North Carolina Administrative Code

10A NCAC 43K .0103 reporting requirements (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 mai…

CHAPTER 44 - DIVISION OF POSTMORTEM MEDICOLEGAL EXAMINATION SECTION .0100 - FILING OF REPORTS 10A NCAC 44 .0101 FILING OF MEDICAL EXAMINER'S REPORT The local medical examiner shall complete a Report of Investigation Form promptly. He shall provide such additional information with…

section .0200 - fees 10A NCAC 44 .0201 MEDICAL EXAMINER FEE 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 …

10A NCAC 44 .0202 PATHOLOGY FEE 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 …

10A NCAC 44 .0203 RADIOLOGY FEE 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. History Note: Authority G.S. 130A-381; 130A-393; Eff. July 1, 1979; Transferred and Recodifi…

10A NCAC 44 .0204 HOSPITAL FEE 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 fac…

SECTION .0300 - MIGRANT WORKER BODY DISPOSITION 10A NCAC 44 .0301 DEFINITIONS History Note: 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 pu…

10A NCAC 44 .0302 RESERVED FOR FUTURE CODIFICATION

SECTION .0400 - INVESTIGATIONAL PROCEDURES 10A NCAC 44 .0401 UNCLAIMED BODIES 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 th…

SECTION .0500 - MEDICAL EXAMINER'S INVESTIGATION 10A NCAC 44 .0501 INVESTIGATION BEFORE CREMATION OR BURIAL AT SEA (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…

CHAPTER 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS SUBCHAPTER 45A - PAYMENT PROGRAMS SECTION .0100 - GENERAL PROVISIONS 10A NCAC 45A .0101 GENERAL (a) The purpose of this Subchapter is to establish uniform policies and procedures for the administration of all Department o…

10A NCAC 45A .0102 DEFINITIONS 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 …

SECTION .0200 - ELIGIBILITY DETERMINATIONS 10A NCAC 45A .0201 RESIDENCY REQUIREMENT (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 purpo…

10A NCAC 45A .0202 DETERMINATION OF FINANCIAL ELIGIBILITY (a) A patient must meet the financial eligibility requirements of this Subchapter to be eligible for benefits provided by the payment programs. Financial eligibility shall be determined by the NC Division of Public Health …

10A NCAC 45A .0203 ANNUAL NET FAMILY INCOME (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 …

10A NCAC 45A .0204 DETERMINATION OF FAMILY SIZE (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) p…

SECTION .0300 - ELIGIBILITY PROCEDURES 10A NCAC 45A .0301 INCOME DOCUMENTATION (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 benefit…

10A NCAC 45A .0302 AUTHORIZATIONS AND CLAIMS PROCESSING TIME FRAMES (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 Departmen…

10A NCAC 45A .0303 PAYMENT LIMITATIONS (a) Payment program payments shall be made for authorized services only when funds are available. (b) During the last six months of the fiscal year, the State Health Director may limit payment program payments that can be authorized when the…

10A NCAC 45A .0304 APPEALS PROCEDURE Appeals concerning the interpretation and enforcement of the rules in this Section shall be made in accordance with G.S. 150B. History Note: Authority G.S. 130A-5(3); 130A-124; 130A-127; 130A-129; 130A-177; 130A-205; Eff. February 1, 1987; Tra…

10A NCAC 45A .0305 DISQUALIFICATION (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 s…

SECTION .0400 - REIMBURSEMENT 10A NCAC 45A .0401 GENERAL (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 …

10A NCAC 45A .0402 REIMBURSEMENT FOR INPATIENT HOSPITALIZATION (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…

10A NCAC 45A .0403 REIMBURSEMENT FOR PROFESSIONAL, OUTPATIENT, OTHER SERVICES (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 otherw…

10A NCAC 45A .0404 REIMBURSEMENT rates FOR SERVICES NOT COVERED BY MEDICAID (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 …

10A NCAC 45A .0405 BILLING THE PATIENT PROHIBITED 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 paym…

SECTION .0500 - QUALITY CONTROL 10A NCAC 45A .0501 GENERAL 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 author…

10A NCAC 45A .0502 TERMINATION OF ELIGIBILITY 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:…

10A NCAC 45A .0503 EFFECT ON AUTHORIZATIONS AND AUTHORIZATION REQUESTS (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 th…

SUBCHAPTER 45B - PROCEDURAL RULES 10A NCAC 45B .0101 PETITIONS (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 P…

10A NCAC 45B .0102 RESERVED FOR FUTURE CODIFICATION

10A NCAC 45B .0103 RESERVED FOR FUTURE CODIFICATION

10A NCAC 45B .0104 DECLARATORY RULINGS (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…

10A NCAC 45B .0105 RESERVED FOR FUTURE CODIFICATION

SUBCHAPTER 45C - PUBLIC HEALTH SERVICES 10A NCAC 45C .0101 ESSENTIAL PUBLIC HEALTH SERVICES History Note: Authority G.S. 130A-1.1; Eff. July 1, 1992; Repealed Eff. February 7, 2014 pursuant to G.S. 150B-21.7.

SECTION .0200 – STANDARDS FOR LOCAL HEALTH DEPARTMENTS 10A NCAC 46 .0201 MANDATED SERVICES 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 ac…

10A NCAC 46 .0202 GENERAL History Note: 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.

10A NCAC 46 .0203 QUALITY ASSURANCE 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…

10A NCAC 46 .0204 CHILD HEALTH (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, i…

10A NCAC 46 .0205 MATERNAL HEALTH (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 establ…

10A NCAC 46 .0206 FAMILY PLANNING (a) A local health department shall provide, contract for the provision of, or certify the availability of family planning services for all individuals within the jurisdiction of the local health department. A local health department shall establ…

10A NCAC 46 .0207 DENTAL PUBLIC HEALTH (a) A local health department shall provide, contract for the provision of, or certify the availability of dental public health services for all individuals within the jurisdiction of the local health department. A local health department sh…

10A NCAC 46 .0208 HOME HEALTH (a) A local health department shall provide, contract for the provision of, or certify the availability of home health services for all individuals within the jurisdiction of the local health department. A local health department shall establish, imp…

10A NCAC 46 .0209 ADULT HEALTH (a) A local health department shall provide, contract for the provision of, or certify the availability of adult health services for all individuals within the jurisdiction of the local health department. A local health department shall establish, i…

10A NCAC 46 .0210 INDIVIDUAL (ON-SITE) WATER SUPPLY (a) A local health department shall provide individual (on-site) water supply sanitation services within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain written…

10A NCAC 46 .0211 SANITARY SEWAGE COLLECTION, TREATMENT AND DISPOSAL (a) A local health department shall regulate sewage collection, treatment, and disposal within the jurisdiction of the local health department. A local health department shall establish, implement, and maintain …

10A NCAC 46 .0212 GRADE A MILK SANITATION History Note: Authority G.S. 130A-9; Eff. October 1, 1984; Amended Eff. October 1, 1985; Transferred and Recodified from 10 NCAC 12 .0238 Eff. April 4, 1990; Repealed Eff. July 1, 2015; Expired Eff. February 1, 2016 pursuant to G.S. 150B-…