SUBCHAPTER 48C - LOCAL HEALTH DEPARTMENT ACCREDITATION - ADMINISTRATION
SECTION .0100 - GENERAL PROVISIONS
10A NCAC 48C .0101 PURPOSE
The rules of this Subchapter establish the process for local health departments to become accredited pursuant to G.S. 130A-34.1.
History Note: Authority G.S. 130A-34.1;
Eff. June 1, 2026.
10A NCAC 48C .0102 DEFINITIONS
The following definitions shall apply throughout this Chapter:
(1) "Accreditation" means an evaluation of an LHD's infrastructure, competence, and capacity to provide public health services through the satisfaction of the standards set out in 10A NCAC 48D Section .0200.
(2) "Accreditation status" means the status assigned to an LHD by the Board in accordance with G.S. 130A-34.1 and the rules of this Subchapter. The types of accreditation status are accredited, conditionally accredited, or unaccredited.
(3) "Activity" means a task demonstrating achievement of a portion of a standard.
(4) "Board" means "Accreditation Board" as defined in G.S. 130A-2(1).
(5) "Board of Health" or "BOH" means a "local board of health" as defined in G.S. 130A-2(4), a board of county commissioners that has assumed control of a local board of health in accordance with G.S. 153A-77(a), a consolidated human services board with the authority to carry out the functions of a local board of health in accordance with G.S. 153A-77(b)(2), or hospital authority board acting pursuant to S.L. 1997-502, Sec. 12.
(6) "Community" means a subdivision of the population that shares one or more characteristics.
(7) "Community Health Assessment" means a process to identify through the collection and analysis of data and to document in a written report the public health needs within an LHD's jurisdiction.
(8) "Community Health Improvement Plan" means a written document setting out the steps to address the public health needs identified in the Community Health Assessment.
(9) "Community Partner" means individuals, groups, or organizations that are not affiliated with federal, state, local, or tribal government, but work with the LHD to identify and address public health needs.
(10) "Dashboard" means the web-based portal developed and maintained by the Institute to receive self-assessments submitted by LHDs. The Dashboard is located at https://nclhdaccreditation.unc.edu/nclhda-dashboard/.
(11) "Evidence-informed practice" means a way of doing something that is based on research findings, public health data, professional public health expertise, or customer feedback.
(12) "Institute" means the North Carolina Institute for Public Health.
(13) "Jurisdiction" means the county or counties that an LHD serves.
(14) "Local health department" or "LHD" means a local health department as defined in G.S. 130A-2(5), a consolidated human services agency that includes the local health department pursuant to G.S. 153A-77(b)(3), or an agency acting under the direction of a hospital authority board acting pursuant to S.L. 1997-502, Sec. 12.
(15) "Local health director" means a local health director as defined in G.S. 130A-2(6) or appointed pursuant to G.S. 153A-77(e).
(16) "Population" means the people residing within an LHD's jurisdiction.
(17) "Self-assessment" means a written review that reflects the degree of an LHD's satisfaction of each standard and activity set out in 10A NCAC 48D Section .0200 that is completed and submitted by the LHD in accordance with 10A NCAC 48D .0201. The self-assessment shall include documentation supporting the completion of each activity.
(18) "Structural or Social Determinants of Health" or "SDOH" means the non-medical factors that impact health, well-being, and quality of life including social, economic, and political factors that generate and maintain individual health outcomes.
(19) "Standard" means a criterion to be assessed in determining an LHD's accreditation. A standard is comprised of activities.
(20) "Source of data" means quantitative or qualitative data collected by an LHD or another entity.
History Note: Authority G.S. 130A-34.1;
Eff. June 1, 2026.
SECTION .0200 - Accreditation Process
10A NCAC 48C .0201 SELF-ASSESSMENT
(a) Each LHD applying for accreditation in accordance with Rule .0205 of this Section shall complete a self-assessment in the Dashboard.
(b) The self-assessment shall include the following components:
(1) contact information for the LHD;
(2) the LHD's organizational chart;
(3) a narrative describing the LHD's population;
(4) a budget for the LHD for the current state fiscal year;
(5) the roster for the LHD's governing board;
(6) a personnel list for the LHD;
(7) the level of completion of each activity in 10A NCAC 48D Section .0200, scored in accordance with 10A NCAC 48D .0101(a); and
(8) documentation supporting the level of completion for each activity in Subparagraph (7) of this Paragraph.
History Note: Authority G.S. 130A-34.1;
Eff. June 1, 2026.
10A NCAC 48C .0202 SITE VISIT
(a) The Institute shall select a site visit team composed of not fewer than three individuals. Each site visit team member shall have experience in an LHD. Together the individuals on a site visit team shall have experience in all of the following areas: health administration, environmental health, public health nursing, health education, and governance of an LHD. An individual shall not be part of a site visit team for an LHD where the individual is currently employed.
(b) The site visit team shall conduct the site visit of the LHD by:
(1) reviewing the LHD's self-assessment; and
(2) speaking with LHD staff and members of the LHD's BOH.
(c) The site visit team shall assess whether the LHD has completed each activity in 10A NCAC 48D Section .0200 and prepare a written report to be shared with the Board summarizing the site visit and recommending an accreditation status based on rule 10A NCAC 48D .0101. The site visit team shall provide a copy of the report to the Institute and to the LHD within 10 business days of the conclusion of the site visit.
History Note: Authority G.S. 130A-34.1;
Eff. June 1, 2026.
10A NCAC 48c .0203 BOARD ACTION
(a) The site visit team shall present the report required by Rule .0202(c) of this Subchapter to the Board at the Board's next regularly scheduled meeting. The LHD shall have an opportunity to respond to the presentation.
(b) For each LHD site visit team report that is presented, the Board shall:
(1) assign the LHD an accreditation status in accordance with 10A NCAC 48D .0101; or
(2) defer assignment of an accreditation status in order to request additional information from the LHD.
(c) The Board may defer the assignment of accreditation status under Paragraph (b)(2) of this Rule by no more than six months.
(d) The Board's assignment of an accreditation status is effective the first day of the month following the date of Board action.
(e) An accreditation status of accredited shall expire four years from the last day of the month in which the Board assigned the accreditation status. Notwithstanding the foregoing, if an LHD's last accreditation status was accredited and the Board defers assigning a new accreditation status under Paragraph (b)(2) of this Rule, the LHD's accreditation status shall remain accredited until the Board assigns a new accreditation status.
(f) If a state of emergency declaration has been issued under G.S. 166A-19.3(19), a disaster declaration has been issued under G.S. 166A-19.3(3), or a disaster declaration has been made by the President of the United States under 44 C.F.R. Part 206, Subpart B naming all or part of an LHD's jurisdiction and the jurisdiction has an accreditation of status of "accredited," the Board may extend the LHD's accreditation status by up to 90 days following the end of the declaration.
(g) An accreditation status of conditionally accredited shall expire as set out in G.S. 130A-34.1(g)(2).
(h) The Board shall provide written notice to the LHD of any action taken under this Rule within 5 business days of the action.
History Note: Authority G.S. 130A-34.1;
Eff. June 1, 2026.
10A NCAC 48C .0204 INFORMAL REVIEW PROCEDURES
(a) If the Board assigns an LHD the status of conditionally accredited or unaccredited, the LHD may submit a written request to the Board within 10 business days of receipt of written notice under Paragraph (g) of Rule .0203 of this Section for reconsideration of the Board's decision. The written request shall describe the LHD's reasoning for how it met the requirements for accreditation as set out in 10A NCAC 48D .0101. The request shall be submitted to NCLHDaccreditation@unc.edu.
(b) The Board shall review the LHD's request at the Board's next regularly scheduled meeting. The Board shall either affirm the LHD's assigned accreditation status or assign a new accreditation status based on the information provided. The Board shall provide written notice to the LHD of the Board's decision within 10 business days of the Board meeting where the request is reviewed.
History Note: Authority G.S. 130A-34.1;
Eff. June 1, 2026.
10A NCAC 48C .0205 APPLYING FOR ACCREDITATION
(a) Each LHD shall apply for accreditation by completing a self-assessment in the Dashboard in accordance with Rule .0201 of this Section.
(b) If an LHD has an accreditation status of accredited or conditionally accredited, the LHD shall complete the self-assessment no later than five months before the expiration date of its accreditation status.
(c) If a county health department joins a district health department pursuant to G.S. 130A-36, the accreditation status of the district health department shall apply. If the district health department does not have an accreditation status, the district health department shall complete the self-assessment no later than five months after forming and shall assume the accreditation status that applies to fifty percent or more of the counties in the district or a status of conditionally accredited. The accreditation status assumed under this Paragraph shall apply until the earlier of the Board taking action in accordance with Rule .0203 of this Section or twelve months have elapsed since formation of the district. If twelve months have elapsed since formation of the district without Board action, the district health department shall be unaccredited.
(d) If a county health department withdraws from a district health department pursuant to G.S. 130A-38, the county health department shall complete the self-assessment no later than five months after withdrawing from the district health department. The county health department shall retain the accreditation status of the district health department until the earlier of the Board taking action in accordance with Rule .0203 of this Section or twelve months elapsing since withdrawal from the district. If twelve months have elapsed since withdrawal from the district without Board action, the county health department shall be unaccredited.
(e) If an LHD timely completes the self-assessment as set out in Paragraphs (b)-(d) of this Rule, the Board shall initiate a site visit in accordance with Rule .0202 of this Section and take action in accordance with Rule .0203 of this Section before the LHD's accreditation status expires. In all other circumstances, the Board shall initiate a site visit in accordance with Rule .0202 of this Section within eight months of completion of the self-assessment and shall take action in accordance with Rule .0203 of this Section at its next regularly scheduled meeting following the site visit.
History Note: Authority G.S. 130A-34.1;
Eff. June 1, 2026.