CHAPTER 39 ‑ ADULT HEALTH

 

SUBCHAPTER 39A ‑ CHRONIC DISEASE

 

SECTION .0100 ‑ MIGRANT HEALTH

 

10A NCAC 39A .0101 RESERVED FOR FUTURE CODIFICATION

10A NCAC 39A .0102 DEFINITIONS

10A NCAC 39A .0103 MIGRANT HEALTH PROGRAM SERVICES

10A NCAC 39A .0104 CO-PAYMENTS

10A NCAC 39A .0105 FEE-FOR-SERVICE REIMBURSEMENT

10A NCAC 39A .0106 ELIGIBLE MIGRANTS

10A NCAC 39A .0107 ELIGIBLE PROVIDERS

 

History Note: Authority G.S. 130A‑223; Sec. 329, Public Health Services Act, 95 Stat. 569(42 U.S.C. 259b); (42 U.S.C. 254b); 42 C.F.R. 56.302(f);

Eff. January 1, 1983;

Amended Eff. June 1, 2004; April 1, 1999; April 1, 1995; October 1, 1990; September 1, 1990; January 1, 1986;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

10A NCAC 39A .0108 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .0109 COVERED SERVICES

10A NCAC 39A .0110 CLAIMS FOR PAYMENT

10A NCAC 39A .0111 PAYMENT LIMITATIONS

 

History Note: Authority G.S. 130A‑223; Sec. 329, 95 Stat 569;

Eff. January 1, 1983;

Temporary Amendment Eff. July 6, 1992 for a period of 180 days to Expire on January 2, 1993;

Amended Eff. October 1, 2006; June 1, 2004; April 1, 1995; October 1, 1992; October 1, 1990; January 1, 1986;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

SECTION .0200 ‑ HOME HEALTH SERVICES

 

10A NCAC 39A .0201 GENERAL

10A NCAC 39A .0202 DEFINITIONS

10A NCAC 39A .0203 REIMBURSEMENT FUNDS

10A NCAC 39A .0204 PATIENT FINANCIAL ELIGIBILITY

10A NCAC 39A .0205 COVERED SERVICES

10A NCAC 39A .0206 BILLING THE PROGRAM

10A NCAC 39A .0207 RATES OF REIMBURSEMENT

10A NCAC 39A .0208 REIMBURSEMENT FUNDS: THIRD PARTY PAYORS

10A NCAC 39A .0209 MONITORING

10A NCAC 39A .0210 AUDITS

 

History Note: Authority G.S. 130A-5(3); 130A-223;

Eff. July 1, 1983;

Amended Eff. October 1, 1990; September 1, 1990; January 1, 1986; July 1, 1985;

Repealed Eff. July 1, 2014.

 

10A NCAC 39A .0211 SPECIAL PROVISION

 

History Note: Authority G.S. 130A-5(3); 130A-223;

Eff. August 1, 1991;

Repealed Eff. July 1, 2014.

 

SECTION .0300 ‑ CHRONIC RENAL DISEASE CONTROL PROGRAM

 

10A NCAC 39A .0301 GENERAL

10A NCAC 39A .0302 MEDICAL ELIGIBILITY

10A NCAC 39A .0303 FINANCIAL ELIGIBILITY

10A NCAC 39A .0304 APPLICATION PROCESS

10A NCAC 39A .0305 CLAIMS FOR REIMBURSEMENT

10A NCAC 39A .0306 COVERED SERVICES

10A NCAC 39A .0307 CONSULTATIVE SERVICES

10A NCAC 39A .0308 ASSISTANCE AGREEMENTS

 

History Note: Authority G.S. 130A‑220;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; January 1, 1986; July 1, 1985; July 1, 1984; July 1, 1983; April 1, 1982; July 1, 1981; March 31, 1980;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

10A NCAC 39A .0309 VENDOR REQUIREMENTS

 

History Note: Authority G.S. 130A‑220;

Eff. March 31, 1980;

Amended Eff. September 1, 1990;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

10A NCAC 39A .0310 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .0311 APPEALS PROCEDURE

 

History Note: Authority G.S. 130A‑220;

Eff. March 31, 1980;

Amended Eff. September 1, 1990; February 1, 1987; July 1, 1984;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

SECTION .0400 - RESERVED FOR FUTURE CODIFICATION

 

SECTION .0500 ‑ ADULT HEALTH PROMOTION AND DISEASE PREVENTION PROGRAM

 

10A NCAC 39A .0501 GENERAL

10A NCAC 39A .0502 DEFINITIONS

10A NCAC 39A .0503 ROLE OF THE PROGRAM

10A NCAC 39A .0504 PROVIDER ELIGIBILITY

10A NCAC 39A .0505 APPLICATIONS FOR PROGRAM FUNDS

10A NCAC 39A .0506 MONITORING AND REPORTING PROGRAM PERFORMANCE

10A NCAC 39A .0507 USE OF PROGRAM FUNDS

10A NCAC 39A .0508 CLIENT AND THIRD PARTY FEES

 

History Note: Authority G.S. 130A‑223;

Eff. January 1, 1985;

Amended Eff. September 1, 1990;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

SECTION .0600 ‑ MEDICATION ASSISTANCE PROGRAM FOR THE DISABLED

 

10A NCAC 39A .0601 GENERAL

10A NCAC 39A .0602 CLIENT ELIGIBILITY

10A NCAC 39A .0603 FINANCIAL ASSISTANCE PAYMENTS

 

History Note: Authority S.L. 1985, c. 791, s. 19(a);

Temporary Rule Eff. October 29, 1985 for a Period of 120 Days to Expire on February 26, 1986;

Eff. February 26, 1986;

Temporary Amendment Eff. October 21, 1987, for a Period of 180 Days to Expire on April 17, 1988;

Amended Eff. September 1, 1990; May 1, 1988;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

SECTION .0700 ‑ HEALTH CARE SERVICES IN THE HOME DEMONSTRATIONPROGRAM

 

10A NCAC 39A .0701 GENERAL

10A NCAC 39A .0702 DEFINITIONS

10A NCAC 39A .0703 ELIGIBLE PROVIDERS

10A NCAC 39A .0704 FINANCIAL ELIGIBILITY

10A NCAC 39A .0705 MEDICAL ELIGIBILITY

10A NCAC 39A .0706 BILLING THE DEMONSTRATION PROGRAM

10A NCAC 39A .0707 RATES OF REIMBURSEMENT

10A NCAC 39A .0708 REIMBURSEMENT FUNDS: THIRD PARTY PAYORS

10A NCAC 39A .0709 MONITORING

10A NCAC 39A .0710 AUDITS

10A NCAC 39A .0711 SPECIAL PROVISIONS

 

History Note: Authority G.S. 130A‑223; Sec. 395, 101 STAT. 979 (42 U.S.C. 280c);

Temporary Rule Eff. March 20, 1989 for a Period of 180 Days to Expire on September 16, 1989;

Eff. August 1, 1989;

Amended Eff. August 1, 1991; September 1, 1990; February 1, 1990;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

 

SECTION .0800 ‑ HOME AND COMMUNITY‑BASED HIV HEALTH SERVICES PROGRAM

 

10A NCAC 39A .0801 GENERAL

10A NCAC 39A .0802 DEFINITIONS

10A NCAC 39A .0803 ELIGIBLE PROVIDERS

10A NCAC 39A .0804 FINANCIAL ELIGIBILITY

10A NCAC 39A .0805 MEDICAL ELIGIBILITY

10A NCAC 39A .0806 BILLING THE HIV HEALTH SERVICES PROGRAM

10A NCAC 39A .0807 RATES OF REIMBURSEMENT

10A NCAC 39A .0808 REIMBURSEMENT FUNDS: THIRD PARTY PAYORS

10A NCAC 39A .0809 MONITORING

10A NCAC 39A .0810 AUDITS

 

History Note: Authority G.S. 130A-223;

Temporary Adoption Eff. January 7, 1991 for a period of 180 Days to Expire on July 6, 1991;

ARRC Objection Lodged January 18, 1991;

Eff. May 1, 1991;

Repealed Eff. July 1, 2014.

 

SECTION .0900 ‑ RYAN WHITE HIV CARE PROGRAM

 

10A NCAC 39A .0901 GENERAL

10A NCAC 39A .0902 DEFINITIONS

10A NCAC 39A .0903 ELIGIBLE PROVIDERS

10A NCAC 39A .0904 APPLICATIONS FOR RWCP CARE CONSORTIUM FUNDS

10A NCAC 39A .0905 FINANCIAL ELIGIBILITY

10A NCAC 39A .0906 MEDICAL ELIGIBILITY

10A NCAC 39A .0907 BILLING THE RYAN WHITE HIV CARE PROGRAM

10A NCAC 39A .0908 LIMITATIONS ON FEE CHARGES

10A NCAC 39A .0909 RATES OF REIMBURSEMENT

10A NCAC 39A .0910 REIMBURSEMENT FUNDS: THIRD PARTY PAYORS

10A NCAC 39A .0911 MONITORING

10A NCAC 39A .0912 AUDITS

 

History Note: Authority G.S. 130A‑223;

Eff. December 1, 1991;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

10A NCAC 39A .0912 AUDITS

Agency financial and statistical records, patient records, and any other pertinent information may be audited by the state as part of the overall monitoring and evaluation effort.

 

History Note: Authority G.S. 130A‑223;

Eff. December 1, 1991.

 

SECTION .1000 ‑ HIV MEDICATIONS PROGRAM

 

10A NCAC 39A .1001 GENERAL

Persons diagnosed by a medical provider to have HIV disease or HIV seropositivity, and who qualify financially pursuant to 15A NCAC 245 .0202, shall be eligible to have medications paid for through the HIV Medications Program in accordance with the rules of this Section.

 

History Note: Authority G.S. 130A‑5(3);

Eff. October 1, 1990;

Transferred and Recodified from 15A NCAC 19A .0701 Eff. August 10, 1992;

Temporary Amendment Eff. July 1, 1995, for a period of 180 days or until the permanent rule becomes effective, whichever is sooner;

Amended Eff. January 1, 1996;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 6, 2016.

 

10A NCAC 39A .1002 COVERED MEDICATIONS

(a) Medications covered by the HIV Medication Program shall be specified on a formulary established by the Program based upon the following factors: the medical needs of persons living with HIV disease, the cost effectiveness of the drugs, the availability of generic or other less costly alternatives, and the need to maximize the benefits to patients using finite Program dollars. The covered medications include: antiretroviral medications used to treat HIV infection in accordance with FDA approved indications included in the official product labeling and other FDA approved medications as approved by the program, used for the prevention and treatment of the side effects of and opportunistic infections related to a diagnosis of HIV disease, or to treat the side effects and toxicities of the other covered medications.

(b) Other medications shall be approved by the program based on:

(1) the expert input and recommendations received from a panel of physicians in North Carolina working directly with the HIV infected community, including physicians at the tertiary care centers, in community practice, in research, and represented on the AIDS Care Advisory Committee; and

(2) an evaluation of the availability of adequate financial resources.

(c) A list of medications on the HIV Medications Program formulary shall be made available upon request by the Purchase of Medical Care Services or the Division of Public Health AIDS Drug Assistance Program, 1902 Mail Service Center, Raleigh, NC 27699-1902. Additionally, as medications are added to the program, announcements shall be made through the monthly newsletter distributed by the Purchase of Medical Care Services to participating pharmacies and through announcements mailed to HIV care consortia, tertiary care centers and other agencies serving HIV infected individuals by the Division of Public Health.

 

History Note: Authority G.S. 130A‑5(3);

Eff. January 1, 1996;

Temporary Amendment Eff. July 1, 2005;

Amended Eff. November 1, 2005;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 6, 2016.

 

10A NCAC 39A .1003 MEDICAL ELIGIBILITY

A person who is determined by a physician to be infected with the human immunodeficiency virus is medically eligible.

 

History Note: Authority G.S. 130A‑5(3);

Eff. January 1, 1996;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 6, 2016.

 

10A NCAC 39A .1004 FINANCIAL ELIGIBILITY

Financial eligibility shall be determined in accordance with 15A NCAC 45A .0200.

 

History Note: Authority G.S. 130A‑5(3);

Eff. January 1, 1996;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 6, 2016.

 

10A NCAC 39A .1005 APPLICATION PROCESS

(a) Applications for assistance must be submitted and shall be processed in accordance with 10A NCAC 45A. All necessary forms may be obtained from the Purchase of Medical Care Services, Office of the Controller, Department of Health and Human Services, 1904 Mail Service Center, Raleigh, N.C. 27699-1904.

(b) Applications must be renewed at least annually for the fiscal year beginning July 1, and ending June 30.

 

History Note: Authority G.S. 130A‑5(3);

Eff. January 1, 1996;

Temporary amendment Eff. July 1, 2005;

Amended Eff. April 1, 2006; January 1, 2006; October 1, 2005;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 6, 2016.

 

10A NCAC 39A .1006 PROGRAM OPERATIONS

Medications provided to eligible clients through this HIV Medication Program shall be dispensed and provided by a pharmacy (or pharmacies) under contract with the Program.

 

History Note: Authority G.S. 130A‑5(3);

Temporary Adoption Eff. July 1, 2005;

Eff. November 1, 2005;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 6, 2016.

 

SECTION .1100 - CANCER DIAGNOSTIC AND TREATMENT PROGRAM

 

10A NCAC 39A .1101 GENERAL

10A NCAC 39A .1102 DEFINITIONS

10A NCAC 39A .1103 LIMITATIONS ON DAYS OF SERVICE

10A NCAC 39A .1104 COVERED SERVICES

10A NCAC 39A .1105 FINANCIAL ELIGIBILITY

10A NCAC 39A .1106 MEDICAL ELIGIBILITY

10A NCAC 39A .1107 PATIENT APPLICATION PROCESS

10A NCAC 39A .1108 REIMBURSEMENT PROCESS

 

History Note: Authority G.S. 130A‑205; 130A-220; Sec. 301 & 317, Public Health Services Act, as amended;

Temporary Adoption Eff. December 1, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner;

Eff. April 1, 1993;

Amended Eff. August 1, 2000; August 1, 1995; January 1, 1995;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

10A NCAC 39A .1109 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1110 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1111 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1112 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1113 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1114 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1115 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1116 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1117 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1118 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1119 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1120 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1121 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1122 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1123 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1124 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1125 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1126 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1127 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1128 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1129 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1130 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1131 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1132 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1133 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1134 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1135 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1136 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1137 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1138 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1139 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1140 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1141 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1142 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1143 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1144 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1145 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1146 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1147 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1148 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1149 RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 39A .1150 REPORTING OF CANCER

10A NCAC 39A .1151 CANCER REGISTRY

 

History Note: Authority G.S. 130A‑205; 130A‑209;

Temporary Adoption Eff. December 1, 1992 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner;

Eff. April 1, 1993;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

SECTION .1200 - BREAST AND CERVICAL CANCER SCREENING AND FOLLOW‑UP PROGRAM

 

10A NCAC 39A .1201 GENERAL

10A NCAC 39A .1202 DEFINITIONS

10A NCAC 39A .1203 FINANCIAL ELIGIBILITY

10A NCAC 39A .1204 MEDICAL ELIGIBILITY

10A NCAC 39A .1205 PARTICIPATING PROVIDERS

10A NCAC 39A .1206 PATIENT APPLICATION PROCESS

10A NCAC 39A .1207 APPLICATIONS FOR PROGRAM FUNDS

10A NCAC 39A .1208 USE OF PROGRAM FUNDS

10A NCAC 39A .1209 QUALITY ASSURANCE

 

History Note: Authority G.S. 130A‑205; Sec. 301 & 317, Public Health Services Act, as amended;

Temporary Adoption Eff. December 1, 1992 for a Period of 180 Days or until the permanent rule becomes effective, whichever is sooner;

Eff. April 1, 1993;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.

 

SECTION .1300 - PRESCRIPTION DRUG ASSISTANCE PROGRAM

 

10A ncac 39a .1301 GENERAL

10a ncac 39a .1302 DEFINITIONS

10a ncac 39a .1303 FINANCIAL ELIGIBILITY

10a ncac 39A .1304 LIMITATIONS

10a ncac 39a .1305 APPLICATION PROCESS

10a ncac 39A .1306 COVERED SERVICES

10a ncac 39a .1307 REIMBURSEMENT

 

History Note: Authority S.L. 1999, c. 237, s. 11.1.(a);

Temporary Adoption Eff. February 10, 2000;

Eff. April 1, 2001;

Expired Eff. January 1, 2017 pursuant to G.S. 150B-21.3A.