUNDS SECTION .0100 - GENERAL REQUIREMENTS 10A NCAC 27B .0101 SCOPE The purpose of the rules in Sections .0100 through .1200 of this Subchapter is to specify sp…

10a NCAC 27b .0102 OTHER SOCIAL SERVICES BLOCK GRANT REQUIREMENTS Additional rules of a general nature applying to all programs receiving Social Services Block Grant [Title XX of the Social Security Act, 20 USC 1397-1397(f)] funds are codified in 10 NCAC 43L Sections .0100, .0200…

10A NCAC 27B .0103 METHODS OF SERVICE PROVISION For purposes of Social Services Block Grant [Title XX of the Social Security Act, 20 USC 1397-1397(f)] reimbursement, services in Sections .0200 through .1200 of this Subchapter may only be provided by the Division of Mental Health,…

SECTION .0200 - ADULT DEVELOPMENTAL vocational PROGRAMS (ADVP) FOR INDIVIDUALS with developmental disabilities 10A NCAC 27B .0201 DEFINITION AND GOALS (a) Definition. (1) Primary Service. An adult developmental vocational program (ADVP) is a day program which provides organized d…

10A NCAC 27B .0202 ELIGIBILITY REQUIREMENTS Individuals must be determined eligible in accordance with the same criteria as for adult developmental vocational program state grant-in-aid funds. History Note: Authority G.S. 143B-10; 143B-147; Eff. March 1, 1983; Transferred from T1…

10A NCAC 27B .0203 CRITERIA Programs providing this service shall meet standards for Adult Developmental and Vocational Programs (ADVP) for Individuals with Developmental Disabilities as codified in 10A NCAC 27G .2300. History Note: Authority G.S. 143B-10; 143B-147; Eff. March 1,…

SECTION .0300 - RESIDENTIAL TREATMENT/REHABILITATION PROGRAMS FOR INDIVIDUALS WHO ARE ALCOHOL OR OTHER DRUG ABUSERS 10A NCAC 27B .0301 DEFINITION AND GOALS (a) Definition. (1) Primary Service. A residential treatment/rehabilitation program provides active treatment for alcoholics…

10A NCAC 27B .0302 ELIGIBILITY REQUIREMENTS Individuals must be determined eligible based on a documented need for residential treatment/rehabilitation services and be diagnosed as alcohol or drug dependent. History Note: Authority G.S. 143B-10; 143B-147; Eff. July 23, 1979; Amen…

10A NCAC 27B .0303 CRITERIA Programs providing this service shall meet standards for Residential Treatment/Rehabilitation Programs for Individuals with Substance Abuse Disorders as codified in 10A NCAC 27G Section .3400. History Note: Authority G.S. 143B-10; 143B-147; Eff. July 2…

SECTION .0400 - DAY TREATMENT PROGRAMS FOR CHILDREN AND ADOLESCENTS WHO ARE EMOTIONALLY DISTURBED 10A NCAC 27B .0401 DEFINITION AND GOALS (a) Definition. (1) Primary Service. Day treatment programs are designed for children and adolescents who are too emotionally disturbed to fun…

10A NCAC 27B .0402 ELIGIBILITY REQUIREMENTS Children and adolescents must be determined eligible based on a documented need for day treatment services and be diagnosed as emotionally disturbed. History Note: Authority G.S. 143B-10; 143B-147; Eff. July 23, 1979; Amended Eff. March…

10A NCAC 27B .0403 CRITERIA Programs providing this service shall meet standards for Day Treatment Programs for Children and Adolescents with Emotional or Behavioral Disturbances as codified in 10A NCAC 27G .2400. History Note: Authority G.S. 143B-10; 143B-147; Eff. July 23, 1979…

SECTION .0500 - DEVELOPMENTAL DAY Services FOR CHILDREN with or at risk for developmental delay, developmental diabilities or atypical development 10A NCAC 27B .0501 DEFINITION AND GOALS (a) Definition. (1) Primary Service. Developmental day centers are specialized child care cen…

10A NCAC 27B .0502 ELIGIBILITY REQUIREMENTS (a) Except as cited in (b) of this Rule, individuals must be determined eligible in accordance with the same criteria as for developmental day state grant-in-aid funds. (b) Subject to prior approval by the regional director or his desig…

10A NCAC 27B .0503 CRITERIA Programs providing this service shall meet standards for Developmental Day Centers for Preschool Children with Developmental Delays, Developmental Disabilities or Atypical Development as codified in 10A NCAC 27G .2400. History Note: Authority G.S. 143B…

SECTION .0600 - EARLY CHILDHOOD INTERVENTION SERVICES (ECIS) FOR CHILDREN with or at risk for developmental delays, developmental disabilities or atypical development and their families 10A NCAC 27B .0601 DEFINITION AND GOALS History Note: Authority G.S. 143B-10; 143B-147; Eff. J…

SECTION .0700 - RESIDENTIAL TREATMENT PROGRAMS FOR CHILDREN AND ADOLESCENTS WHO ARE EMOTIONALLY DISTURBED or who have a mental illness 10A NCAC 27B .0701 DEFINITION AND GOALS (a) Definition. (1) Primary Service. Residential treatment programs provide a structured living environme…

10A NCAC 27B .0702 ELIGIBILITY REQUIREMENTS Children and adolescents under 18 years of age must be determined eligible based on a documented need for residential treatment services and be diagnosed as emotionally disturbed. If an adolescent has his eighteenth birthday while recei…

10a NCAC 27B .0703 CRITERIA Programs providing this service shall meet standards for Residential Treatment Programs for Children and Adolescents Who are Emotionally Disturbed or Who have a Mental Illness as codified in 10A NCAC 27G .1300. History Note: Authority G.S. 143B-10; 143…

SECTION .0800 - OUTPATIENT SERVICES FOR INDIVIDUALS OF ALL DISABILITY GROUPS 10A NCAC 27B .0801 DEFINITION AND GOALS (a) Definition. (1) Primary Service. Outpatient services are periodic services which encompass the clinical activities provided for all disability groups which may…

10A NCAC 27B .0802 ELIGIBILITY REQUIREMENTS Individuals must be determined eligible based on their need for outpatient services for problems associated with emotional disturbance, mental retardation or substance abuse. History Note: Authority G.S. 143B-10; 143B-147; Eff. March 1,…

10a NCAC 27B .0803 CRITERIA Programs providing this service shall meet standards for Outpatient Services for Individuals of All Disability Groups as codified in 10A NCAC 27G .6200. History Note: Authority G.S. 143B-10; 143B-147; Eff. March 1, 1983; Transferred from T10.43I .1303 …

SECTION .0900 - PARTIAL HOSPITALIZATION SERVICES FOR ADULT AND ELDERLY INDIVIDUALS WHO ARE ACUTELY MENTALLY ILL OR ARE SUBSTANCE ABUSERS 10A NCAC 27B .0901 DEFINITION AND GOALS (a) Definition. (1) Primary Service. Partial hospitalization programs for adult and elderly individuals…

10A NCAC 27B .0902 ELIGIBILITY REQUIREMENTS Individuals must be determined eligible based on a documented need for partial hospitalization services and be diagnosed as acutely mentally ill, chronically mentally ill, alcohol dependent or drug dependent. History Note: Authority G.S…

10A NCAC 27B .0903 CRITERIA Programs providing this service shall meet standards for Partial Hospitalization Services for Adult and Elderly Individuals Who Are Acutely Mentally Ill as codified in 10A NCAC 27G .1100. History Note: Authority G.S. 143B-10; 143B-147; Eff. March 1, 19…