chapter 43 – personal health

 

SUBCHAPTER 43A ‑ FAMILY PLANNING

 

SECTION .0100 ‑ GENERAL POLICIES

 

10A NCAC 43A .0101      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43A .0102      REFERENCES

(a)  For purposes of this Subchapter, the following regulations and documents are hereby adopted by reference in accordance with G.S. 150B‑14(c):

(1)           42 C.F.R. 50, POLICIES OF GENERAL APPLICABILITY;

(2)           42 C.F.R. 59, GRANTS FOR FAMILY PLANNING SERVICES;

(3)           45 C.F.R. 74, ADMINISTRATION OF GRANTS;

(4)           OMB Circular No. A‑95; and

(5)           Local Health Department Standard, 10 NCAC 12 .0207, Family Planning Standard.

(b)  The materials listed in (a) of this Rule are available for inspection at the Division of Public Health, 1915 Mail Service Center, Raleigh, North Carolina 27699-1915.

 

History Note:        Authority G.S. 130A‑124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; December 1, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10A NCAC 43A .0103      LOCAL PROVIDER

For purposes of this Subchapter, "local provider" means a local health department or a public or private nonprofit agency which delivers comprehensive family planning services at the county or district level.

 

History Note:        Authority G.S. 130A‑124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; December 1, 1980;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10A NCAC 43A .0104      RESPONSIBILITIES

(a)  The branch shall be responsible for the overall operation of the North Carolina statewide family planning program, including the submission of an annual renewal application for funding under Title X of the Public Health Services Act that outlines priorities, plans, and related funding requirements for each of the participating local providers.

(b)  The branch shall have the authority to negotiate agreements with local providers through approval of the annual renewal application by the United States Department of Health and Human Services.

(c)  The branch shall be responsible for support services including:

(1)           provision for statewide data collection and technical assistance,

(2)           consultation and training for local providers to assure accountability in:

(A)          the use of family planning funds,

(B)          comprehensiveness and quality of services.

 

History Note:        Authority G.S. 130A‑124;

Eff. December 1, 1980;

Amended Eff. September 1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10A NCAC 43A .0105      REGIONAL PROGRAM MANAGEMENT

10A NCAC 43A .0106      SUBCONTRACTING

10A NCAC 43A .0107      SUBMISSION OF REQUIRED REPORTS

 

History Note:        Authority G.S. 130A‑124;

Eff. December 1, 1980;

Amended Eff. December 1, 1991; September 1, 1990; July 1, 1983;

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

 

SECTION .0200 ‑ LOCAL PROVIDER FUNDING

 

10A NCAC 43A .0201      DESCRIPTION

10A NCAC 43A .0202      REQUIREMENTS

10A NCAC 43A .0203      DETERMINATION

10A NCAC 43A .0204      FUNDING STIPULATIONS

10A NCAC 43A .0205      THIRD PARTY REIMBURSEMENT PROCEDURES FOR LOCAL PROVIDERS

 

History Note:        Authority G.S. 130A‑124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; October 1, 1985; July 1, 1983; December 1, 1980;

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

 

10A NCAC 43A .0206      DIRECT PATIENT CHARGES

 

History Note:        Authority G.S. 130A‑124;

Eff. December 1, 1980;

Amended Eff. September 1, 1990; July 1, 1983;

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

 

SECTION .0300 ‑ LOCAL PROVIDER SERVICES

 

10A NCAC 43A .0301      MEDICAL SERVICES

10A NCAC 43A .0302      PATIENT EDUCATION

10A NCAC 43A .0303      COMMUNITY EDUCATION

10A NCAC 43A .0304      SOCIAL SERVICES

10A NCAC 43A .0305      INTERAGENCY COORDINATION

10A NCAC 43A .0306      ELIGIBILITY FOR SERVICES

 

History Note:        Authority G.S. 130A‑124;

Eff. December 1, 1980;

Amended Eff. September 1, 1990;

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

 

SECTION .0400 ‑ QUALITY ASSURANCE

 

10A NCAC 43A .0401      SCOPE

10A NCAC 43A .0402      LOCAL FAMILY PLANNING QUALITY ASSURANCE PROGRAMS

10A NCAC 43A .0403      CLINICAL EFFECTIVENESS INDICATORS

10A NCAC 43A .0404      LOCAL RESPONSIBILITY FOR QUALITY ASSURANCE

 

History Note:        Authority G.S. 130A‑124;

Eff. December 1, 1980;

Amended Eff. September 1, 1990;

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

 

SECTION .0500 ‑ PROGRAM POLICIES GOVERNING CLINIC PROCEDURES

 

10A NCAC 43A .0501      VOLUNTARY PARTICIPATION

10A NCAC 43A .0502      MEDICAL RECORDS

10A NCAC 43A .0503      SERVICES TO MINORS

10A NCAC 43A .0504      PATIENT CONSENT

10A NCAC 43A .0505      STERILIZATION

10A NCAC 43A .0506      ABORTION

 

History Note:        Authority G.S. 130A‑124; P.L. 91‑572; 42 C.F.R. 50.205; 42 C.F.R. 50.208;

Eff. December 1, 1980;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43A .0502      MEDICAL RECORDS

(a)  Local providers shall maintain complete medical records for every patient. The medical records shall be completely and accurately documented, readily accessible and systematically organized. Each entry to a medical record shall be signed by the person making the entry.

(b)  All records shall be maintained, either in the original or by microfilm, for no less than five years.

(c)  Local providers shall protect the medical record against breaches of confidentiality.

 

History Note:        Authority 130A‑124;

Eff. December 1, 1980;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43A .0503      SERVICES TO MINORS

Family planning services shall be available to all who voluntarily request such services without regard to age or parental consent.

 

History Note:        Authority G.S. 90‑21.5; 130A‑124;

Eff. December 1, 1980;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43A .0504      PATIENT CONSENT

Method‑specific informed consent shall be obtained each time the individual changes the birth control method selected.

 

History Note:        Authority G.S. 130A‑124;

Eff. December 1, 1980;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43A .0505      STERILIZATION

(a)  Local providers shall not use federal funds to pay for sterilization procedures, including arranging for such procedures, unless all the requirements of 42 C.F.R., 50.201 through 50.204, which are adopted by reference in accordance with G.S. 150B‑14(c), have been met. In addition, informed consent procedures for sterilization operations contained in Chapter 90, Article 19, of the North Carolina General Statutes, which are adopted by reference in accordance with G.S. 150B‑14(c), shall also be followed.

(b)  Local providers shall follow Chapter 35, Article 7, of the North Carolina General Statutes, which are adopted by reference in accordance with G.S. 150B‑14(c), in cases involving sterilization of mentally ill and mentally retarded persons.

(c)  Local providers shall notify the branch of any sterilization covered by (a) of this Rule.

(d)  Local providers receiving funds from the branch are subject to penalty if they coerce or try to coerce any individual to undergo a sterilization.

 

History Note:        Authority G.S. 130A‑124; 42 C.F.R. 50.205; 42 C.F.R. 50.208;

Eff. December 1, 1980;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43A .0506      ABORTION

(a)  No funds provided by the branch shall be used by local providers for abortion services.

(b)  Local providers receiving funds from the branch shall be subject to penalty if they coerce or try to coerce any individual to undergo an abortion.

 

History Note:        Authority G.S. 130A‑124; P.L. 91‑572;

Eff. December 1, 1980;

Amended Eff. September 1, 1990;

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

 

SECTION .0600 ‑ RESERVED FOR FUTURE CODIFICATION

 

SECTION .0700 ‑ RESERVED FOR FUTURE CODIFICATION

 

SECTION .0800 - TEEN PREGNANCY PREVENTION

 

10A NCAC 43A .0801      GENERAL

10A NCAC 43A .0802      DEFINITIONS

10A ncac 43A .0803      GRANT APPLICATIONS

10a ncac 43a .0804      MAXIMUM FUNDING LEVEL

10a ncac 43A .0805      OPERATING STANDARDS

10a ncac 43a .0806      EVALUATION AND MONITORING

10A NCAC 43A .0807      RENEWAL OF GRANT FUNDS

 

History Note:        Authority G.S. 130A-124; 130A-131.15A; S.L. 1989, c. 752, s. 136;

Eff. August 1, 1990;

Amended Eff. January 4, 1994; July 1, 1992; August 1, 1991;

Temporary Amendment Eff. December 1, 2001;

Temporary Amendment Expired September 13, 2002;

Amended Eff. August 1, 2004; April 1, 2003;

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

 

10a ncac 43a .0808      CRITERIA FOR PROJECT SELECTION

 

History Note:        Authority G.S. 130A-124; 130A-131.15A;

Temporary Adoption Eff. December 1, 2001;

Temporary Adoption Expired September 13, 2002;

Eff. April 1, 2003;

Amended Eff. April 1, 2008; August 1, 2004;

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

 

 

SUBCHAPTER 43B ‑ MATERNAL HEALTH

 

SECTION .0100 ‑ LOCAL HEALTH DEPARTMENT PROGRAM AND FUNDING

 

10A NCAC 43B .0101      GENERAL

The Maternal and Child Health Program is administered by the Division of Public Health. 1915 Mail Service Center, Raleigh, North Carolina 27699-1915.

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10A NCAC 43B .0102      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43B .0103      DEFINITIONS

The following definitions shall apply throughout Sections .0300 and .0400 of this Subchapter:

(1)           "Division" means the Division of Public Health.

(2)           "MCH" means Maternal and Child Health.

(3)           "Low Income" means an individual or family with an income determined to be below the nonfarm income official poverty line defined by the Office of Management and Budget and revised annually in accordance with Section 624 of the Economic Opportunity Act of 1964.

(4)           "Provider" means a county or district health department or other public or private nonprofit agency receiving MCH Program funds.

(5)           "Child" means any individual under twenty‑one years of age.

(6)           "Minor remodeling" means any building or facility reconstruction project having a total cost of one thousand dollars ($1,000) or less.

(7)           "Major medical equipment" means any fixed asset that has a unit cost of five thousand dollars ($5,000) or more and is used for the screening diagnosis, or treatment of health related problems.

(8)           "New State or Federal Funds" means any funds which are in excess of the amount allocated by the MCH Program to local providers as of July 1, 1983.

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10A NCAC 43B .0104      PROVIDER ELIGIBILITY

(a)  Local health departments are eligible to receive MCH program funds from the division.

(b)  MCH program funds may be awarded to any public or private nonprofit agency in the event a local health department is unwilling or unable to provide a particular maternal and child health service or services.

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10A NCAC 43B .0105      CLIENT ELIGIBILITY

To be eligible for maternal and child health ambulatory services provided by MCH program funds, clients must meet the eligibility criteria established by the local provider. Financial eligibility requirements may not be more restrictive than the official poverty line issued annually by the United States Department of Health and Human Services.

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. August 1, 1987;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10A NCAC 43B .0106      SCOPE OF SERVICES

10A NCAC 43B .0107      ALLOCATION OF FUNDS: CONTRACT

10A NCAC 43B .0108      EVALUATION AND MONITORING

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

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

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

 

10A NCAC 43B .0109      CLIENT AND THIRD PARTY FEES

(a)  If a local provider imposes any charges on clients for maternal and child health services, such charges:

(1)           Will be applied according to a public schedule of charges;

(2)           Will not be imposed on low‑income individuals or their families;

(3)           Will be adjusted to reflect the income, resources, and family size of the individual receiving the services.

(b)  If client fees are charged, providers must make reasonable efforts to collect from third party payors.

(c)  Client and third party fees collected by the local provider for the provision of maternal and child health services must be used, upon approval of the program, to expand, maintain, or enhance these services. No person shall be denied services because of an inability to pay.

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

SECTION .0200 ‑ MISCELLANEOUS PROGRAM/PROJECT FUNDING

 

10A NCAC 43B .0201      GENERAL

10A NCAC 43B .0202      PROVIDER ELIGIBILITY

10A NCAC 43B .0203      APPLICATION FOR FUNDS

10A NCAC 43B .0204      BUDGETING OF GRANT FUNDS

10A NCAC 43B .0205      ANNUAL REPORT

10A NCAC 43B .0206      RENEWAL OF GRANT FUNDS

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990;

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

 

 SECTION .0300 ‑ RURAL OBSTETRICAL CARE INCENTIVE FUNDS

 

10A NCAC 43B .0301      GENERAL

10A NCAC 43B .0302      APPLICATION FOR FUNDS

10A NCAC 43B .0303      PHYSICIANS AND NURSE‑MIDWIVES ELIGIBLE TO PARTICIPATE

10A NCAC 43B .0304      DISBURSEMENT OF FUNDS

10A NCAC 43B .0305      PARTICIPATION REQUIREMENTS FOR LOCAL HEALTH DEPARTMENTS

10A NCAC 43B .0306      PARTICIPATION REQUIREMENTS FOR PHYSICIANS AND NURSE‑MIDWIVES

 

History Note:        Authority S.L. 1989, c. 1066, s. 49; S.L. 1993, c. 321, s. 283;

Temporary Rule Eff. October 20, 1988, for a period of 180 Days to expire on April 18, 1989;

Eff. March 1, 1989;

Amended Eff. January 4, 1994; July 1, 1992; February 1, 1991; February 1, 1990; December 1, 1990;

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

 

 

 

SUBCHAPTER 43C ‑ PERINATAL CARE

 

SECTION .0100 ‑ GENERAL

 

10A NCAC 43C .0101      MISSION AND ADMINISTRATION

 

History Note:        Authority G.S. 130A‑127;

Eff. July 1, 1983;

Amended Eff. September 1, 1990;

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

10A NCAC 43C .0102      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43C .0103      ADVISORY BODIES

10A NCAC 43C .0104      DEFINITIONS

 

History Note:        Authority G.S. 130A‑127;

Eff. July 1, 1983;

Amended Eff. September 1, 1990; April 1, 1985;

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

 

SECTION .0200 ‑ RESERVED FOR FUTURE CODIFICATION

 

SECTION .0300 ‑ HIGH RISK MATERNITY CLINIC FUNDS AND HIGH RISK MATERNITY CLINIC REIMBURSEMENT FUNDS

 

10A NCAC 43C .0301      GENERAL

10A NCAC 43C .0302      APPLICATION FOR FUNDS

10A NCAC 43C .0303      BUDGETING OF FUNDS

10A NCAC 43C .0304      CLIENT AND THIRD PARTY FEES

10A NCAC 43C .0305      CLIENT ELIGIBILITY

10A NCAC 43C .0306      REIMBURSEMENT

10A NCAC 43C .0307      SCOPE OF SERVICES

10A NCAC 43C .0308      STAFFING

10A NCAC 43C .0309      FACILITY AND EQUIPMENT

10A NCAC 43C .0310      MONITORING AND EVALUATION

10A NCAC 43C .0311      PROVIDER ELIGIBILITY

 

History Note:        Authority G.S. 130A‑127;

Eff. July 1, 1988;

Amended Eff. December 6, 1991; September 1, 1990;

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

 

SECTION .0400 ‑ CONTRACTS FOR EDUCATION AND TRAINING

 

10A NCAC 43C .0401      GENERAL

10A NCAC 43C .0402      APPLICATION FOR FUNDS

10A NCAC 43C .0403      BUDGETING OF GRANT FUNDS

10A NCAC 43C .0404      ANNUAL REPORT

10A NCAC 43C .0405      RENEWAL OF GRANT FUNDS

 

History Note:        Authority G.S. 130A‑127;

Eff. July 1, 1983;

Amended Eff. September 1, 1990; June 1, 1989; April 1, 1985;

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

 

SECTION .0500 ‑ SPECIAL PROJECTS

 

10A NCAC 43C .0501      GENERAL

10A NCAC 43C .0502      ANNUAL REPORT

 

History Note:        Authority G.S. 130A‑127;

Eff. July 1, 1983;

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

 

 

 

subchapter 43d – wic/nutrition

 

section .0100 - DEFINITIONS

 

10A NCAC 43D .0101      DIETETICS

10A NCAC 43D .0102      DIETITIAN

10A NCAC 43D .0103      NUTRITIONIST

10A NCAC 43D .0104      THE AMERICAN DIETETIC ASSOCIATION

10A NCAC 43D .0105      HOME ECONOMIST

10A NCAC 43D .0106      COMPETENT DIETARY PROFESSIONAL

10A NCAC 43D .0107      WIC

 

History Note:        Authority G.S. 130A‑361;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. December 6, 1991; November 1, 1990;

Repealed Eff. October 1, 2009.

 

SECTION .0200 ‑ WIC PROGRAM GENERAL INFORMATION

 

10A NCAC 43D .0201      DESCRIPTION

The Nutrition Services Branch is responsible for the administration of the WIC Program in North Carolina.

 

History Note:        Authority G.S. 130A‑361; 7 C.F.R. 246;

Eff. July 1, 1981;

Amended Eff. October 1, 2009; December 6, 1991; November 1, 1990.

 

10A NCAC 43D .0202      DEFINITIONS

(a)  For the purposes of this Subchapter, all definitions set forth in 7 C.F.R. Part 246.2 are hereby incorporated by reference, including subsequent amendments and editions, with the following additions and modifications:

(1)           An "administrative appeal" is an appeal in accordance with Section .0800 of this Subchapter through which a local WIC agency, potential local WIC agency, authorized WIC vendor, or WIC vendor applicant may appeal the adverse actions listed in 7 C.F.R. 246.18(a)(1)(i), (a)(1)(ii), and (a)(3)(i).

(2)           An "authorized store representative" includes an owner, manager, assistant manager, head cashier, or chief fiscal officer.

(3)           An "authorized WIC vendor" is a food retailer or free-standing pharmacy that has executed a currently effective North Carolina WIC Vendor Agreement, as set forth in 7 C.F.R 246.12(h)(3).

(4)           A "chain store" is a store that is owned or operated by a corporation, partnership, cooperative association, or other business entity that has 20 or more stores owned or operated by the business entity.

(5)           An "Electronic Benefit Transfer (EBT) Processor" is an entity contracted by a government agency for the implementation, maintenance, and operation of the State WIC agency's WIC EBT system that acts as the agent of the State WIC agency to process and settle EBT transactions.

(6)           A "fair hearing" is the informal dispute resolution process in Section .0900 of this Subchapter through which any individual may appeal a State or local agency action that results in a claim against the individual for repayment of the cash value of issued benefits by which the individual is not eligible or results in the individual's denial of participation or disqualification from the WIC Program, as set forth in Rule .0410 of this Subchapter. This process must be complied with prior to requesting a contested case hearing in accordance with G.S. 150B, as set forth in 7 CFR 246.9.

(7)           "FNS" means the Food and Nutrition Service of the U.S. Department of Agriculture.

(8)           "Free-standing pharmacy" means a pharmacy that does not operate within another retail store. Free-standing pharmacy includes free-standing pharmacies that are chain stores and free-standing pharmacies participating under a WIC corporate agreement.

(9)           The "local WIC agency" is the local agency that enters into an agreement with the Division of Public Health to operate the Special Supplemental Nutrition Program for Women, Infants and Children.

(10)         A "local WIC program plan" is a written compilation of information on the local WIC agency policies concerning program operation, including administration, nutrition education, personnel functions, costs and other information prepared by the local WIC agency and submitted to the Nutrition Services Branch.

(11)         A "personal identification number" (PIN) is a numeric password selected and used by a WIC participant to authenticate the participant to the EBT system.

(12)         A "point of sale terminal" (POS) is an electronic device used to process EBT card payments at authorized vendor locations.

(13)         A "predominantly WIC vendor" is an "above-50-percent vendor" as defined in 7 C.F.R. 246.2.

(14)         A "product look-up (PLU) code" is an identification number placed on produce sold at authorized vendor locations.

(15)         "Redemption" is the process by which a vendor deposits for payment a food instrument or cash-value voucher transacted at that vendor and the State agency (or its financial agent) makes payment to the vendor for the food instrument or cash-value voucher.

(16)         "Shelf price" is the price a vendor charges a non-WIC customer for a WIC supplemental food.

(17)         "SNAP-eligible food sales" means "food sales" as defined in 7 C.F.R. 246.2, which are those foods that can be purchased with Supplemental Nutrition Assistance Program ("SNAP") benefits.

(18)         The "State agency" is the Nutrition Services Branch, Women's and Children's Health Section, Division of Public Health, North Carolina Department of Health and Human Services.

(19)         "Store" means a food retailer or free-standing pharmacy operating at a single, fixed location.

(20)         "Supplemental food" or "WIC supplemental food" is a food that satisfies the requirements of 10A NCAC 43D .0501.

(21)         " Support costs" are clinic costs, administrative costs, and nutrition education costs.

(22)         "Transaction" is the process by which a WIC customer tenders a food instrument or a cash-value voucher to a vendor in exchange for authorized supplemental foods.

(23)         "Universal Product Code (UPC)" means an identification code printed on the packaging of WIC approved foods sold at WIC authorized vendor locations.

(24)         "Vendor applicant" is a store that has submitted an application to become an authorized WIC vendor but is not yet authorized.

(25)         A "vendor overcharge" is intentionally or unintentionally charging more for supplemental food provided to a WIC customer than to a non-WIC customer or charging more than the current shelf price for supplemental food provided to a WIC customer.

(26)         A "WIC corporate agreement" is a single WIC Vendor Agreement with a corporate entity that has 20 or more stores authorized as WIC vendors under the Agreement.

(27)         "WIC customer" means a WIC participant, parent, or caretaker of an infant or child participant, proxy for the eligible participant, or compliance investigator who tenders a food instrument or a cash-value voucher to a vendor in exchange for WIC supplemental food.

(28)         "WIC program" means the Special Supplemental Nutrition Program for Women, Infants, and Children authorized by 42 U.S.C. 1786 of the Child Nutrition Act of 1966 as amended.

(b)  A copy of 7 C.F.R. Part 246 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 27609. Copies are available at no cost from the Supplemental Nutrition Programs Division, Food and Nutrition Service, USDA, 3101 Park Center Drive, Room 540, Alexandria, Virginia 22302, by calling (703) 305-2730 or online at https://www.ecfr.gov/cgi-bin/text-idx?SID=a42889f84f99d56ec18d77c9b463c613&node=7:4.1.1.1.10&rgn=div5.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246; U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. December 6, 1991; November 1, 1990; July 1, 1989;

Temporary Amendment Eff. May 17, 2000;

Amended Eff. April 1, 2001;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. August 1, 2004;

Temporary Amendment Eff. July 1, 2006;

Amended Eff. October 1, 2017; February 1, 2013; October 1, 2009; April 1, 2007.

 

10A NCAC 43D .0203      REFERENCES

(a)  The State agency shall administer the WIC program in accordance with:

(1)           42 U.S.C. 1786; and

(2)           7 C.F.R. 246.1 through 246.28, United States Department of Agriculture, Food and Nutrition Service, Special Supplemental Nutrition Program for Women, Infants and Children.

(b)  The documents listed in Paragraph (a) of this Rule are available for inspection at the Division of Public Health, Women's and Children's Section, Nutrition Services Branch at 5601 Six Forks Road, Raleigh, NC 27609 during regular business hours, Monday through Friday from 8:00 AM to 5:00 PM.

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. October 1, 2017; October 1, 2009; April 1, 1984; April 1, 1982.

 

10A NCAC 43D .0204      CONTRACT WITH FNS

(a)  The Division of Public Health shall maintain the Federal-State Special Supplemental Nutrition Program Agreement with the United States Department of Agriculture, Food and Nutrition Service.

(b)  The state agency shall prepare, submit to FNS, and maintain the North Carolina State WIC Program Plan of Operations to fulfill the requirements of 7 C.F.R. 246.4.  This plan is available for inspection at the state agency during business hours.

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. October 1, 2009.

 

10A NCAC 43D .0205      POLICIES: GUIDELINES AND MANUALS

(a)  The state agency shall promulgate policies, guidelines and manuals to facilitate operation of the WIC Program in accordance with the contract with FNS, the guidelines and instructions issued by FNS in policy letters and management evaluations, and the North Carolina State WIC Program Plan of Operations and the rules contained in this Subchapter.

(b)  The policies, guidelines and manuals maintained under (a) of this Rule are available for inspection at the state agency during regular business hours.

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981.

 

10A NCAC 43D .0206      GENERAL ADMINISTRATION

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. November 1, 1990;

Repealed Eff. October 1, 2009.

 

10A NCAC 43D .0207      LOCAL WIC AGENCY AGREEMENT AND BUDGET

(a)  The state agency shall enter into an agreement and negotiate a budget with each local WIC agency in accordance with 7 C.F.R. 246.6.

(b)  The availability of budgeted support cost funds for each local WIC agency is contingent upon the availability of WIC program support cost funds.

(c)  Since local support cost funds are allocated according to the assigned number of participants to be served, in the event a local WIC agency is unable to serve the assigned number of participants, the state agency shall reduce the amount of support cost funds provided to the local WIC agency by a portion reflective of the level of underperformance.

(d)  The state agency shall notify the local WIC agency in writing of any reduction of support cost funds available to the local WIC agency.

(e)  When state food dollars are overexpended during a federal fiscal year, local WIC Programs that have maintained an active case load in excess of their assigned number of participants shall reimburse to the state their proportionate share of the overexpenditure.

 

History Note:        Authority G.S. 130A-361;

Eff. April 1, 1982;

Amended Eff. October 1, 2009; April 1, 1984.

 

SECTION .0300 ‑ SELECTION OF LOCAL WIC AGENCIES

 

10A NCAC 43D .0301      INITIAL APPLICATION

(a)  Any local agency interested in applying for a WIC program grant shall, upon request to the state agency, be sent an information package to facilitate the application process.

(b)  If the application is submitted but is incomplete, the state agency shall notify the applicant of the additional information required within fifteen days of receipt of the application.

(c)  The state agency shall send notice of approval or denial of the application within thirty days of receipt of a complete application.  The applicant will be informed as to whether funds are available to expand WIC program services.

(d)  If the application is approved, a written agreement will be executed.

(e)  If the application is denied, the applicant may appeal the decision according to Section .0800 of this Subchapter.

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. September 1, 1991.

 

10A NCAC 43D .0302      CRITERIA FOR SELECTION OF LOCAL AGENCIES

(a)  The state agency shall only accept applications from local agencies as defined in 7 C.F.R. 246.2.

(b)  The application must be to provide WIC program benefits to an area or population not receiving program benefits from a local WIC agency.

(c)  WIC program funds must be available to serve the area or population described in the application.

(d)  The State Agency shall consider the local agency priority system and Affirmative Action Plan described in 7 C.F.R. 246.5 in making the decision to fund or not to fund an application.

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. October 1, 2009.

 

10A NCAC 43D.0303       CONTINUATION OF LOCAL WIC AGENCIES

(a)  All grants to local WIC agencies shall be issued annually through an agreement unless the agreement has been terminated as specified in Rule .0305 of this Section.

(b)  All local WIC agencies are eligible to obtain a grant for the next fiscal year provided that:

(1)           WIC program funds are available to serve the area or population;

(2)           The agency continues to operate as a local WIC agency; and

(3)           The agency signs and submits the grant agreement and budget required by the state agency.

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. October 1, 2009; September 1, 1991.

 

10A NCAC 43D .0304      EXPANSION OF LOCAL WIC PROGRAMS

Local WIC agencies that plan to increase the number of persons served shall submit a written request to the Nutrition Services Section.  The availability of funds and the Affirmative Action Plan contained in the North Carolina State WIC Program Plan of Operation will be considered in making the decision to approve or deny the request.

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. December 6, 1991; November 1, 1990.

 

10A NCAC 43D .0305      TERMINATION OF LOCAL WIC AGENCIES

(a)  The authority to operate a local WIC program may be terminated for noncompliance. 

(b)  If FNS terminates or suspends the North Carolina WIC program, the state agency shall in turn, terminate or suspend its agreements with local WIC agencies.

(c)  Termination of a local agency is subject to the appeal provisions of 7 C.F.R. 246.18(a)(3) and Section .0800 of this Subchapter.

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. October 1, 2009; September 1, 1991.

 

section .0400 - ELIGIBILITY FOR WIC PROGRAM PARTICIPATION

 

10A NCAC 43D .0401      ELIGIBILITY

10A NCAC 43D .0402      APPLICATION

10A NCAC 43D .0403      MEDICAL AND NUTRITION ASSESSMENT

10A NCAC 43D .0404      NUTRITIONAL RISK CERTIFICATION CRITERIA

10A NCAC 43D .0405      SCHEDULE OF CERTIFICATION

10A NCAC 43D .0406      DOCUMENTATION OF CERTIFICATION

10A NCAC 43D .0407      TRANSFER OF CERTIFICATION

 

History Note:        Authority G.S. 130A‑361; 7 C.F.R. 246; 143B‑10;

Eff. July 1, 1981;

Amended Eff. October 1, 1993; September 1, 1991; December 6, 1991; November 1, 1990; October 1, 1990; July 1, 1989;

Repealed Eff. October 1, 2009.

 

10A NCAC 43D .0408      WAITING LIST

(a)  If a local WIC agency is serving its maximum caseload or spending its maximum food money and additional participants cannot be issued food instruments, a waiting list must be established in accordance with 7 C.F.R. 246.7.

(b)  Local WIC agencies maintaining a waiting list shall continue to provide WIC program benefits to all individuals enrolled in the program until the expiration of their certification period.

(c)  Local WIC agencies shall enroll individuals in a manner which ensures that applicants in a higher priority group are first given an opportunity to receive food instruments in accordance with 7 C.F.R. 246.7(e)(4) which is incorporated by reference with all subsequent amendments and editions.

 

History Note:        Authority G.S. 130A-361;

Eff. July 1, 1981;

Amended Eff. October 1, 2009; November 1, 1990; July 1, 1989.

 

10A NCAC 43D .0409      REQUIRED NOTIFICATIONS

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. September 1, 1991; July 1, 1989;

Repealed Eff. October 1, 2009.

 

10A NCAC 43D .0410      participant violations and sanctions

(a)  The State agency shall assess a claim for the full value of Program benefits that have been obtained or disposed of improperly as the result of a participant violation.  "Participant violation" means those violations listed in 7 C.F.R. 246.2 which are incorporated by reference in Rule .0202 of this Subchapter. A claim shall not be paid by offsetting the claim against future Program benefits.

(b)  The following participant violations committed by a participant, parent or caretaker of an infant or child participant, or proxy shall result in a one-year disqualification of the participant from the WIC Program, except as provided in Paragraphs (c) and (d) of this Rule:

(1)           Exchanging food instruments, cash-value vouchers or supplemental food for cash;

(2)           Exchanging food instruments, cash-value vouchers or supplemental food for alcohol, alcoholic beverages, tobacco products, firearms, ammunition, explosives, or controlled substances as defined in 21 U.S.C. 802;

(3)           A claim for dual participation resulting from intentional misrepresentation;

(4)           Intentionally making false or misleading statements or intentionally misrepresenting, concealing, or withholding facts to obtain Program benefits;

(5)           Any participant violation for which a claim of one hundred dollars ($100.00) or more is assessed;

(6)           A second or subsequent claim assessed for any participant violation, regardless of the dollar amount.  The second or subsequent claim does not have to be for the same participant violation as the initial claim to result in a one-year disqualification; and

(7)           Physical harm to clinic or vendor staff.

(c)  The one-year disqualification referenced in Paragraph (b) of this Rule shall not be imposed against the participant if a claim is assessed and full payment is made or a repayment schedule is agreed upon within 30 days of receipt of a written demand for repayment of the claim for the improperly obtained or disposed of Program benefits.

(d)  The one-year disqualification referenced in Paragraph (b) of this Rule shall not be imposed against the participant if the participant is an infant, child, or under age 18 and the state or local agency approves the designation of a proxy for the participant.  Designation of a proxy shall be approved if the proxy:

(1)           is at least 18 years of age;

(2)           presents proof of identification in the form of a government-issued photo identification card, work or school identification card, health benefits or social services program card, social security card, birth certificate, or a pay stub or utility bill no more than 60 days old;

(3)           has written authorization from the participant or the parent or caretaker of an infant or child participant;

(4)           will not be serving as proxy for more than two families at the same time; and

(5)           will be the person who transacts the food instruments.

(e)  Except as provided in Subparagraphs (b)(5) and (b)(6) of this Rule, the following participant violations committed by a participant, parent or caretaker of an infant or child participant, or proxy shall result in a written warning for the first violation and the assessment of a claim for the full amount of any improperly obtained or disposed of Program benefits:

(1)           Exchanging food instruments, cash-value vouchers or supplemental food for credit;

(2)           Exchanging food instruments, cash-value vouchers or supplemental food for non-food items, other than alcohol, alcoholic beverages, tobacco products, firearms, ammunition, explosives, or controlled substances as defined in 21 U.S.C. 802; and

(3)           Exchanging food instruments, cash-value vouchers or supplemental food for unauthorized food items, including supplemental foods in excess of those listed on the participant's food instrument.

For the violations listed in this Paragraph, failure to pay a claim in full or agree to a repayment schedule within 30 days of receipt of a written demand for repayment of a claim, shall result in a 90-day disqualification of the participant, unless the participant is an infant, child, or under age 18 and the state or local agency approves the designation of a proxy for the participant in accordance with Paragraph (d) of this Rule. 

(f)  The occurrence of a second or subsequent participant violation listed in Paragraph (e) of this Rule shall result in a one-year disqualification of the participant and the assessment of a claim for the full amount of any improperly obtained or disposed of Program benefits.  The second or subsequent violation does not have to be the same as the initial violation to result in a one-year disqualification.  The one-year disqualification shall not be imposed against the participant if full payment is made or a repayment schedule is agreed upon within 30 days of receipt of a written demand for repayment of a claim.  Additionally, the one-year disqualification shall not be imposed against the participant if the participant is an infant, child, or under age 18 and the state or local agency approves the designation of a proxy for the participant in accordance with Paragraph (d) of this Rule.

(g)  Threatening physical harm to or verbal abuse of clinic or vendor staff by a participant, parent or caretaker of an infant or child participant, or proxy shall result in a written warning for the first occurrence of this violation.   A second occurrence within a 12-month period shall result in a 90-day disqualification of the participant, unless the participant is an infant, child, or under age 18 and the state or local agency approves the designation of a proxy for the participant in accordance with Paragraph (d) of this Rule.

(h)  For any disqualification imposed under this Rule, a participant may reapply for Program participation if during the period of the disqualification full payment is made or a repayment schedule is agreed upon, or in the case of a participant who is an infant, child, or under age 18, the state or local agency approves the designation of a proxy in accordance with Paragraph (d) of this Rule.

(i)  The participant has a right to a fair hearing in accordance with Section .0900 of this Subchapter for sanctions imposed under this Rule.

 

History Note:        Authority G.S. 130A‑361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. July 1, 1983;

Amended Eff.  November 1, 1990;

Temporary Amendment Eff. July 1, 2002;

 Amended Eff. October 1, 2009; August 1, 2004.

 

10A NCAC 43D .0411      DUAL PARTICIPATION

(a)  A WIC participant shall not participate simultaneously in one or more than one WIC clinic, or participate in the WIC Program and the Commodity Supplemental Food Program ("CSFP") during the same period of time.  For purposes of this Rule, participate means certification as a WIC participant for the receipt of WIC food instruments or cash-value vouchers or certification as a CSFP participant for the receipt of CSFP food.

(b)  The state agency shall immediately terminate the participation in one of the clinics or Programs, or the simultaneous participation in a single clinic, in accordance with 7 C.F.R. 246.7 (l) when a participant is found to be in violation of Paragraph (a) of this Rule.

(c)  In the case of dual participation resulting from intentional misrepresentation, the participant, parent or caretaker of an infant or child participant, or proxy shall repay Program benefits improperly issued as a result of the dual participation, and the participant shall be disqualified from participation in both Programs or clinic(s) in accordance with 7 C.F.R. 246.7 (l) and Paragraph (b) of Rule .0410 of this Section.  For purposes of this Paragraph, receiving WIC food instruments or cash-value vouchers under two or more participant identities in a single WIC clinic during the same issuance period and transacting one or more of the food instruments or cash-value vouchers received under two or more of the identities constitutes dual participation based on intentional misrepresentation.  Receiving WIC food instruments or cash-value vouchers from more than one WIC clinic during the same issuance period and transacting one or more of the food instruments or cash-value vouchers received from two or more of the clinics constitutes dual participation based on intentional misrepresentation.  Additionally, receiving WIC food instruments or cash-value vouchers and CSFP food during the same time period and transacting one or more of the WIC food instruments or cash-value vouchers constitutes dual participation based on intentional misrepresentation.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246; 42 U.S.C. 1786;

Temporary Adoption Eff. July 1, 2002;

Eff. July 1, 2004;

Amended Eff. October 1, 2009.

 

section .0500 – wic program food package

 

10A NCAC 43D .0501      Supplemental FOODS

(a)  The foods which may be provided to WIC program participants are specified in 7 C.F.R. 246.10, which is incorporated by reference including any subsequent amendments and editions.  This material is available for inspection at the Department of Health and Human Services, Division of Public Health, 5601 Six Forks Road, Raleigh, North Carolina 27609 and may be obtained from Nutrition Services at no cost.

(b)  The following exclusions from the food package have been adopted by the North Carolina WIC program and approved by the United States Department of Agriculture, Food and Nutrition Service:

(1)           shredded, diced, grated and organic cheese;

(2)           eggs other than white, fresh, grade A large;

(3)           mackerel and sardines;

(4)           organic foods other than fruits and vegetables obtained with cash-value vouchers;

(5)           goat milk; and

(6)           dried fruits and vegetables.

(c)  The state agency may exclude foods other than those described in Paragraph (b) of this Rule if it determines such foods to be inappropriate for provision as supplemental foods through the WIC program as a result of their cost, nutritional composition, packaging, statewide availability, participant acceptance, or promotion in a manner which is contrary to the purpose of the program as contained in 7 C.F.R. 246.1.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. October 1, 1993; October 1, 1990; July 1, 1989; October 1, 1988;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. October 1, 2009; August 1, 2004.

 

10A NCAC 43D .0502      QUANTITY OF FOODS

The amount of supplemental foods provided shall not exceed the maximum quantities specified in 7 C.F.R. 246.10, which is incorporated by reference with all subsequent amendments and editions.

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. October 1, 2009; July 1, 1989; July 1, 1982.

 

10A NCAC 43D .0503      USE OF WIC SUPPLEMENTAL FOODS

WIC supplemental foods shall be provided for consumption by the participant and not be distributed for use by institutions such as child and day care centers.

 

History Note:        Authority G.S. 130A‑361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. October 1, 1990;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

section .0600 - WIC PROGRAM NUTRITION EDUCATION

 

10A NCAC 43D .0601      EDUCATION OF PARTICIPANTS

10A NCAC 43D .0602      DOCUMENTATION OF NUTRITION EDUCATION

10A NCAC 43D .0603      CONTINUING EDUCATION OF STAFF

10A NCAC 43D .0604      THE LOCAL AGENCY NUTRITION EDUCATION PLAN

 

History Note:        Authority G.S. 130A‑361;

Eff. July 1, 1981;

Amended Eff. December 6, 1991; November 1, 1990;

Repealed Eff. October 1, 2009.

 

SECTION .0700 ‑ WIC PROGRAM FOOD delivery SYSTEM

 

10A NCAC 43D .0701      The North carolina automated wic system

The WIC program shall provide supplemental foods through a uniform retail distribution system in accordance with 7 C.F.R. 246.12.  An automated data processing system shall be utilized to promote the provision of and accounting for food instruments and cash-value vouchers issued to participants.

 

History Note:        Authority G.S. 130A‑361; 42 U.S.C. 1786; 7 C.F.R. 246;

Eff. July 1, 1981;

Amended Eff. October 1, 2009; April 1, 2001.

 

10A nCAC 43D .0702      ISSUANCE OF FOOD INSTRUMENTS and cash-value vouchers

(a)  Local WIC agencies shall issue WIC program food instruments and cash-value vouchers to program participants in a manner which ensures that participants can receive the appropriate supplemental foods that have been prescribed for them.

(b)  Local WIC agencies shall issue food instruments and cash-value vouchers in a manner which prevents theft and shall retain documentation of the disposition of the food instruments and cash-value vouchers.  The documentation of issuance shall include the dated signature of the authorized individual receiving the food instruments or cash-value vouchers unless the food instruments or cash-value vouchers are mailed.

(c)  Participants shall be given appointments to receive food instruments or cash-value vouchers in a manner which promotes coordination with WIC program certification, nutrition education, other health services and the services being received by other family members.

(d)  Food instruments and cash-value vouchers shall be issued only to the participant, the participant's parent, the participant's caretaker, a proxy, or a compliance investigator.

 

History Note:        Authority G.S. 130A‑361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. April 1, 2001;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. October 1, 2009; August 1, 2004.

 

10A NCAC 43D .0703      USE OF FOOD INSTRUMENTS AND CASH-VALUE VOUCHERS

(a)  Participants may transact food instruments and cash-value vouchers on any day on or between the "First Date to Spend" and "Last Date to Spend" printed on the food instrument or cash-value voucher.

(b)  Food instruments and cash-value vouchers shall be transacted only at authorized WIC vendors in accordance with the terms of the signed WIC Vendor Agreement and WIC program rules, regulations, and statutes. Authorized WIC vendors shall not be reimbursed for food instruments and cash-value vouchers that are not properly transacted as set forth in Rule .0708 of this Section. Stores that are not authorized WIC vendors shall not be reimbursed for food instruments and cash-value vouchers transacted at their store.

(c)  Printed food instruments and cash-value vouchers shall be deposited at the vendor's bank. Vendors that use EBT shall have their bank account credited with payments for completed EBT transactions. Food instruments and cash-value vouchers shall not be assigned, transferred, sold, or otherwise negotiated.

 

History Note:        Authority G.S. 130A‑361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. April 1, 2001; November 1, 1990; July 1, 1989;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. October 1, 2017; October 1, 2009; August 1, 2004.

 

10A NCAC 43D .0704      VALIDITY OF WIC FOOD INSTRUMENTS and cash-value vouchers

(a)  North Carolina WIC food instruments and cash-value vouchers shall not be valid if:

(1)           the instrument or voucher has not been legibly imprinted with an authorized WIC vendor stamp;

(2)           the instrument or voucher has been counterfeited or the signature forged;

(3)           the instrument or voucher has been mutilated, defaced or otherwise tampered with or altered;

(4)           the instrument or voucher is not deposited in the vendor's bank within 60 days of the "date of issue" assigned to the instrument or voucher;

(5)           the "pay exactly" amount (i.e. purchase price) is not recorded on the food instrument or voucher;

(6)           the signature is missing;

(7)           the "date transacted" entered on the instrument or voucher is not on or between the "date of issue" and "participant must use by" dates assigned to the instrument or voucher;

(8)           the instrument or voucher is not completed in indelible ink.  Invalid food instruments and cash-value vouchers shall be stamped with the reason for invalidity and returned to the vendor without payment.

(b)  A vendor may attempt to justify or correct an invalid food instrument or cash-value voucher and shall receive payment if:

(1)           for a food instrument or cash-value voucher invalid under Subparagraph (a)(1) of this Rule, the vendor legibly imprints the authorized WIC vendor stamp on the food instrument or cash-value voucher and redeposits it within 95 days from the "date of issue" on the food instrument or cash-value voucher;

(2)           for a food instrument or cash-value voucher invalid under Subparagraphs (a)(2) or (a)(3) of this Rule, the vendor can demonstrate the food instrument or cash-value voucher was invalid due solely to the actions of a third party other than the vendor's owners, officers, managers, agents, or employees and the "pay exactly" amount is legible or can be verified by the vendor with a receipt. 

(3)           for a food instrument or cash-value voucher invalid under Subparagraph (a)(3) of this Rule, the food instrument or cash-value voucher was unintentionally mutilated or defaced by the vendor's owners, officers, managers, agents, or employees and the "pay exactly" amount is legible or can be verified by the vendor with a receipt.

(4)           for a food instrument or cash-value voucher invalid under Subparagraph (a)(3) of this Rule, the "pay exactly" amount has been altered and the vendor provides a receipt that confirms the altered amount is the correct "pay exactly" amount;

(5)           for a food instrument or cash-value voucher invalid under Subparagraph (a)(4) of this Rule, the state WIC office gives approval to the local WIC agency to replace.  The state WIC office shall give approval to the local WIC agency to replace unless:

(A)          the total value of food instruments and cash-value vouchers submitted at one time to the local WIC agency exceeds five hundred dollars ($500.00);

(B)          the vendor has submitted food instruments or cash-value vouchers for replacement to the local agency on two separate occasions within the preceding 12 months; or

(C)          the date the vendor submits the food instrument or cash-value voucher to the local WIC agency for replacement is more than six months past the "date of issue" on the food instrument or cash-value voucher.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. July 1, 1989; July 1, 1985;

Temporary Amendment Eff. May 17, 2000;

Amended Eff. April 1, 2001;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. October 1, 2009; August 1, 2004.

 

10A NCAC 43D .0705      PAYMENT OF WIC FOOD INSTRUMENTS and cash-value vouchers

The State of North Carolina shall:

(1)           accept North Carolina WIC food instruments and cash-value vouchers through the Federal Reserve and commercial banking systems;

(2)           ensure that WIC food instruments and cash-value vouchers are valid in accordance with Rule .0704 of this Subchapter;

(3)           provide payment for all valid WIC food instruments and cash-value vouchers. To the extent that sufficient funds are available in the WIC disbursing account, payment shall be provided according to established Department of Health and Human Services procedures for payment of WIC food instruments and cash-value vouchers.

(4)           ensure that every invalid WIC food instrument or cash-value voucher is stamped to indicate the reason for invalidity;

(5)           ensure that invalid WIC food instruments and cash-value vouchers are returned to the banks from which they were received, according to established banking procedures.

 

History Note:        Authority G.S. 130A‑361; 42 U.S.C. 1786; 7 C.F.R. 246;

Eff. July 1, 1981;

Amended Eff. October 1, 2009; April 1, 2001.

 

10A NCAC 43D .0706      VENDOR PEER GROUPS

Vendor applicants and authorized vendors shall be placed into peer groups as follows:

(1)           When annual WIC supplemental food sales are not yet available, vendor applicants and authorized vendors, excluding chain stores, stores under a WIC corporate agreement, military commissaries, and free-standing pharmacies, shall be placed into peer groups based on the number of cash registers in the store until annual WIC supplemental food sales become available.  The following are the peer groups based on the number of cash registers in the store:

Peer Group I - - zero to two cash registers;

Peer Group II - - three to five cash registers; and

Peer Group III - - six or more cash registers.

WIC sales figures of new vendors shall be reviewed six months from authorization.  A vendor whose first six months of WIC sales exceed twenty five thousand dollars ($25,000) shall be placed in a peer group in accordance with the dollar thresholds of Item (2) of this Rule.

(2)           Authorized vendors for which annual WIC supplemental food sales are available, excluding chain stores, stores under a WIC corporate agreement, military commissaries, and free-standing pharmacies, shall be placed into peer groups as follows, except as provided in Item (9) of this Rule:

Peer Group I - - two thousand dollars ($2,000) to twenty five thousand dollars ($25,000) annually in WIC supplemental food sales at the store;

Peer Group II - - greater than twenty five thousand dollars ($25,000) but not exceeding seventy five thousand dollars ($75,000) annually in WIC supplemental food sales at the store;

Peer Group III - - greater than seventy five thousand dollars ($75,000) but not exceeding three hundred thousand dollars ($300,000) annually in WIC supplemental food sales at the store; and

Peer Group IV - - greater than three hundred thousand dollars ($300,000) annually in WIC supplemental food sales at the store.

(3)           Chain stores, stores under a WIC corporate agreement (20 or more authorized vendors under one agreement), military commissaries, and free-standing pharmacies, including free-standing pharmacy chain stores and free-standing pharmacies participating under a WIC corporate agreement, shall be placed into peer groups as follows:

Peer Group IV - - chain stores, stores under a WIC corporate agreement (20 or more authorized vendors under one agreement), and military commissaries; and

Peer Group V - - free-standing pharmacies, including free-standing pharmacy chain stores and free-standing pharmacies participating under a WIC corporate agreement.

(4)           "Annual WIC supplemental food sales" is the dollar amount an authorized vendor redeems in WIC food instruments and cash-value vouchers within a 12-month period.

(5)           In determining a vendor's peer group designation based on annual WIC supplemental food sales under Item (2) of this Rule, the state agency shall look at the most recent 12-month period of redemption data.

(6)           The state agency may reassess an authorized vendor's peer group designation at any time during the vendor's agreement period and place the vendor in a different peer group if upon reassessment the state agency determines that the vendor is no longer in the appropriate peer group.

(7)           If the state agency determines that a vendor applicant is expected to be a predominantly WIC vendor as defined in Rule .0202 of this Subchapter, the vendor application shall be denied.  The store must wait 90 days to reapply for vendor authorization.  The state agency shall apply the methodology set forth in 7 CFR 246.12(g)(4)(i)(E) for determining whether a vendor applicant is expected to be a predominantly WIC vendor.

(8)           If at any time during a vendor's authorization the state agency determines that the vendor has become a predominantly WIC vendor as defined in Rule .0202 of this Subchapter, the vendor's WIC Vendor Agreement shall be terminated.  The store must wait 90 days to reapply for vendor authorization.  The state agency shall apply the methodology set forth in 7 CFR 246.12(g)(4)(i)(F) for determining whether an authorized vendor has become a predominantly WIC vendor.

(9)           A vendor applicant previously authorized in a peer group under Item (2) of this Rule that is being reauthorized following the nonrenewal or termination of its agreement or disqualification or withdrawal from the WIC Program shall be placed into the same peer group the vendor applicant was previously in under Item (2) of this Rule, provided that no more than one year has passed since the nonrenewal, termination, disqualification or withdrawal.  If more than one year has passed, the vendor applicant shall be placed into a peer group in accordance with Item (1) of this Rule.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. August 1, 1995; October 1, 1993; May 1, 1991; December 1, 1990;

Temporary Amendment Eff. June 23, 2000; May 17, 2000;

Amended Eff. April 1, 2001;

Temporary Amendment Eff. September 1, 2002; July 1, 2002;

Amended Eff. November 1, 2005; August 1, 2004;

Temporary Amendment Eff. July 1, 2006;

Amended Eff. February 1, 2013; October 1, 2009; February 1, 2008; April 1, 2007.

 

10A NCAC 43D .0707      VENDOR APPLICANTS

To become authorized as a WIC vendor, a vendor applicant shall comply with the following vendor selection criteria:

(1)           A vendor applicant shall complete a WIC Vendor Application, a WIC Price List, as set forth in Item (4) of this Rule, and a WIC Vendor Agreement, as set forth in 7 C.F.R. 246.12(h)(3). A vendor applicant shall submit its current highest shelf price for each WIC supplemental food listed on the WIC Price List, as set forth in Item (4) of this Rule.

(2)           A vendor applicant, at the time of application and throughout the term of authorization, shall submit all completed forms to the local WIC agency, except that a corporate entity operating under a WIC corporate agreement shall submit one completed WIC corporate agreement and the WIC Price Lists to the State agency and a separate WIC Vendor Application for each store to the local WIC agency. A corporate entity operating under a WIC corporate agreement may submit a single WIC Price List for those stores that have the same prices for WIC supplemental foods in each store, rather than submitting a separate WIC Price List for each store.

(3)           A vendor applicant shall purchase all infant formula, exempt infant formula, and WIC-eligible nutritionals directly from:

(a)           The sources specified in 42 U.S.C 1786(h)(8)(A)(ix), which is incorporated by reference with all subsequent amendments and editions;

(b)           Retail food stores that purchase directly from the sources referenced in Sub-item (3)(a) of this Item; or

(c)           A source on another state's list of approved infant formula sources as verified by that state's agency.

A vendor applicant shall make available to the State or local WIC agency invoices or receipts documenting purchases of all infant formula, exempt infant formula, and WIC-eligible nutritionals. Receipts and invoices shall satisfy the requirements of Sub-items (32)(a) through (32)(c) of Rule .0708 of this Section. A vendor applicant shall not be authorized if within the last year the vendor applicant had a previous WIC Vendor Agreement terminated for failure to purchase infant formula, exempt infant formula, or WIC-eligible nutritionals from the sources specified in this Item. A vendor applicant shall not be authorized if within the last year the vendor applicant had a previous WIC Vendor Agreement terminated for providing infant formula, exempt infant formula, or WIC-eligible nutritionals to WIC customers that was not purchased from the sources specified in this Item.

(4)           A vendor applicant's current highest shelf price for each WIC supplemental food listed on the WIC Price List shall not exceed the maximum price set by the State agency for each supplemental food within that vendor applicant's peer group, except as provided in Sub-item (4)(b) of this Item. The maximum price for each supplemental food shall be established as follows:

(a)           The most recent WIC Price Lists submitted by authorized vendors within the same peer group shall be used to determine the maximum price for each supplemental food. The maximum price shall be the 97th percentile of the current highest shelf prices for each supplemental food within a vendor peer group. The State agency shall reassess the maximum price set for each supplemental food at least four times a year. For two of its price assessments, the State agency shall use the WIC Price Lists which shall be submitted by all vendors by April 1 and October 1 each year in accordance with Item (34) of Rule .0708 of this Section. The other two price assessments shall be based on WIC Price Lists requested from a sample of vendors within each peer group in January and July of each year.

(b)           If any of the vendor applicant's price(s) on its WIC Price List exceed the maximum price(s) set by the State agency for that applicant's peer group, the agency shall send the applicant written notice. Within 30 days of the date of the written notice, the vendor applicant may resubmit price(s) that it will charge the State WIC Program for those foods that exceeded the maximum price(s). If none of the vendor applicant's resubmitted prices exceed the maximum prices set by the State agency, the vendor applicant shall be deemed to have met the requirements of Item (4) of this Rule. If any of the vendor applicant's resubmitted prices still exceed the maximum prices set by the State agency, or the vendor applicant does not resubmit prices within 30 days of the date of written notice, the agency shall send the applicant a written notice of denial. The vendor applicant shall wait 90 days from the date of receipt of the written denial to reapply for authorization.

(5)           A vendor applicant shall pass an announced monitoring review by the local WIC agency to determine whether the store has minimum inventory of supplemental foods as specified in Item (25) of Rule .0708 of this Section. A vendor applicant that fails this review shall be allowed a second opportunity for an unannounced monitoring review within 14 days. If the applicant fails both reviews, the application shall be denied in writing and the applicant shall wait 90 days from the date of the second monitoring review before submitting a new application.

(6)           A vendor applicant shall either attend, or cause a manager or another authorized store representative to attend, WIC Vendor Training provided by the local WIC agency prior to vendor authorization and ensure that the vendor applicant's employees receive instruction in WIC program procedures and requirements.

(7)           An applicant shall mark the current shelf prices of all WIC supplemental foods on the foods or have the prices posted on the shelf or display case at all times.

(8)           The store shall be at a single, fixed location within North Carolina. The store shall be located at the address indicated on the WIC vendor application and shall be the site where WIC supplemental foods are selected by the WIC customer.

(9)           A vendor applicant shall use point of sale (POS) terminals to support the WIC Program that are deployed in accordance with the minimum lane coverage provisions of 7 C.F.R. 246.12(z)(2)(ii).

(10)         The store shall be open throughout the year for business with the public at least six days a week for at least 40 hours per week between 8:00 a.m. and 11:00 p.m.

(11)         The store shall not use the acronym "WIC" or the WIC logo, including facsimiles, in total or in part, in the official name under which the business is registered or in the name under which it does business.

(12)         A vendor applicant shall not submit false, erroneous, or misleading information in an application to become an authorized WIC vendor or in subsequent documents submitted to the state or local WIC agency. A vendor applicant shall not be authorized if within the last year the vendor applicant had a previous WIC Vendor Agreement terminated for submitting false, erroneous, or misleading information.

(13)         The owner(s), officer(s), or manager(s) of a vendor applicant shall not be employed, or have a spouse, child, or parent who is employed by the State WIC program, or the local WIC program serving the county where the vendor applicant conducts business. A vendor applicant shall not have an employee who handles, transacts, deposits, or stores WIC food instruments or cash-value vouchers who is employed, or has a spouse, child, or parent who is employed by the State WIC program or the local WIC program serving the county where the vendor applicant conducts business. Such situations present a conflict of interest.

(14)         WIC vendor authorization shall be denied if in the last six years any of the vendor applicant's current owners, officers, or managers have been convicted of or had a civil judgment entered against them for any activity indicating a lack of business integrity, including fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims, and obstruction of justice, as set out in 7 C.F.R 246.12(g)(3)(ii). For purposes of this Item, "convicted" or "conviction" includes:

(a)           a plea of guilty;

(b)           a verdict or finding of guilt by a jury, judge, magistrate, or adjudicating body, tribunal, or official, either civilian or military;

(c)           a plea of no contest, nolo contendere, or the equivalent; or

(d)           entry of a prayer for judgment continued following a conviction as defined in this Item is the same as a conviction for purposes of this Item.

(15)         A vendor applicant shall not be authorized if it is currently disqualified from the Supplemental Nutrition Assistance Program ("SNAP") or it has been assessed a SNAP civil money penalty for hardship and the disqualification period that otherwise would have been imposed has not expired.

(16)         A vendor applicant, excluding chain stores and stores under a WIC corporate agreement that have a separate manager on site for each store, shall not have an owner who holds a financial interest in any of the following:

(a)           a SNAP vendor that is disqualified from participation in the SNAP or has been assessed a civil money penalty for hardship in lieu of disqualification and the time period during which the disqualification would have run, had a penalty not been paid, is continuing; or

(b)           another WIC vendor that is disqualified from participation in the WIC Program or has been assessed a monetary or civil money penalty pursuant to G.S. 130A-22(c1), Paragraph (e) or Paragraph (f) of Rule .0710 of this Section as the result of violation of Paragraphs (a) or (b) of Rule .0710 of this Section and if assessed a penalty, the time during which the disqualification would have run, had a penalty not been assessed, is continuing.

The requirements of this Item shall not be met by the transfer or conveyance of financial interest during the period of disqualification. Additionally, the requirements of this Item shall not be met even if such transfer or conveyance of financial interest in a SNAP vendor under Sub-item (16)(a) of this Item prematurely ends the disqualification period applicable to that SNAP vendor. The requirements of this Item shall apply until the time the SNAP vendor disqualification otherwise would have expired.

(17)         A vendor applicant, excluding free-standing pharmacies, shall have SNAP authorization for the store as a prerequisite for WIC vendor authorization and shall provide its SNAP authorization number to the State agency.

(18)         A vendor applicant shall not become authorized as a WIC vendor if the store has been disqualified from participation in the WIC Program and the disqualification period has not expired. A vendor applicant shall not be authorized as a WIC vendor if any of the vendor applicant's owner(s), officer(s) or manager(s) currently has or previously had a financial interest in a WIC vendor that was assessed a claim by the WIC Program and the claim has not been paid in full.

(19)         A vendor applicant shall enter into contract with the State WIC Program's EBT processor or a third party processor certified according to criteria established by the State WIC Program's EBT processor prior to WIC authorization and comply with all requirements detailed in the EBT or third party processor's Vendor Agreement.

For a food retailer or free-standing pharmacy to participate in the WIC Program, a current WIC Vendor Agreement must be signed by the vendor, the local WIC agency, and the State agency. If an application for status as an authorized WIC vendor is denied, the applicant is entitled to an administrative appeal as described in Section .0800 of this Subchapter.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246; 7 C.F.R. 246.12(g)(3); 7 C.F.R. 246.12(g)(3)(ii); 7 C.F.R. 246.12(h)(3)(xix); 7 C.F.R. 246.12(t); 42 U.S.C. 1786;

Eff. February 1, 2013;

Amended Eff. October 1, 2017.

 

10A NCAC 43D .0708      AUTHORIZED VENDORS

By signing the WIC Vendor Agreement, the vendor agrees to:

(1)           Process WIC Program food instruments and cash-value vouchers in accordance with the terms of the WIC Vendor Agreement and 42 U.S.C. 1786, 7 C.F.R. 246.1-246.28, and the rules of this Subchapter;

(2)           Accept WIC Program food instruments and cash-value vouchers in exchange for WIC supplemental foods. Supplemental foods are those foods that satisfy the requirements of 10A NCAC 43D .0501;

(3)           Provide only the authorized supplemental foods listed on the printed food instrument, or authorized fruits and vegetables with a printed cash-value voucher. Determine the charges to the WIC Program and complete the "Pay Exactly" box on the printed food instrument, or printed cash-value voucher, as set forth in Item (4) of this Rule, prior to obtaining the signature of the WIC customer. When transacting EBT, the vendor shall provide to the WIC customer only the approved supplemental foods, fruits, and vegetables contained in the authorized product list (APL) after it has been determined that the WIC customer has an available balance on the date of the transaction. The WIC customer is not required to get all of the supplemental foods listed on the printed food instrument or the full dollar value of the printed cash-value voucher. However, a WIC customer may obtain more fruits and vegetables than the full dollar value of a cash-value voucher if the WIC customer pays the difference, as set forth in 7 C.F.R. 246.12(h)(3)(xi);

(4)           Enter in the "Pay Exactly" box on the printed food instrument or printed cash-value voucher only the total amount of the current shelf prices, or less than the current shelf prices, for the supplemental food provided and shall not charge or collect sales taxes for the supplemental food provided. Vendors that utilize EBT shall only transmit the current shelf price of all WIC-approved supplemental foods purchased in the correct sizes, quantities, and the total dollar amount of all WIC-approved supplemental foods purchased in the EBT system;

(5)           Charge no more for supplemental food provided to a WIC customer than to a non-WIC customer or no more than the current shelf price, whichever is less;

(6)           Accept payment from the State WIC Program only up to the maximum price set by the State agency for each supplemental food within that vendor's peer group. The maximum price for each supplemental food shall be based on the maximum prices set by the State agency for each supplemental food, as described in Sub-item (4)(a) of Rule .0707 of this Section, listed on the food instrument. A request for payment submitted over the maximum price allowed by the State agency will only be paid up to the maximum price for that supplemental food;

(7)           Accept payment from the State WIC Program only up to the full dollar value of the cash-value voucher;

(8)           Not charge the State WIC Program more than the maximum price set by the State agency under Item (4)(a) of Rule .0707 of this Section for each supplemental food within the vendor's peer group;

(9)           Provide to WIC customers infant formula, exempt infant formula, and WIC eligible nutritionals purchased only from the sources specified in Item (3) of Rule .0707 of this Section. Providing infant formula, exempt infant formula, or WIC eligible nutritionals that has not been purchased from the sources specified in Item (3) of Rule .0707 of this Section shall result in termination of the WIC Vendor Agreement;

(10)         For free-standing pharmacies, provide only exempt infant formula and WIC-eligible nutritionals;

(11)         Excluding free-standing pharmacies, redeem at least two thousand dollars ($2,000) annually in WIC supplemental food sales. Failure to redeem at least two thousand dollars ($2,000) annually in WIC supplemental food sales shall result in termination of the WIC Vendor Agreement. The store must wait 180 days to reapply for authorization;

(12)         Accept WIC Program food instruments and cash-value vouchers only on or between the "First Date to Spend" and the "Last Date to Spend" dates;

(13)         Prior to obtaining the WIC customer's signature on the printed food instrument and cash-value voucher, enter in the "Date Transacted" box the month, day, and year the WIC food instrument or cash-value voucher is exchanged for supplemental food;

(14)         Ensure that the WIC customer signs the food instrument or cash-value voucher in the presence of the cashier. Vendors that utilize EBT shall ensure that a personal identification number (PIN) is used by the WIC customer to complete the EBT transaction in lieu of a signature;

(15)         Ensure that the WIC customer enters the PIN to initiate the EBT transaction. The vendor shall not enter the PIN for the WIC customer;

(16)         Refuse to transact any food instrument or cash-value voucher that has been altered;

(17)         Not transact food instruments or cash-value vouchers in whole or in part for cash, credit, unauthorized foods, or non-food items;

(18)         Not provide refunds or permit exchanges for authorized supplemental foods obtained with food instruments or cash-value vouchers, except for exchanges of an identical authorized supplemental food when the original authorized supplemental food is defective, spoiled, or has exceeded its "sell by," "best if used by," or other date limiting the sale or use of the food. An "identical authorized supplemental food" means the exact brand, type and size as the original authorized supplemental food obtained and returned by the WIC customer;

(19)         Imprint the authorized WIC vendor stamp in the "Pay the Authorized WIC Vendor Stamped Here" box on the face of the printed food instrument or cash-value voucher to enable the vendor number to be read during the WIC Program's editing process;

(20)         Imprint the vendor's bank deposit stamp or the vendor's name, address, and bank account number in the "Authorized WIC Vendor Stamp" box in the endorsement on the printed food instrument or cash-value voucher;

(21)         Deposit WIC program printed food instruments and cash-value vouchers in the vendor's bank. All North Carolina WIC program printed food instruments and cash-value vouchers must be deposited in the vendor's bank within 60 days of the "First Date to Spend" on the printed food instrument or cash-value voucher;

(22)         Ensure that the authorized WIC vendor stamp is used only for the purpose and in the manner authorized by the Agreement and be responsible for the unauthorized use of the authorized WIC vendor stamp;

(23)         Maintain storage of the authorized WIC vendor stamp so only the staff designated by the vendor owner or manager have access to the stamp and report loss of this stamp within two business days to the local WIC agency;

(24)         Notify the local WIC agency of misuse (attempted or actual) of WIC Program food instruments or cash-value vouchers;

(25)         Maintain a minimum inventory of supplemental foods in the store for purchase. Supplemental foods that are outside of the manufacturer's expiration date do not count towards meeting the minimum inventory requirement. The following items and sizes constitute the minimum inventory of supplemental foods for vendors in Peer Groups I through III of Item (1), vendors in Vendor Peer Groups I through IV of Item (2), and vendors in Vendor Peer Group IV of Item (3) of Rule .0706 of this Section:

 

Food Item

Type of Inventory

Quantities Required

Milk

Whole fluid: gallon

-and-

Skim/lowfat fluid: gallon

2 gallons

 

4 gallons

Cheese

1 pound package

2 packages

Cereals

2 types: whole grain

(minimum package size 12 ounce)

6 packages total

Eggs

Grade A, large, white:

1 dozen size carton

2 dozen

Juices

Single strength:

48 ounce container

64 ounce container

 

4 containers

4 containers

Dried Peas and Beans

1 pound package

2 packages

Peanut Butter

16 to 18 ounce container

2 containers

Tuna

5 to 6 ounce can

6 cans

Bread/Tortillas

16 ounce loaf of bread or package of tortillas

2 loaves or 2 packages OR 1 loaf and 1 package

Rice

14 to 16 ounce package

2 packages

Infant Cereal

8 ounce box

6 boxes

Infant Fruits and Vegetables

3.5 to 4 ounce container

1 type of fruit and 1 type of vegetable

64 ounces

Infant Formula

milk-based powder; 11.0 to 14.0 ounce

-and-

soy-based powder; 11.0 to 14.0 ounce

Brands must be the primary contract infant formulas

 

8 cans

 

4 cans

 

 

Fruits

14 to 16 ounce can: 2 varieties

10 cans total

Vegetables

(Excludes foods in Dried Peas and Beans category)

14 to 16 ounce can: 2 varieties

10 cans total

All vendors in Vendor Peer Groups I through III of Item (1), Peer Groups I through IV of Item (2), and Vendor Peer Groups IV and V of Item (3) of Rule .0706 of this Section shall supply milk, soy-based or lactose-free infant formula in 32 ounce ready-to-feed or lactose-free powder within 48 hours of request by the State or local WIC agency;

(26)         Ensure that all supplemental foods in the store for purchase are within the manufacturer's expiration date;

(27)         Permit the purchase of supplemental food without requiring other purchases;

(28)         Comply with the following EBT provisions:

(a)           Sign the WIC Vendor Agreement of the EBT Processor selected by the State WIC Program or a third-party processor that has been certified according to criteria established by the EBT Processor selected by the State WIC Program. Failure by a vendor to sign and retain a WIC Vendor Agreement with the State WIC Program's EBT Processor or a third-party processor that has been certified by the State WIC Program's EBT Processor shall result in termination of the WIC Vendor Agreement. Vendors shall notify the WIC Program within 24 hours of any periods of time during which they do not maintain an Agreement with the state WIC Program's EBT Processor or a third-party processor that has been certified by the State WIC Program's EBT Processor;

(b)           Process EBT transactions in accordance with the terms of the North Carolina WIC Vendor Agreement, WIC Program State Rules, federal regulations, and statutes;

(c)           Maintain Point of Sale (POS) terminals used to support the WIC Program in accordance with the minimum lane provisions of 7 C.F.R. 246.12(z)(2);

(d)           Maintain a North Carolina EBT Processor certified in-store EBT system that is available for WIC redemption processing during all hours the store is open;

(e)           Request the North Carolina EBT Processor re-certify its in-store system if the vendor alters or revises the system in any manner that impacts the EBT redemption or claims processing system after initial certification is completed;

(f)            For vendors with integrated systems, obtain EBT card readers to support EBT transactions within their store(s). The vendor shall ensure that the EBT card readers they obtain meets all EBT and North Carolina EBT Processor requirements;

(g)           Require an owner, manager or other authorized store representative to complete training on WIC EBT procedures. The vendor shall ensure that all cashiers and staff are fully trained on WIC EBT requirements, including training in the acceptance and processing of WIC EBT transactions;

(h)           Require the WIC customer to approve the WIC transaction. Vendors shall ensure that the vendor's staff does not approve the WIC transactions for WIC customers under any circumstances;

(i)            Release supplemental food to WIC customers when the transaction has been completed to include receipt of transaction approval by the EBT processing system, printing of the receipt, and updated balance of the WIC customer's account;

(j)            Scan or manually enter Universal Product Codes (UPC) only from approved supplemental foods being purchased by the WIC customer in the types, sizes and quantities available on the WIC customer's EBT account. The vendor shall not scan codes from UPC codebooks or reference sheets;

(k)           Return any EBT card found on the vendor's property and unclaimed for 24 hours to the WIC Program. The vendor shall not hold or use a WIC customer's EBT card and PIN for any purpose whatsoever;

(l)            Connect the vendor's in-store system for each outlet covered by the WIC Vendor agreement to the State's WIC EBT system at least once each 24-hour period to download reconciliation files and the WIC Authorized Product UPC/Product Look-Up (PLU) list.

(29)         Attend, or cause a manager or other authorized store representative to attend, annual vendor training upon notification by the local WIC agency. Failure to attend annual vendor training by September 30 of each year shall result in termination of the WIC Vendor Agreement;

(30)         Inform and train vendor's cashiers and other staff on WIC Program requirements;

(31)         Be accountable for the actions of its owners, officers, managers, agents, and employees who commit vendor violations;

(32)         Allow monitoring and inspection by State and local WIC Program staff of the store premises and procedures to ensure compliance with the agreement and State, and federal WIC Program rules, regulations, and applicable law. This includes providing access to all program-related records, including access to all WIC food instruments and cash-value vouchers at the store; vendor records pertinent to the purchase and sale of WIC supplemental foods, including invoices, receipts, copies of purchase orders, and any other proofs of purchase; federal and state corporate and individual income tax and sales and use tax returns and all records pertinent to these returns; and books and records of all financial and business transactions. These records must be retained by the vendor for a period of three years or until any audit pertaining to these records is resolved, whichever is later. Notwithstanding any other provision of this Rule and Rules .0707 and .0710 of this Section, failure or inability to provide these records for an inventory audit or providing false records for an inventory audit shall be deemed a violation of 7 C.F.R. 246.12(l)(1)(iii)(B) and Subparagraph (a)(1) of Rule .0710 of this Section. Invoices, receipts, purchase orders, and any other proofs of purchase for WIC supplemental foods shall include:

(a)           the name of the seller and be prepared entirely by the seller without alteration by the vendor or on the seller's business letterhead;

(b)           the date of purchase and the date the authorized vendor received the WIC supplemental food at the store if different from the date of purchase; and

(c)           a description of each WIC supplemental food item purchased, including brand name, unit size, type or form, and quantity;

(33)         Maintain a record of all SNAP-eligible food sales and provide to the State agency upon request a statement of the total amount of revenue derived from SNAP-eligible food sales and written documentation to support the amount of sales claimed by the vendor, such as sales records, financial statements, reports, tax documents or other verifiable documentation;

(34)         Submit a current completed WIC Price List when signing this agreement, and by April 1 and October 1 of each year. The vendor also agrees to submit a WIC Price List within two weeks of any written request by the State or local WIC agency;

(35)         Reimburse the state agency in full or agree to a repayment schedule with the state agency within 30 days of written notification of a claim assessed due to a vendor violation that affects payment to the vendor or a claim assessed due to the unauthorized use of the WIC vendor stamp. Failure to reimburse the State agency in full or agree to a repayment schedule within 30 days of written notification of a claim shall result in termination of the WIC Vendor Agreement. The state agency shall deny payment or assess a claim in the amount of the full purchase price of each food instrument or cash-value voucher invalid under Subparagraphs (a)(2), (a)(5), (a)(6) or (a)(7) of Rule .0704 of this Section. Denial of payment by the State agency or payment of a claim by the vendor for a vendor violation(s) shall not absolve the vendor of the violation(s). The vendor shall also be subject to any vendor sanctions authorized under Rule .0710 of this Section for the vendor violation(s);

(36)         Not seek restitution from the WIC customer for reimbursement paid by the vendor to the State agency or for WIC food instruments or cash-value vouchers not paid or partially paid by the state agency. Additionally, the vendor shall not charge the WIC customer for authorized supplemental foods obtained with food instruments or cash-value vouchers;

(37)         Not contact a WIC customer outside the store regarding the transaction or redemption of WIC food instruments or cash-value vouchers;

(38)         Notify the local WIC agency in writing at least 30 days prior to a change of ownership, change in store location, cessation of operations, or withdrawal from the WIC Program. Change of ownership, change in store location of more than three miles from the store's previous location, cessation of operations, withdrawal from the WIC Program, or disqualification from the WIC Program shall result in termination of the WIC Vendor Agreement by the State agency. Change of ownership, change in store location, ceasing operations, withdrawal from the WIC Program, or nonrenewal of the WIC Vendor Agreement shall not stop a disqualification period applicable to the store;

(39)         Return the authorized WIC vendor stamp to the local WIC agency upon termination of the WIC Vendor Agreement or disqualification from the WIC Program;

(40)         Not discriminate on the basis of WIC participation, such as failing to offer WIC customers the same courtesies, as set forth in 7 C.F.R. 246.12(g)(3)(iii), offered to other customers or requiring separate WIC lines;

(41)         Reapply to continue to be authorized beyond the period of its current WIC Vendor Agreement. Additionally, a store shall reapply to become authorized following the expiration of a disqualification period or termination of the Agreement. In all cases, the vendor applicant is subject to the vendor peer group criteria of Rule .0706 of this Section and the vendor selection criteria of Rule .0707 of this Section; and

(42)         Comply with all the requirements for vendor applicants of Items (3), (4), and (7) through (17), and (19) of Rule .0707 of this Section throughout the term of authorization. The State agency may reassess a vendor at any time during the vendor's period of authorization to determine compliance with these requirements. The State agency shall terminate the WIC Vendor Agreement of any vendor that fails to comply with Items (3), (4), (8), (9), (10), (11), (12), (13), (14), (16), (17), or (19) of Rule .0707 of this Section during the vendor's period of authorization, and terminate the agreement of or sanction or both any vendor that fails to comply with Items (7), (15), (17),or (19) of Rule .0707 of this Section during the vendor's period of authorization.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. March 1, 2013;

Amended Eff. October 1, 2017.

 

10A NCAC 43D .0709      LOCAL WIC AGENCY

By signing the WIC Vendor Agreement, the local WIC agency agrees to the following:

(1)           Provide annual vendor training on WIC procedures and rules;

(2)           Conduct routine monitoring, as set forth in 7 C.F.R. 246.2 and 7 C.F.R. 246.12(j)(2), of the vendor's performance under the agreement to ensure compliance with the agreement and state and federal WIC program rules, regulations, and applicable law.  A minimum of one-third of all authorized vendors shall be monitored within a fiscal year (October 1 through September 30) and all vendors shall be monitored at least once within three consecutive fiscal years.  Any vendor shall be monitored within one week of written request by the state agency;

(3)           Provide vendors with the North Carolina WIC Vendor Manual, all Vendor Manual amendments, blank WIC Price Lists, and the authorized WIC vendor stamp indicated on the signature page of the WIC Vendor Agreement; and

(4)           Assist the vendor with questions which may arise under the agreement or through the vendor's participation in the WIC Program.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. February 1, 2013.

 

10A NCAC 43D .0710      VENDOR VIOLATIONS AND SANCTIONS

(a)  Title 7 C.F.R. 246.12(l)(1)(i) through (vi) and (xii) are incorporated by reference with all subsequent amendments and editions.  In accordance with 7 C.F.R. 246.12(l)(1)(i), the state agency shall not allow imposition of a civil money penalty in lieu of disqualification for a vendor permanently disqualified.  A pattern, as referenced in 7 CFR 246.12 (l)(1)(iii)(B) through (F) and 246.12(l)(1)(iv)(A), shall be established as follows:

(1)           claiming reimbursement for the sale of an amount of a specific supplemental food item which exceeds the store's documented inventory of that supplemental food item for six or more days within a 60-day period.  The six or more days do not have to be consecutive days within the 60-day period.  Failure or inability to provide records or providing false records required under Item (30) of Rule .0708 for an inventory audit shall be deemed a violation of 7 C.F.R. 246.12(l)(1)(iii)(B) and this Subparagraph;

(2)           two occurrences of vendor overcharging within a 12-month period;

(3)           two occurrences of receiving, transacting or redeeming food instruments or cash-value vouchers outside of authorized channels, including the use of an unauthorized vendor or an unauthorized person within a 12-month period;

(4)           two occurrences of charging for supplemental food not received by the WIC customer within a 12-month period;

(5)           two occurrences of providing credit or non-food items, other than alcohol, alcoholic beverages, tobacco products, cash, firearms, ammunition, explosives, or controlled substances as defined in 21 U.S.C. 802, in exchange for food instruments or cash-value vouchers within a 12-month period; or

(6)           three occurrences of providing unauthorized food items in exchange for food instruments or cash-value vouchers, including charging for supplemental food provided in excess of those listed on the food instrument within a 12-month period.

(b)  Title 7 C.F.R. 246.12(l)(2)(i) is incorporated by reference with all subsequent amendments and editions.  Except as provided in 7 C.F.R. 246.12 (l)(1)(xii), a vendor shall be disqualified from the WIC Program for the following state-established violations in accordance with the number of occurrences and sanctions set forth below: 

(1)           One year for two occurrences within a 12-month period of discrimination on the basis of WIC participation as referenced in Item (38) of Rule .0708.  Each date this violation is detected is a separate occurrence;

(2)           One year for three occurrences within a 12-month period of failure to properly transact a WIC food instrument or cash-value voucher by not completing the date and purchase price on the WIC food instrument or cash-value voucher before obtaining the WIC customer's signature, by not obtaining the WIC customer's signature in the presence of the cashier, or by accepting a WIC food instrument or cash-value voucher prior to the "Issue Date" or after the "Participant Must Use By" dates on the food instrument or cash-value voucher.  Except as provided in 7 C.F.R. 246.12(l)(3)(iv), each improperly transacted food instrument or cash-value voucher is a separate occurrence;

(3)           One year for three occurrences within a 12-month period of requiring a cash purchase to transact a WIC food instrument or cash-value voucher.  Except as provided in 7 C.F.R. 246.12(l)(3)(iv), each transacted food instrument or cash-value voucher requiring a cash purchase is a separate occurrence;

(4)           270 days for three occurrences within a 12-month period of contacting a WIC customer in an attempt to recoup funds for a food instrument or cash-value voucher or contacting a WIC customer outside the store regarding the transaction or redemption of a WIC food instrument or cash-value voucher. Each contact with any WIC customer is a separate occurrence, whether each contact is with the same or different WIC customers;

(5)           180 days for three occurrences within a 12-month period of failure to provide program-related records referenced in Item (30) of Rule .0708 when requested by WIC staff, except as provided in Item (30) of Rule .0708 and Subparagraph (a)(1) of this Rule for failure or inability to provide records for an inventory audit.  Each request for records is a separate occurrence, whether each request is for the same or different records;

(6)           180 days for three occurrences within a 12-month period of failure to provide the information referenced in Item (31) of Rule .0708 when requested by WIC staff.  Each request for information is a separate occurrence, whether each request is for the same or different information;

(7)           180 days for three occurrences within a 12-month period of failure to stock the minimum inventory specified in Item (24) of Rule .0708.  Each date this violation is detected is a separate occurrence;

(8)           90 days for three occurrences within a 12-month period of stocking WIC supplemental foods outside of the manufacturer's expiration date.  Each date this violation is detected is a separate occurrence;

(9)           90 days for three occurrences within a 12-month period of failure to allow monitoring of a store by WIC staff.  Each attempt to monitor the store is a separate occurrence;

(10)         90 days for five occurrences within a 12-month period of failure to submit a WIC Price List as required by Item (32) of Rule .0708.  Each written request by the state or local WIC agency for submission of a WIC Price List is a separate occurrence, whether each request is for the same or different WIC Price Lists;

(11)         60 days for three occurrences within a 12-month period of failure to mark the current shelf prices of all WIC supplemental foods on the foods or have the prices posted on the shelf or display case.  Each date this violation is detected is a separate occurrence; and

(12)         60 days for five occurrences within a 12-month period of requiring the purchase of a specific brand when more than one WIC supplemental food brand is available.  Except as provided in 7 C.F.R. 246.12(l)(3)(iv), each transacted food instrument or cash-value voucher requiring the purchase of a specific brand when more than one WIC supplemental food brand is available is a separate occurrence.

If during the course of a single investigation the state agency determines that a vendor has committed multiple state-established violations, the disqualification periods shall be cumulative, provided that the total period of disqualification shall not exceed one year for state-established violations investigated as part of a single investigation, as defined in Paragraph (c) of this Rule.

(c)  For investigations pursuant to this Section, a single investigation is:

(1)           Compliance buy(s) conducted by undercover investigators within a 12-month period to detect the following violations:

(A)          buying or selling food instruments or cash-value vouchers for cash (trafficking);

(B)          selling firearms, ammunition, explosives, or controlled substances as defined in 21 U.S.C. 802, in exchange for food instruments or cash-value vouchers;

(C)          selling alcohol or alcoholic beverages or tobacco products in exchange for food instruments or cash-value vouchers;

(D)          vendor overcharging;

(E)           receiving, transacting, or redeeming food instruments or cash-value vouchers outside of authorized channels, including the use of an unauthorized vendor or an unauthorized person;

(F)           charging for supplemental food not received by the WIC customer;

(G)          providing credit or non-food items, other than alcohol, alcoholic beverages, tobacco products, cash, firearms, ammunition, explosives, or controlled substances as defined in 21 U.S.C. 802, in exchange for food instruments or cash-value vouchers;

(H)          providing unauthorized food items in exchange for food instruments or cash-value vouchers, including charging for supplemental food provided in excess of those listed on the food instrument;

(I)            failure to properly transact a WIC food instrument or cash-value voucher;

(J)            requiring a cash purchase to transact a WIC food instrument or cash-value voucher; or

(K)          requiring the purchase of a specific brand when more than one WIC supplemental food brand is available.

(2)           Monitoring reviews of a vendor conducted by WIC staff within a 12-month period which detect the following violations:

(A)          failure to stock the minimum inventory specified in Item (24) of Rule .0708;

(B)          stocking WIC supplemental food outside of the manufacturer's expiration date;

(C)          failure to allow monitoring of a store by WIC staff;

(D)          failure to provide program-related records referenced in Item (30) of Rule .0708 when requested by WIC staff; 

(E)           failure to mark the current shelf prices of all WIC supplemental foods on the foods or have the prices posted on the shelf or display case; or

(F)           unauthorized use of the "WIC" acronym or the logo.

(3)           Any other method used by the state or local agency to detect the following violations by a vendor within a 12-month period:

(A)          failure to attend annual vendor training;

(B)          failure to submit a WIC Price List as required by Item (32) of Rule .0708;

(C)          discrimination on the basis of WIC participation as referenced in Item (38) of Rule .0708.

(D)          contacting a WIC customer in an attempt to recoup funds  for food instruments or cash-value vouchers or contacting a WIC customer outside the store regarding the transaction or redemption of WIC food  instruments or cash-value vouchers;

(E)           nonpayment of a claim assessed by the state agency;

(F)           providing false, erroneous, or misleading information to the state or local WIC agency;

(G)          claiming reimbursement for the sale of an amount of a specific supplemental food item which exceeds the store's documented inventory of that supplemental food item for a specific period of time, or failure or inability to provide records or providing false records required under Item (30) of Rule .0708 for an inventory audit;

(H)          failure to purchase infant formula, exempt infant formula or WIC-eligible medical foods from the sources specified in Item (3) of Rule .0707; or

(I)            providing WIC customers infant formula, exempt infant formula, or WIC eligible medical food that was not purchased from the sources specified in Item (3) of Rule .0707.

(d)  The SNAP disqualification provisions in 7 C.F.R. 246.12(l)(1)(vii) are incorporated by reference with all subsequent amendments and editions.

(e)  The participant access provisions of 7 C.F.R. 246.12(l)(1)(ix) and 246.12(l)(8) are incorporated by reference with all subsequent amendments and editions.  The existence of any of the factors listed in Parts (f)(3)(A), (f)(3)(B) or (f)(3)(C) of this Rule shall conclusively show adequate participant access provided there is no geographic barrier, such as an impassable mountain or river, to using the other authorized WIC vendors referenced in these Parts.  The agency shall not consider other indicators of inadequate participant access when any of these factors exist.

(f)  The following provisions apply to monetary and civil money penalties assessed in lieu of disqualification of a vendor:

(1)           The civil money penalty formula in 7 C.F.R. 246.12(l)(l)(x) is incorporated by reference with all subsequent amendments and editions, provided that the vendor's average monthly redemptions shall be calculated by using the six-month period ending with the month immediately preceding the month during which the notice of administrative action is dated.

(2)           The state agency may also impose monetary penalties in accordance with G.S. 130A-22(c1) in lieu of disqualification of a vendor for the state-established violations listed in Paragraph (b) of this Rule when the state agency determines that disqualification of a vendor would result in participant hardship in accordance with Subparagraph (f)(3) of this Paragraph.

(3)           In determining whether to disqualify a WIC vendor for the state-established violations listed in Paragraph (b) of this Rule, the agency shall not consider other indicators of hardship if any of the following factors, which conclusively show lack of hardship, are found to exist:

(A)          the noncomplying vendor is located outside of the limits of a city, as defined in G.S. 160A-2, and another WIC vendor is located within seven miles of the noncomplying vendor;

(B)          the noncomplying vendor is located within the limits of a city, as defined in G.S. 160A-2, and another WIC vendor is located within three miles of the noncomplying vendor; or

(C)          a WIC vendor, other than the noncomplying vendor, is located within one mile of the local agency at which WIC participants pick up their food instruments or cash-value vouchers.

(4)           The provisions for failure to pay a civil money penalty in 7 C.F.R. 246.12(l)(6) are incorporated by reference with all subsequent amendments and editions.  These provisions also apply to a vendor that fails to pay a monetary penalty imposed under G.S. 130A-22(c1). 

(g)  The provisions of 7 C.F.R. 246.12(l)(1)(viii) prohibiting voluntary withdrawal from the WIC Program or nonrenewal of the WIC Vendor Agreement as an alternative to disqualification are incorporated by reference with all subsequent amendments and editions.

(h)  The provisions of 42 USC 1786 (f)(26) and 7 CFR 246.12(l)(3) regarding vendor notification of violations are incorporated by reference with all subsequent amendments and editions.

(i)  The state agency may offset payments to an authorized vendor if the vendor fails to reimburse the state agency in accordance with Item (33) of Rule .0708.

(j)  In accordance with 7 C.F.R. 246.12(l)(7) or 246.12(u)(5) or both, North Carolina's procedures for dealing with abuse of the WIC program by authorized WIC vendors do not exclude or replace any criminal or civil sanctions or other remedies that may be applicable under any federal or state law.

(k)  Notwithstanding other provisions of this Rule and Rules .0707 and .0708, for the purpose of providing a one-time payment to a non-authorized store for WIC food instruments or cash-value vouchers accepted by the store, an agreement for a one-time payment need only be signed by the store manager and the state agency.  The store may request such one-time payment directly from the state agency.  The store manager shall sign an agreement indicating that the store has provided foods as prescribed on the food instrument or as allowed with the cash-value voucher, charged current shelf prices or less than current shelf prices, not charged sales tax, and verified the identity of the WIC customer.  Any agreement entered into in this manner shall automatically terminate upon payment of the food instruments or cash-value vouchers.  After entering into an agreement for a one-time payment, a non-authorized store shall not be allowed to enter into any further one-time payment agreements for WIC food instruments or cash-value vouchers accepted thereafter.

(l) Except as provided in 7 C.F.R. 246.18(a)(2), an authorized WIC vendor shall be given at least 15 days advance written notice of any adverse action which affects the vendor's participation in the WIC Program.  The vendor appeal procedures shall be in accordance with 10A NCAC 43D .0800.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246; 42 U.S.C. 1786;

Eff. February 1, 2013.

 

SECTION .0800 ‑ WIC PROGRAM ADMINISTRATIVE APPEALS

 

10A NCAC 43D .0801      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43D .0802      APPEALS

(a)  The appeal provisions for vendors and local agencies found in 7 C.F.R. 246.18(a), (b)(1) and (b)(9) are incorporated by reference with all subsequent amendments and editions.  The appeal procedures in 7 C.F.R. 246.18(b)(1) and (b)(9) shall apply to the adverse actions listed in 7 C.F.R. 246.18(a)(1)(i), (a)(1)(ii) and (a)(3)(i).

(b)  All administrative appeals under this Section shall be made in accordance with G.S. 150B and G.S. 130A-24.

 

History Note:        Authority G.S. 130A-361; 7 C.F.R. 246.18; 42 USC 1786;

Eff. July 1, 1981;

Amended Eff. July 1, 1987; July 1, 1986; July 1, 1983; July 1, 1982;

Temporary Amendment Eff. May 17, 2000;

Amended Eff. April 1, 2001;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10a ncac 43d .0803      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43D .0804      CONTINUATION OF PARTICIPATION

Except as provided in 42 U.S.C. 1786(o)(2) and 7 C.F.R. 246.18(a)(2) and (a)(3)(iii), the participation of a local WIC agency or authorized WIC vendor in the WIC program may continue during an administrative appeal.  Except as provided in 42 U.S.C. 1786(o)(2) and 7 C.F.R. 246.18(a)(2) and (a)(3)(iii), the adverse action shall become effective upon issuance of a final agency decision pursuant to G.S. 150B-36 which upholds the adverse action.

 

History Note:        Authority G.S. 130A‑361; 7 C.F.R. 246.18; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. July 1, 1986;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0805      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43D .0806      CONTINUING RESPONSIBILITIES

An appeal shall not relieve the local agency or authorized WIC vendor that is permitted to continue Program operations while its appeal is in process from the responsibility of continued compliance with the terms of any written agreement or contract with the state or local agency and WIC Program rules, regulations, and law.

 

History Note:        Authority G.S. 130A‑361; 7 C.F.R. 246.18; 42 U.S.C. 1786;

Eff. July 1, 1981;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

SECTION .0900 ‑ WIC PROGRAM PARTICIPANT FAIR HEARINGS

 

10A NCAC 43D .0901      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43D .0902      GENERAL CONDITIONS

(a)  This Section shall be carried out in accordance with 7 C.F.R. 246.9 and G.S. 150B‑22.  The fair hearing procedures set out in this Section establish an informal dispute resolution process which must be complied with prior to making a formal appeal in accordance with G.S. 150B.

(b)  For the purposes of this Section, agency official shall mean the Branch Head of the Nutrition Services Branch or his or her designee.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. December 6, 1991; November 1, 1990; July 1, 1987;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0903      AVAILABILITY

Any individual may appeal a state or local agency action which results in a claim against the individual for repayment of the cash value of improperly issued Program benefits or results in the individual's denial of participation or disqualification from the WIC Program by requesting a fair hearing.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. November 1, 1990;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0904      NOTIFICATION OF THE RIGHT TO A FAIR HEARING

(a)  Every current or potential WIC participant shall be informed by the local WIC agency of his or her right to a fair hearing:

(1)           in writing at the time of application;

(2)           in writing whenever he or she is determined ineligible;

(3)           in writing if disqualified due to abuse of the program;

(4)           in writing at the time of assessment of a claim for repayment of the cash value of improperly issued Program benefits; and

(5)           orally or in writing at least 15 days before the expiration of each certification period.

(b)  The content of the notice of fair hearing shall include:

(1)           a statement of the right to a fair hearing;

(2)           the method by which a fair hearing may be requested, including the time limit; and

(3)           who may represent the individual.

(c)  In order to notify current and potential participants of the fair hearing process, a simplified summary of the steps involved in obtaining a fair hearing shall be posted in a visible place at every WIC site where certifications are performed, food instruments are issued or applications are accepted.  This notification shall contain:

(1)           notice of right to a fair hearing;

(2)           a simplified explanation of the definition and purpose of a fair hearing;

(3)           the method by which a fair hearing may be requested, including the time limit; and

(4)           who may represent the individual at the fair hearing and in requesting a fair hearing.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0905      REQUEST FOR A FAIR HEARING

(a)  A request for a fair hearing is any expression that conveys a desire to present a case contesting an action that results in an individual's denial of participation, or disqualification from the program or a claim against an individual for repayment of the cash value of improperly issued Program benefits.  This request may be made to any of the following:

(1)           the agency official;

(2)           the agency director of the local WIC agency;

(3)           the WIC director of the local WIC agency;

(4)           any person serving in one of the above three roles in the absence of the agency official, agency director or WIC director.

(b)  If the request is not made directly to the agency official, the individual receiving the request shall immediately notify the agency official of the request by telephone.

(c)  All requests shall be documented in writing.

(1)           If the original request is made in writing, the individual receiving the request shall retain a photocopy and send the original to the agency official immediately following the telephone call.

(2)           If a verbal request is received, the individual receiving the request shall document the request in writing, including:

(A)          the applicant's or participant's name;

(B)          the name of the individual making the request:

(i)            their mailing address;

(ii)           telephone number; and

(iii)          relation to the applicant or participant;

(C)          the date of the request; and

(D)          the cause for the request along with the name, title, and signature of the person writing the documentation.

The original copy of this documentation shall be sent to the agency official immediately following the telephone call with a copy being retained by the sender.

(d)  The request for a fair hearing may be made by the individual affected by the action or the individual's parent, caretaker, or any other person acting on his or her behalf.

(e)  If an individual or an individual's parent, caretaker, or any other person acting on his or her behalf expresses verbally the desire for a fair hearing to a state or local agency staff member not authorized to accept a request, that staff member shall provide assistance in contacting the individuals who can accept a fair hearing request.

(f)  The request for a fair hearing must be made within 60 days from the date the applicant or participant is given notice of the action.  If the notification is mailed, this time period shall begin on the date the notification was mailed.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. November 1, 1990;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0906      DENIAL OR DISMISSAL OF A REQUEST

The hearing officer shall deny or dismiss a hearing if:

(1)           the request is not received within 60 days of the date of notification of the action;

(2)           the request is withdrawn in writing by the appellant or his or her representative;

(3)           the request is verbally withdrawn by the appellant or the appellant's parent, caretaker, or any other person acting on his or her behalf during conversation with the agency Official. Within 10 days of this verbal withdrawal request the agency official shall send a letter to the appellant and the local WIC agency summarizing the events which lead to the withdrawal of the request.  This letter shall include notification of the appellant's right to reinstate the request for a fair hearing;

(4)           the appellant or the appellant's parent, caretaker, or any other person acting on his or her behalf fails to appear at the scheduled hearing, unless the failure to appear was due to circumstances beyond the control of the appellant or his or her representative;

(5)           the request is made in reference to the tailoring of the food package; or

(6)           the initial action assessing a claim for the cash value of improperly issued Program benefits or denying participation or disqualifying from the program has been reversed by the local WIC agency or the state agency, resulting in the provision of program benefits to the appellant.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. November 1, 1990;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0907      CONTINUATION OF BENEFITS

(a)  WIC program benefits shall be continued during the appeal of the following actions when the request for a hearing is received within 15 days of notification of the action:

(1)           disqualification from the program for abuse during a certification period;

(2)           determination of ineligibility during a certification period due to categorical ineligibility or residential ineligibility; or

(3)           other terminations during a certification period.

(b)  WIC program benefits shall not be continued when a fair hearing is requested:

(1)           in any of the situations in Paragraph (a) of this Rule if the request is made more than 15 days after the date of notification; or

(2)           by applicants who are denied benefits at the initial or subsequent determination of WIC eligibility if the previous certification period has expired.

(c)  When benefits are continued due to a request for a fair hearing as specified above, the individual shall continue to receive benefits until an adverse hearing decision is reached or the certification period expires, whichever occurs first.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0908      NOTICE OF HEARING

(a)  The agency official shall notify the aggrieved party, the local WIC agency and the Nutrition Services Branch in writing that a request for a hearing has been received and shall appoint a time, date, and place for the hearing within 10 days of receipt of the request.

(b)  Notice shall be given to all parties at least 10 days in advance of the hearing.

(c)  The notice to the aggrieved party shall include a stamped envelope with the return address of the agency official with a request that it be returned indicating whether the time and place for the hearing is satisfactory.  If a response is not received at least 24 hours prior to the time proposed for the hearing, it shall be assumed that the time and place are satisfactory.

(d)  The notice shall contain:

(1)           a simplified explanation of the procedure for the hearing;

(2)           a statement of the date, hour, place and nature of the hearing;

(3)           a reference to the particular sections of the statutes and rules involved; and

(4)           a short and plain statement of the factual allegations.

(e)  If the aggrieved party indicates that he‑she desires another time and date, the agency official shall set a new time and date for the hearing.  The hearing shall be accessible to the appellant.

(f)  The hearing shall be held within three weeks from the date of the receipt of the request.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. November 1, 1990;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0909      HEARING OFFICER

The Director of the Division of Public Health shall designate a representative who did not participate in taking the action under appeal to be the hearing officer.  The hearing officer shall:

(1)           preside over the informal proceeding;

(2)           ensure that all relevant issues are considered;

(3)           request, receive and insert into the hearing record all evidence determined necessary to reach a decision;

(4)           conduct the meeting in accordance with due process and ensure an orderly hearing;

(5)           order, if relevant and necessary, an independent medical assessment or professional evaluation for the appellant from a source mutually satisfactory to all parties to the hearing; and

(6)           issue a decision.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. July 1, 1995; July 1, 1987;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0910      HEARING PROCEDURE AND RIGHTS OF THE AGGRIEVED PARTY

(a)  Any party to the hearing may be assisted or represented by an attorney or other person.

(b)  Any party to the hearing may examine, prior to and during the hearing, the documents and records presented to support the action under appeal.

(c)  The hearing shall be open to the public, and the aggrieved party and the state and local agency may have witnesses.

(d)  Any party to the hearing may present any oral or documentary evidence and arguments.

(e)  Any party to the hearing may question or refute any testimony or other evidence.

(f)  Any party to the hearing may submit evidence to establish pertinent facts and circumstances in the case.

(g)  The appellant or his or her representative may obtain a continuance by notifying the hearing officer by telephone or in writing at least 48 hours before the original hearing date.  If the appellant or representative fails to attend the scheduled hearing without requesting a continuance from the hearing officer by telephone or in writing at least 48 hours before the original hearing date, the appellant waives any right to a hearing and the original action of the agency shall become final, unless the failure to attend the hearing without requesting a continuance was due to circumstance beyond the control of the appellant or his or her representative.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. July 1, 1987; October 1, 1985;

Temporary Amendment Eff. July 1 2002;

Amended Eff. July 1, 2004.

 

10A NCAC 43D .0911      DECISION

(a)  The fair hearing decision shall be made by the hearing official and shall be based only on the oral and documentary evidence presented at the hearing and applicable state statutes and rules, and federal laws and regulations and shall be made a part of the hearing record by the hearing officer.

(b)  The hearing official shall notify in writing the aggrieved party, any designated representative of the aggrieved party, the local WIC agency and the Nutrition Services Branch of the decision within 45 days from the date of the request for the hearing.

(c)  If the decision is in favor of the aggrieved party and benefits were denied or discontinued, benefits shall begin within two business days after issuance of the decision.

(d)  If the decision is in favor of the agency, as soon as administratively feasible any continued benefits shall be terminated as decided by the hearing official.

(e)  The hearing officer shall prepare a recording of testimony and exhibits, or an official report containing the substance of what transpired at the hearing which, together with all papers and requests filed in the proceeding and the written fair hearing decision, shall constitute the exclusive hearing record.

(f)  The decision shall be binding on the local WIC agency.

(g)  All hearing records shall be retained for three years.

(h)  Upon request by any member of the public a copy of all hearing records and decisions in a form that does not identify individuals (appellant or local agency) shall be prepared by the Nutrition Services Branch and be available for inspection and copying.

 

History Note:        Authority G.S. 130A‑361; 150B‑22; 7 C.F.R. 246.9; 42 U.S.C. 1786;

Eff. July 1, 1981;

Amended Eff. December 6, 1991;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. July 1, 2004.

 

section .1000 - CONSULTATION SERVICES

 

10A NCAC 43D .1001      ADMINISTRATION

 

History Note:        Authority G.S. 130A‑361; 42 U.S.C. 1761;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. December 6, 1991; November 1, 1990;

Repealed Eff. October 1, 2009.

 

10A NCAC 43D .1002      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43D .1003      PUBLIC HEALTH DIETITIANS

10A NCAC 43D .1004      NUTRITION PROGRAM CONSULTANTS

 

History Note:        Authority G.S. 130A‑361;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. July 1, 1985;

Repealed Eff. October 1, 2009.

 

SECTION .1100 ‑ RESERVED FOR FUTURE CODIFICATION

 

SECTION .1200 ‑ MATERNAL AND CHILD HEALTH BLOCK GRANT NUTRITION PROGRAM

 

10A NCAC 43D .1201      GENERAL

10A NCAC 43D .1202      PROVIDER ELIGIBILITY

10A NCAC 43D .1203      ALLOCATION OF FUNDS

10A NCAC 43D .1204      CLIENT ELIGIBILITY

10A NCAC 43D .1205      SCOPE OF SERVICES

10A NCAC 43D .1206      SERVICE PROVIDER QUALIFICATIONS

10A NCAC 43D .1207      PAYMENT FOR REIMBURSABLE SERVICES

 

History Note:        Authority G.S. 130A-361;

Eff. October 1, 1993;

Repealed Eff. July 1, 2014.

 

 

 

SUBCHAPTER 43E ‑ CHILD HEALTH

 

SECTION .0100 ‑ SCHOOL HEALTH FUNDS

 

10A NCAC 43E .0101      GENERAL

10A NCAC 43E .0102      ALLOCATION OF FUNDS

10A NCAC 43E .0103      BUDGETING OF FUNDS

10A NCAC 43E .0104      CLIENT ELIGIBILITY

10A NCAC 43E .0105      USE OF SCHOOL HEALTH FUNDS

10A NCAC 43E .0106      AUTHORIZATION AND REIMBURSEMENT

10A NCAC 43E .0107      MONITORING AND EVALUATION

 

History Note:        Authority G.S. 130A‑124;

Eff. July 1, 1984;

Amended Eff. February 1, 1990;

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

SECTION .0200 ‑ KINDERGARTEN HEALTH ASSESSMENTS

 

10A NCAC 43E .0201      HEALTH ASSESSMENTS

10A NCAC 43E .0202      REPORTING

 

History Note:        Authority G.S. 130A‑440; 130A-441; 130A‑443;

Eff. January 1, 1988;

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

 

SECTION .0300 ‑ PEDIATRIC PRIMARY CARE PROGRAM

 

10A NCAC 43E .0301      GENERAL

10A NCAC 43E .0302      DEFINITIONS

10A NCAC 43E .0303      PROVIDER ELIGIBILITY

10A NCAC 43E .0304      CLIENT ELIGIBILITY

10A NCAC 43E .0305      APPLICATION FOR FUNDS: PROGRAM PLAN: RENEWAL

10A NCAC 43E .0306      BUDGETING OF GRANT FUNDS

10A NCAC 43E .0307      MEDICAL RECORDS

10A NCAC 43E .0308      CLIENT AND THIRD PARTY FEES

10A NCAC 43E .0309      MONITORING AND EVALUATION

 

History Note:        Authority G.S. 130A-124;

Eff. April 1, 1985;

Amended Eff. December 1, 1990; September 1, 1990; August 1, 1987; April 1, 1987; February 1, 1987;

Repealed Eff. July 1, 2014.

 

SECTION .0400 - Early Childhood Vision Care Program

 

10A NCAC 43E .0401      GENERAL

10A NCAC 43E .0402      COVERED SERVICES

10A NCAC 43E .0403      ELIGIBILITY

10A NCAC 43E .0404      APPLICATIONS FOR PROGRAM SERVICES

10A NCAC 43E .0405      REIMBURSEMENT TO PROVIDERS

 

History Note:        Authority G.S. 130A-440.1; 143B-216.75;

Temporary Adoption Eff. November 1, 2007;

Temporary Adoption Expired August 11, 2008.

 

 

 

SUBCHAPTER 43F ‑ CHILDREN'S SPECIAL HEALTH SERVICES:

CHILDREN AND YOUTH SECTION

 

SECTION .0100 ‑ GENERAL PROVISIONS

 

10A NCAC 43F .0101       PURPOSE

10A NCAC 43F .0102       DEFINITIONS

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. October 1, 1993; September 1, 1990; July 1, 1986; July 1, 1984; July 1, 1980;

Repealed Eff. July 1, 2014.

 

SECTION .0200 ‑ GENERAL POLICIES

 

10A NCAC 43F .0201       REFERRAL AND FOLLOW‑UP

10A NCAC 43F .0202       RELEASE OF MEDICAL INFORMATION

10A NCAC 43F .0203       OUT‑OF‑STATE CARE

10A NCAC 43F .0204       SPONSORED CLINICS

10A NCAC 43F .0205       PARTICIPATING PHYSICIANS, ORTHODONTISTS AND PROSTHODONTISTS

10A NCAC 43F .0206       NEW CLINIC DIRECTORS AND NEW CLINICS

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; November 1, 1989; August 1, 1988; July 1, 1986; July 1, 1984; April 1, 1981; July 1, 1980;

Repealed Eff. July 1, 2014.

 

10A NCAC 43F .0207       SPEECH AND LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS

 

History Note:        Authority G.S. 130A-124;

Eff. July 1, 1980;

Amended Eff. September 1, 1990; July 1, 1986; July 1, 1984; December 1, 1980;

Repealed Eff. July 1, 2014.

 

SECTION .0300 ‑ ELIGIBILITY

 

10A NCAC 43F .0301       DETERMINATION

10A NCAC 43F .0302       AGE

10A NCAC 43F .0303       MEDICAL CONDITIONS SUPPORTED BY THE PROGRAM

10A NCAC 43F .0304       MEDICAL CONDITIONS OR PROCEDURES NOT SUPPORTED

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; July 1, 1986; January 1, 1982; July 1, 1981; July 1, 1980;

Repealed Eff. July 1, 2014.

 

10A NCAC 43F .0305       APPEALS PROCEDURE CONCERNING ELIGIBILITY

 

History Note:        Authority G.S. 130A-124;

Eff. July 1, 1980;

Amended Eff. September 1, 1990; February 1, 1987; July 1, 1986;

Repealed Eff. July 1, 2014.

 

SECTION .0400 ‑ SERVICES

 

10A NCAC 43F .0401       CLINIC SERVICES

10A NCAC 43F .0402       OTHER OUTPATIENT SERVICES

10A NCAC 43F .0403       HOSPITALS

10A NCAC 43F .0404       HOSPITALIZATION

10A NCAC 43F .0405       SPECIAL THERAPY

10A NCAC 43F .0406       ORTHODONTIC AND PROSTHODONTIC DENTAL CARE

10A NCAC 43F .0407       APPLIANCES AND EQUIPMENT

10A NCAC 43F .0408       DRUGS

10A NCAC 43F .0409       BLOOD

10A NCAC 43F .0410       STAFF CONSULTANT AND ADVISORY SERVICES

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; August 1, 1988; July 1, 1986; July 1, 1984; April 1, 1984; October 1, 1983; July 1, 1983; January 1, 1982; July 1, 1981; April 1, 1981; July 1, 1980;

Repealed Eff. July 1, 2014.

 

SECTION .0500 ‑ AUTHORIZATION AND BILLING PROCEDURES

 

10A NCAC 43F .0501       AUTHORIZATION POLICIES

10A NCAC 43F .0502       SERVICE AUTHORIZATION

10A NCAC 43F .0503       CANCELLATIONS

10A NCAC 43F .0504       SPECIAL THERAPY REQUESTS

10A NCAC 43F .0505       BILLING POLICIES

10A NCAC 43F .0506       PHYSICIANS' BILLING POLICIES

10A NCAC 43F .0507       OTHER PROFESSIONAL SERVICES

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; July 1, 1986; July 1, 1984; April 1, 1984; April 1, 1982; July 1, 1981; December 1, 1980; July 1, 1980;

Repealed Eff. July 1, 2014.

 

10A NCAC 43F .0508       CLINIC CHARGES AND OUTPATIENT CHARGES

10A NCAC 43F .0509       CLERICAL CHARGES

10A NCAC 43F .0510       AUTHORIZED HOSPITALIZATION

10A NCAC 43F .0511       AUTHORIZED APPLIANCES

10A NCAC 43F .0512       AUTHORIZED DRUGS FOR OUTPATIENTS

 

History Note:        Authority G.S. 130A-124;

Eff. July 1, 1980;

Amended Eff. September 1, 1990; July 1, 1986; April 1, 1982; July 1, 1981; December 1, 1980;

Repealed Eff. July 1, 2014.

 

10A NCAC 43F .0513       REIMBURSEMENT RATES

 

History Note:        Authority G.S. 130A-124;

Temporary Rule Eff. August 15, 1982, for a Period of 120 Days to Expire on December 12, 1982;

Eff. October 1, 1982;

Amended Eff. July 1, 1986;

Repealed Eff. July 1, 2014.

 

10A NCAC 43F .0514       APPEALS PROCEDURE

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1987;

Repealed Eff. July 1, 2014.

 

SECTION .0600 ‑ FORMS

 

10A NCAC 43F .0601       REQUESTS FOR FORMS

10A NCAC 43F .0602       REQUEST FORM FOR COST SERVICES

10A NCAC 43F .0603       FINANCIAL ELIGIBILITY FORM

10A NCAC 43F .0604       FORMS FOR DENIAL OF REQUESTS FOR SERVICE

10A NCAC 43F .0605       CLINIC NOTES FORM

10A NCAC 43F .0606       CLINIC RECORD

10A NCAC 43F .0607       CLERICAL SERVICES

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; July 1, 1986; July 1, 1984; April 1, 1982; July 1, 1980;

Repealed Eff. July 1, 2014.

 

SECTION .0700 ‑ ROSTERS

 

10A NCAC 43F .0701       QUALIFICATIONS

10A NCAC 43F .0702       FURTHER INFORMATION

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. April 1, 1992; January 1, 1990; June 1, 1989; July 1, 1986; July 1, 1980;

Repealed Eff. July 1, 2014.

 

10A NCAC 43F .0703       APPEALS PROCEDURE

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1987;

Repealed Eff. July 1, 2014.

 

10A NCAC 43F .0704       ADMINISTRATIVE REQUIREMENTS

 

History Note:        Authority G.S. 130A-124;

Eff. June 1, 1989;

Amended Eff. September 1, 1990;

Repealed Eff. July 1, 2014.

 

SECTION .0800 ‑ ADOPTION

 

10A NCAC 43F .0801       GENERAL PROVISION

10A NCAC 43F .0802       REQUIREMENTS FOR THE ADOPTIVE CHILD

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. January 4, 1993; June 1, 1990; July 1, 1986; July 1, 1981; July 1, 1980;

Repealed Eff. July 1, 2014.

 

10A NCAC 43F .0803       RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43F .0804       APPLICATION FOR COVERAGE AFTER ADOPTION

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. January 4, 1993; July 1, 1986; July 1, 1980;

Repealed Eff. July 1, 2014.

 

SECTION .0900 ‑ AGREEMENTS WITH OTHER AGENCIES

 

10A NCAC 43F .0901       AGREEMENT WITH VOCATIONAL REHABILITATION

 

History Note:        Authority G.S. 130A-124;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. July 1, 1986; July 1, 1980;

Repealed Eff. July 1, 2014.

 

SECTION .1000 ‑ CHILDREN'S SPECIAL HEALTH CONTRACT FUNDS

 

10A NCAC 43F .1001       OUTPATIENT CLINIC SERVICES

10A NCAC 43F .1002       DEFINITIONS

10A NCAC 43F .1003       PROVIDER ELIGIBILITY

10A NCAC 43F .1004       CLIENT ELIGIBILITY

10A NCAC 43F .1005       SCOPE OF SERVICES

10A NCAC 43F .1006       ALLOCATION OF FUNDS: CONTRACT

10A NCAC 43F .1007       REPORTING REQUIREMENTS

10A NCAC 43F .1008       CLIENT AND THIRD PAR TY FEES

10A NCAC 43F .1009       APPLICATION FOR FUNDS

10A NCAC 43F .1010       BUDGETING OF GRANT FUNDS

10A NCAC 43F .1011       ANNUAL PLAN

10A NCAC 43F .1012       RENEWAL OF GRANT FUNDS

 

History Note:        Authority G.S. 130A-124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990; November 1, 1988; August 1, 1988; July 1, 1986;

Repealed Eff. July 1, 2014.

 

SECTION .1100 ‑ NORTH CAROLINA HEMOPHILIA ASSISTANCE PLAN

 

10A NCAC 43F .1101       GENERAL

10A NCAC 43F .1102       ALLOCATION OF FUNDS

10A NCAC 43F .1103       ELIGIBILITY

10A NCAC 43F .1104       PAYMENT LIMITATIONS

10A NCAC 43F .1105       SERVICES

 

History Note:        Authority G.S. 130A‑124;

Eff. January 1, 1982;

Temporary Rule Eff. August 15, 1982, for a Period of 120 Days to Expire on December 12, 1982;

Amended Eff. January 1, 1996; June 1, 1990; July 1, 1986; July 1, 1983;

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

 

SECTION .1200 - NEWBORN SCREENING PROGRAM

 

10A NCAC 43F .1201       GENERAL

The hearing screening component of the Department of Health and Human Services' Newborn Screening Program is administered by the central office staff for Children's Special Health Services. The genetic screening component of the Department's Newborn Screening Program is found in 10A NCAC 43H .0314.

 

History Note:        Authority G.S. 130A‑125;

Temporary Adoption Eff. October 1, 1999;

Eff. August 1, 2000;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10A NCAC 43F .1202       DEFINITIONS

As used in this Section:

(1)           "CSHS" means the Children's Special Health Services Program central office staff;

(2)           "Neonate" means any term infant less than one month of age or any preterm infant less than one month corrected age; and

(3)           "Person" means any natural person, partnership, corporation, unit of government of this State, and any unincorporated organizations.

 

History Note:        Authority G.S. 130A‑125;

Temporary Adoption Eff. October 1, 1999;

Eff. August 1, 2000;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10a ncac 43F .1203       SCREENING REQUIREMENTS

(a)  Medical facilities that provide birthing or inpatient neonatal services shall:

(1)           Physiologically screen each newborn in each ear for the presence of permanent hearing loss before the infant is discharged from the medical facility after birth unless medical complications prevent such; and

(2)           Maintain the equipment necessary to physiologically screen each newborn for the presence of permanent hearing loss.

(b)  Any physician that attends a newborn within 30 days of birth and determines that the newborn has not been physiologically screened in each ear for the presence of permanent hearing loss shall refer the patient for such screening within 30 days of birth or as soon as is practical.

(c)  Parents or guardians may object to the hearing screening in accordance with G.S. 130A-125(b).

(d)  When an attending physician has issued an order that diagnostic auditory evoked response testing be performed for an infant who exhibits medically recognized risk factors of auditory deficits, a hearing screening is not required to be performed on the infant. The outcome of the diagnostic testing procedure shall be reported in accordance with 10A NCAC 43F .1204.

 

History Note:        Authority G.S. 130A-125; S.L. 1998, c. 131, s. 13;

Temporary Adoption Eff. October 1, 1999;

Eff. August 1, 2000;

Amended Eff. August 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

10a ncac 43f .1204       REPORTING REQUIREMENTS

(a)  All persons performing physiologic hearing screenings for infants less than six months of age shall report within five days following the screening (or date of the appointment for the screening) to the North Carolina State Laboratory for Public Health, using forms developed by the Department of Health and Human Services:

(1)           Identifying information (such as name, address, birthdate, mother's name, mother's Social Security number, mother's Medicaid number, birth hospital, physician, county of residence) for each infant, and either

(2)           The outcome of each hearing screening; or

(3)           The date of the missed scheduled appointment for such screening.

Birthing/neonatal facilities shall submit initial hearing screening outcomes simultaneously with each infant's blood specimen for genetic screening, using forms developed by the Department of Health and Human Services.

(b)  All birthing/neonatal facilities performing neonatal physiologic hearing screenings shall report quarterly to the Division of Public Health, using forms developed by the Department of Health and Human Services, within 30 days after the end of each quarter in the calendar year, total unduplicated count of:

(1)           Neonates who were screened;

(2)           Neonates whose parents or guardians objected to the hearing screening;

(3)           Live births, if the report is being submitted by a medical facility;

(4)           Transfers into the facility, not previously screened; and

(5)           Neonates not screened due to transfer out of the facility, NICU complications, missed screening, death or other reasons.

(a)  All persons performing diagnostic auditory evaluations and assessments for selection of amplification for infants less than twelve months of age shall report within five days of the appointment to the North Carolina State Laboratory for Public Health, using forms developed by the Department of Health and Human Services:

(1)           Identifying information (such as name, address, birthdate, mother's name, mother's Social Security number, mother's Medicaid number, birth hospital, physician, county of residence) for each child, and either

(2)           The outcome of the diagnostic evaluation and amplification selection; or

(3)           The date of the missed appointment for such evaluations or assessments.

 

History Note:        Authority G.S. 130A-125;

Temporary Adoption Eff. October 1, 1999;

Eff. August 1, 2000;

Temporary Amendment Eff. January 8, 2001;

Temporary Amendment Expired October 29, 2001;

Temporary Amendment Eff. May 17, 2002;

Amended Eff. April 1, 2003;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. October 3, 2017.

 

 

 

subchapter 43g – developmental evaluation centers:  specialized services Branch

 

section .0100 – General Polices

 

10a NCAC 43G .0101      Administration

10A NCAC 43G .0102      definitions

10A NCAC 43G .0103      location of services

10A NCAC 43G .0104      types of services provided

10A ncac 43g .0105      eligibility for direct services

 

History Note:        Authority G.S. 130A-5(3); 130A-124;

Eff. January 1, 1984;

Amended Eff: September 1, 1990;

Temporary Repeal Eff. July 1, 2006;

Repeal Eff. January 1, 2007.

10A NCAC 43G .0106      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43G .0107      fees

 

History Note:        Authority G.S. 130A-5(3); 130A-124;

Eff. January 1, 1984;

Temporary Repeal Eff. July 1, 2006;

Repealed Eff. January 1, 2007.

 

10A NCAC 43G .0108      ADMINISTRATION

The Department of Health and Human Services shall administer the statewide early intervention program under Federal law, Part C of the Individuals with Disabilities Act (IDEA).

 

History Note:        Authority G.S. 130A‑126;

Temporary Adoption Eff. July 1, 2006;

Adoption Eff. January 1, 2007.

 

10A NCAC 43G .0109      CHILDREN'S DEVELOPMENTAL SERVICES AGENCIES

The Children's Developmental Services Agencies within the Early Intervention Branch shall manage the Early Intervention Program at the local level.  Each Children's Developmental Services Agency shall serve children birth to three years of age who have been referred by parents, community agencies, physicians, or other interested parties for early intervention services.  The Children's Developmental Services Agency shall determine the child's eligibility for the Early Intervention Program.

 

History Note:        Authority G.S. 130A‑126;

Temporary Adoption Eff. July 1, 2006;

Adoption Eff. January 1, 2007;

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

 

10A NCAC 43G .0110      Eligibility

(a)  Children from birth to age three are eligible for early intervention services under the provisions of this subchapter and under Part C of the Individuals with Disabilities Education Act (IDEA) if they have been determined by the Children's Developmental Services Agency to meet the criteria of one of the two following categories:

(1)           developmental delay; or

(2)           established conditions.

(b)  Developmental Delay.

(1)           A child is considered to have developmental delay if the child's development is delayed in one or more of the following areas:

(A)          Cognitive Development;

(B)          Physical Development, including fine and gross motor function;

(C)          Communication Development;

(D)          Social-Emotional Development; or

(E)           Adaptive Development.

(2)           The specific level of delay shall be:

(A)          documented by scores of 2.0 standard deviations below the mean of the composite score (total test score) on standardized tests in at least one of the above areas of development; or

(B)          documented by a 30 percent delay on instruments which determine scores in months in at least one of the above areas of development, or

(C)          documented by scores of 1.5 standard deviations below the mean of the composite score (total test score) on standardized tests in at least two of the above areas of development, or

(D)          documented by a 25 percent delay on instruments which determine scores in months in at least two of the above areas of development.

(c)  Established Conditions.  A child is considered to have an established condition if the child has a diagnosed physical or mental condition which has a high probability of resulting in developmental delay.  Diagnosis may be made by Children's Developmental Services Agency staff or the child's physician.  Specific conditions through which a child shall be deemed eligible in the established conditions category are as follows:

(1)           Congenital Anomaly/Genetic Disorders/Inborn Errors of Metabolism.  These are children diagnosed with one or more congenital abnormalities or genetic disorders with developmental implications.  Some examples are Down Syndrome, Fragile X Syndrome, familial retardation syndromes, and fetal alcohol syndrome.

(2)           Congenital Infections.  These are children diagnosed with congenital infections with developmental implications.  Some examples are toxoplasmosis, rubella, cytomegelovirus, and HIV.

(3)           Autism.  These are children diagnosed with autism or autism spectrum disorders.

(4)           Attachment disorder.  These are children with a diagnosed attachment disorder.

(5)           Hearing Loss.  These are children diagnosed with unilateral or bilateral permanent hearing loss.

(6)           Visual Impairment.  These are children diagnosed with a visual impairment that is not correctable with treatment, surgery, glasses, or contact lenses.

(7)           Neurologic Disease/Central Nervous System Disorders.  These are children diagnosed with a disease or disorder known to affect the nervous system with developmental implications, such as Cerebral Palsy, Spina Bifida, Epilepsy, and Microcephaly.

(8)           Neonatal Conditions and Associated Complications.  These are children diagnosed with one or more of the following neonatal diseases or disorders:

(A)          Gestational age less than 27 weeks or birth weight less than 1000 grams;

(B)          Neonatal encephalopathy with neurological abnormality persisting at discharge from the neonatal intensive care unit.

(C)          Moderate to Severe Ventricular Enlargement at discharge from the neonatal intensive care unit or a ventriculoperitoneal shunt;

(D)          Neonatal seizures, stroke, meningitis, encephalitis, porencephaly, or holoprosencephaly;

(E)           Bronchopulmonary Dysplasia requiring supplemental oxygen at discharge from the neonatal intensive care unit;

(F)           Intrauterine Growth Retardation;

(G)          Necrotizing enterocolitis requiring surgery;

(H)          Abnormal neurological exam at discharge;

(I)            Intraventricular hemorrhage III or IV; or

(J)            Periventricular leukomalacia.

 

History Note:        Authority G.S. 130A‑126;

Temporary Adoption Eff. July 1, 2006;

Adoption Eff. January 1, 2007.

 

10A NCAC 43G .0111      SERVICE PLAN – SERVICE DELIVERY

Once a child is determined eligible for the program, the Children's Developmental Services Agency shall develop a service plan based on the child's needs and the requirements of Part C of the Individuals with Disabilities Education Act (IDEA).  Service provision shall be monitored by the Children's Developmental Services Agency.  The services shall be provided by the following:

(1)           staff of the Children's Developmental Services Agency, or

(2)           agencies or individuals within the community who have executed a provider agreement with the Children's Developmental Services Agency.

 

History Note:        Authority G.S. 130A‑126;

Temporary Adoption Eff. July 1, 2006;

Adoption Eff. January 1, 2007.

 

SECTION .0200 ‑ AGENCY MANAGEMENT PROCEDURES

 

10A NCAC 43G .0201      CENTER‑PROGRAM OPERATIONS MANUAL

10A NCAC 43G .0202      PERSONNEL MANAGEMENT

10A NCAC 43G .0203      SAFETY

10A NCAC 43G .0204      ANNUAL PROGRAM PLANNING AND PERFORMANCE EVALUATION

10A NCAC 43G .0205      INTEGRATION OF SERVICES WITH LOCAL COMMUNITIES

10A NCAC 43G .0206      FORMS

 

History Note:        Authority G.S. 130A‑5(3); 130A‑124;

Eff. January 1, 1984;

Amended Eff. September 1, 1990;

Temporary Repeal Eff. July 1, 2006;

Repealed Eff. January 1, 2007.

 

SECTION .0300 ‑ SERVICE PROVISIONS

 

10A NCAC 43G .0301      CLINICAL ASSESSMENT SERVICES

10A NCAC 43G .0302      TREATMENT AND CLIENT/FAMILY INSTRUCTION SERVICES

10A NCAC 43G .0303      CASE MANAGEMENT SERVICES

10A NCAC 43G .0304      SCREENING SERVICES

10A NCAC 43G .0305      CASE‑SPECIFIC TECHNICAL ASSISTANCE SERVICES

 

History Note:        Authority G.S. 130A‑5(3); 130A‑124;

Eff. January 1, 1984;

Amended Eff. September 1, 1990;

Temporary Repeal Eff. July 1, 2006;

Repealed Eff. January 1, 2007.

 

SECTION .0400 – RECORD-KEEPING: CONFIDENTIALITY OF CLIENT INFORMATION

 

10A NCAC 43G .0401      CONFIDENTIALITY

10A NCAC 43G .0402      INFORMATION FROM OTHER AGENCIES

10A NCAC 43G .0403      OWNERSHIP OF RECORDS

10A NCAC 43G .0404      SECURITY OF RECORDS

10A NCAC 43G .0405      RIGHT OF ACCESS

10A NCAC 43G .0406      WITHHOLDING INFORMATION FROM THE CLIENT

10A NCAC 43G .0407      CONTESTED INFORMATION

10A NCAC 43G .0408      PROCEDURE OBTAINING PERMISSION FOR RELEASE OF INFORMATION

10A NCAC 43G .0409      DISCLOSURE FOR THE PURPOSE OF RESEARCH

10A NCAC 43G .0410      DISCLOSURE PURSUANT TO A COURT ORDER

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990;

Temporary Repeal Eff. July 1, 2006;

Repealed Eff. January 1, 2007.

 

SECTION .0500 ‑ DEC CONTRACT FUNDS

 

10A NCAC 43G .0501      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43G .0502      DEFINITIONS

10A NCAC 43G .0503      PROVIDER ELIGIBILITY

10A NCAC 43G .0504      CLIENT ELIGIBILITY

10A NCAC 43G .0505      SCOPE OF SERVICES

10A NCAC 43G .0506      ALLOCATION OF FUNDS

10A NCAC 43G .0507      REPORTING REQUIREMENTS

10A NCAC 43G .0508      CLIENT AND THIRD PARTY FEES

10A NCAC 43G .0509      APPLICATION FOR FUNDS

10A NCAC 43G .0510      BUDGETING OF GRANT FUNDS

10A NCAC 43G .0511      ANNUAL PLAN

10A NCAC 43G .0512      RENEWAL OF GRANT FUNDS

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990;

Temporary Repeal Eff. July 1, 2006;

Repealed Eff. January 1, 2007.

 

 

 

SUBCHAPTER 43H ‑ SICKLE CELL SYNDROME: GENETIC COUNSELING:

CHILDREN AND YOUTH SECTION

 

SECTION .0100 ‑ SICKLE CELL SYNDROME PROGRAM

 

10A NCAC 43H .0101      RESERVED FOR FUTURE CODIFICATION

10A NCAC 43H .0102      EDUCATION

 

History Note:        Authority G.S. 130A‑129;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43H .0103      TESTING

(a)  Testing services are made available to individuals requesting these services, especially those in the childbearing age groups.  The division shall provide, without cost, testing and counseling services in conjunction with the local health departments.  Voluntary testing shall not be done without adequate counseling and educational services.

(b)  Testing shall be encouraged by the sickle cell syndrome program on a voluntary individual basis.

 

History Note:        Authority G.S. 130A‑129;

Eff. February 1, 1976;

Amended Eff. April 22, 1977;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; July 1, 1982;

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

 

10A NCAC 43H .0104      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43H .0105      LABORATORY SERVICES

The laboratory services of the state laboratory of public health shall be available only to health departments and local physicians unless otherwise approved by the program.

 

History Note:        Authority G.S. 130A‑129;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43H .0106      FORMS FOR COLLECTING BLOOD

 

History Note:        Authority G.S. 130A‑129;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43H .0107      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43H .0108      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43H .0109      COUNSELING

Adequate follow‑up procedures and counseling techniques shall be provided to patients who have positive test results.

 

History Note:        Authority G.S. 130A‑129;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43H .0110      ELIGIBILITY REQUIREMENTS

(a)  Eligibility requirements for medical services shall be based on income and diagnosis.  In order to be considered for medical services, the individual must be diagnosed as having one of the following disorders:

(1)           sickle cell anemia,

(2)           sickle cell/hemoglobin D disease,

(3)           sickle cell/hemoglobin C disease,

(4)           sickle cell beta thalassemia, or

(5)           sickle cell hemoglobin that coexist with other abnormal hemoglobins with symptomatic abnormal clinical manifestations.

(b)  Financial eligibility for sickle cell syndrome program medical services shall be determined in accordance with rules found in 10A NCAC 45A.

 

History Note:        Authority G.S. 130A‑129;

Eff. February 1, 1976;

Amended Eff. April 22, 1977;

Readopted Eff. December 5, 1977;

Amended Eff. September 1, 1990; July 1, 1981;

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

 

10a ncac 43h .0111      MEDICAL SERVICES COVERED

The following medical services are covered under the N.C. Sickle Cell Syndrome Program if the North Carolina Division of Public Health Sickle Cell Program Supervisor determines that these services are related to sickle cell disease:

(1)           hospital outpatient care including emergency room visits.  The total number of emergency room visits per fiscal year shall not exceed three times the average number of emergency visits per patient over the previous two fiscal years, and it will be adjusted annually on July 1.

(2)           physicians' office visits;

(3)           drugs on a formulary established by the program based upon the following factors: the medical needs of sickle cell patients, the efficacy and cost effectiveness of the drugs, the availability of generic or other less costly alternatives, and the need to maximize the benefits to patients utilizing finite Program dollars.  A copy of this formulary may be obtained free of charge by writing to the N.C. Sickle Cell Syndrome Program, 1929 Mail Service Center, Raleigh, North Carolina, 27699-1929 or on the Purchase of Medical Care Services website at http://www.ncdhhs.gov/control/pomcs/guides/billing_sicklecell.pdf;

(4)           medical supplies and equipment;

(5)           preventive dentistry including education, examinations, cleaning, and X-rays; remedial dentistry including tooth removal, restoration, and endodontic treatment for pain prevention; and emergency dental care to control bleeding, relieve pain, and treat infection; dental care, including:

(a)           preventive dentistry including education, examinations, cleaning, and X-rays;

(b)           remedial dentistry including tooth removal, restoration, and endodontic treatment for pain prevention; and

(c)           emergency dental care to control bleeding, relieve pain, and treat infection;

(6)           eye care (when the Division of Services for the Blind will not provide coverage); and

(7)           the cost of inpatient care per client per year for a maximum of two admissions per fiscal year.

 

History Note:        Authority G.S. 130A-129;

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. August 1, 2000;

Temporary Amendment Eff. December 17, 2001; December 1, 2001;

Amended Eff. April 1, 2003;

Temporary Amendment Eff. January 27, 2004;

Amended Eff. January 1, 2014; October 1, 2006; July 1, 2004;

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

 

10A NCAC 43H .0112      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43H .0113      PROCEDURE FOR REQUESTING SERVICES

(a)  Any provider (physician, hospital, dentist) rendering services to a patient with one of the named disorders may request reimbursement services through the Sickle Cell Syndrome Program.  The request shall be made by completing the appropriate program authorization request form.  The form shall include:

(1)           biographical data of patient;

(2)           diagnoses (primary and secondary);

(3)           provider information including service date(s);

(4)           request and describe service;

(5)           describe and justify treatment or service, list other providers and state drug information if applicable;

(6)           check number services provided for ambulatory visits and answer all questions pertaining to patient's treatment and financial support; and

(7)           signature of physician or dentist, address and date of request.

(b)  A financial eligibility form shall be submitted in accordance with rules found in 10A NCAC 45A.

 

History Note:        Authority G.S.130A-129;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. July 1, 1982; April 1, 1982;

Temporary Amendment Eff. June 19, 1996;

Temporary Amendment Expired on March 11, 1997;

Amended Eff. August 1, 2000;

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

 

10A NCAC 43H .0114      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43H .0115      REIMBURSEMENT

Reimbursement shall be made in accordance with rules found in 10A NCAC 45A.

 

History Note:        Authority G.S. 143B‑193;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. April 1, 1982;

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

 

10A NCAC 43H .0116      CLAIMS FOR REIMBURSEMENT

Claims for payment shall be submitted in accordance with rules found in 10A NCAC 45A.

 

History Note:        Authority G.S. 143B‑193;

Eff. February 1, 1976;

Readopted Eff. December 5, 1977;

Amended Eff. April 1, 1982;

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

 

10A NCAC 43H .0117      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43H .0118      REIMBURSEMENT RATES

Reimbursement rates for the sickle cell syndrome program are found in 10A NCAC 45A .0400.

 

History Note:        Authority G.S. 143B‑193;

Temporary Rule Eff. August 15, 1982, for a period of 120 days to expire on December 12, 1982;

Eff. October 1, 1982;

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

 

SECTION .0200 ‑ SICKLE CELL CONTRACT FUNDS

 

10A NCAC 43H .0201      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43H .0202      DEFINITIONS

The following definitions shall apply throughout this Subchapter:

(1)           "Sickle cell disease" means sickle cell anemia (Hgb.SS), sickle C disease (Hgb.SC), sickle D disease (Hgb.SD), sickle‑Thalassemia (Hgb. S‑Thal), and includes sickle cell hemoglobin that co‑exists with other abnormal hemoglobins with symptomatic abnormal clinical manifestations.

(2)           "Education" means making the general population aware of sickle cell syndrome (i.e., the difference between sickle cell disease and the carrier status of abnormal hemoglobins.)  This term also means educational sessions for provision of sickle cell information to the lay public and medical and non‑medical professionals.

(3)           "Counseling" means a clear communication of the diagnosis, psychological, social, and genetic factors relating to the specific condition.  Counseling also includes information on risk, reoccurrence, and prognosis, and alternatives for prevention and treatment of the condition diagnosed.

(4)           "Counseling follow‑up" means that the initial counseling session was not adequately completed and there is the need to follow‑up with additional counseling session in order to provide the necessary genetic information based on test results.

(5)           "Case management services" means the facilitation and provision of medical, educational, and psychosocial services provided through developing and monitoring individual service care plans.

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43H .0203      PROVIDER ELIGIBILITY

10A NCAC 43H .0204      CLIENT ELIGIBILITY

10A NCAC 43H .0205      SCOPE OF SERVICES

10A NCAC 43H .0206      ALLOCATION OF FUNDS

10A NCAC 43H .0207      REPORTING REQUIREMENTS

10A NCAC 43H .0208      APPLICATION FOR FUNDS

10A NCAC 43H .0209      BUDGET OF CONTRACT FUNDS

10A NCAC 43H .0210      RENEWAL OF CONTRACT FUNDS

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990; December 1, 1987;

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

 

SECTION .0300 ‑ GENETIC HEALTH CARE

 

10A NCAC 43H .0301      GENERAL

The Genetic Health Care Program is administered by the Children and Youth Section.

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43H .0302      RESERVED FOR FUTURE CODIFICATION

 

10A NCAC 43H .0303      DEFINITIONS

10A NCAC 43H .0304      PROVIDER ELIGIBILITY

10A NCAC 43H .0305      CLIENT ELIGIBILITY

10A NCAC 43H .0306      SCOPE OF SERVICES

10A NCAC 43H .0307      ALLOCATION OF FUNDS

10A NCAC 43H .0308      REPORTING REQUIREMENTS

10A NCAC 43H .0309      CLIENT AND THIRD PARTY FEES

10A NCAC 43H .0310      APPLICATION FOR FUNDS

10A NCAC 43H .0311      BUDGETING OF GRANT FUNDS

10A NCAC 43H .0312      ANNUAL REPORT

10A NCAC 43H .0313      RENEWAL OF GRANT FUNDS

 

History Note:        Authority G.S. 130A‑124;

Eff. April 1, 1985;

Amended Eff. September 1, 1990;

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

 

10A NCAC 43H .0314      SUBMISSION OF BLOOD SPECIMENS FOR SCREENING OF NEWBORNS

(a)  The attending physician shall draw a blood specimen for each infant born in North Carolina and shall submit such specimens to the North Carolina State Laboratory for Public Health for testing for the following metabolic and other hereditary and congenital disorders:

(1)           phenylketonuria (PKU);

(2)           galactosemia;

(3)           congenital primary hypothyroidism;

(4)           congenital adrenal hyperplasia (21-hydroxylase deficiency); and

(5)           sickle cell disease.

(b)  Notwithstanding Paragraph (a) of this Rule, parents or guardians may object to screening in accordance with G.S. 130A‑125(b).

(c)  The hearing screening component of the Department's Newborn Screening Program is found in 10A NCAC 43F .1200.

 

History Note:        Authority G.S. 130A‑125;

Eff. April 1, 1992;

Transferred and Recodified from 15A NCAC 21E .0501 Eff. February 10, 1993;

Amended Eff. April 1, 1994;

Temporary Amendment Eff. October 1, 1999;

Amended Eff. August 1, 2000;

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

 

 

 

SUBCHAPTER 43I ‑ SUMMER FOOD SERVICE PROGRAM

 

SECTION .0100 - GENERAL PROVISIONS

 

10A NCAC 43I .0101        INCORPORATION BY REFERENCE: 7 C.F.R. PART 225

Title 7, Code of Federal Regulations, Part 225 is hereby incorporated by reference along with all subsequent amendments and editions.  A copy of 7 C.F.R. Part 225 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 225 may be downloaded and printed from the Internet at http://www.fns.usda.gov/cnd/summer/Administration/Regulations/CFR225.pdf.

 

History Note:        Authority G.S. 130A-29; 130A-361; S.L. 1995, c. 324, s. 17.11; 42 U.S.C. 1761;

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.

 

 

SUBCHAPTER 43J - CHILD AND ADULT CARE FOOD PROGRAM

 

SECTION .0100 - GENERAL PROVISIONS

 

10A NCAC 43J .0101       INCORPORATION BY REFERENCE: 7 C.F.R. PART 226

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.

 

History Note:        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.

 

 

CHAPTER 43 – PERSONAL HEALTH

 

subchapter 43K – newborn screening for critical congenital Heart defects

 

10A NCAC 43K .0101      Definitions

As used in this Section:

(1)           "Neonate" means any term infant less than 28 days of age or any preterm infant less than 28 days corrected age.

(2)           "Infant" means a person who is less than 365 days of age.

(3)           "Critical congenital heart defects" (CCHD) means heart conditions present at birth that are dependent on therapy to maintain patency of the ductus arteriosus for either adequate pulmonary or systemic blood flow and that require catheter or surgical intervention in the first year of life.  Critical congenital heart defects are associated with significant morbidity and mortality and may include hypoplastic left heart syndrome, pulmonary atresia, tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus arteriosus.

(4)           "Medical facility" means a free-standing birthing center, licensed hospital, or licensed ambulatory surgery center where scheduled or emergency births occur or where inpatient neonatal services are provided.

(5)           "Pulse oximetry" means a non-invasive transcutaneous assessment of arterial oxygen saturation using near infrared spectroscopy.  This screening test measures with high reliability and validity the percentage of hemoglobin that is oxygenated, also known as the blood oxygen saturation.

(6)           "Positive screening" means the final result is a failed or abnormal pulse oximetry screening for critical congenital heart defects for a neonate or infant using a screening protocol based on the most current American Academy of Pediatrics and American Heart Association (AAP/AHA) recommendations. This includes neonates or infants who have not yet been confirmed to have critical congenital heart defects or have other conditions to explain abnormal pulse oximetry results.  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.

(7)           "Negative screening" means the final result is a passed or normal pulse oximetry screening for critical congenital heart defects for a neonate or infant using a screening protocol based on the most current AAP/AHA recommendations.

(8)           "Attending providers of the neonate or infant" means the health care providers, such as pediatricians, family physicians, physician assistants, midwives, nurse practitioners, neonatologists, and other specialty physicians, who perform neonatal and infant assessments and review positive and negative pulse oximetry screening results to perform an evaluation and to create a plan of care for the neonate or infant prior to discharge from the care of the health care provider. This includes health care providers who attend to neonates or infants in hospitals, free-standing birthing centers, homes, or other locations.

 

History Note:        Authority G.S. 130A-125;

Temporary Adoption Eff. July 25, 2014;

Eff. April 1, 2015.

10A NCAC 43K .0102      screening requirements

(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.

(b)  Parents or guardians may object to the critical congenital heart defects screening at any time before the screening is performed in accordance with G.S. 130A-125.

(c)  All medical facilities and attending providers of the neonate or infant shall have and implement a written protocol developed by the provider for evaluation and follow up of positive critical congenital heart defect screenings.

(1)           Evaluation and follow up of a positive screening for all neonates shall occur as soon as possible but no later than 24 hours of obtaining a positive screening result.  Evaluation and follow-up shall be in accordance with the most current published recommendations from the American Academy of Pediatrics and American Heart Association (AAP/AHA) which is incorporated by reference including subsequent amendments and editions.  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)           Attending providers of neonates and infants in neonatal intensive care units must have a written protocol developed by the provider for evaluation and follow up of positive screenings in place at their medical facility.

(3)           Options for neonatal or infant echocardiograms may include on-site, telemedicine, or by transfer or referral to an appropriate medical facility with the capacity to perform and interpret a neonatal or infant echocardiogram. Echocardiograms must be interpreted as recommended by the most current recommendations from the AAP/AHA, which are incorporated by reference including subsequent amendments and editions.  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.

 

History Note:        Authority G.S. 130A-125;

Temporary Adoption Eff. July 25, 2014;

Eff. April 1, 2015.

 

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 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.

(b)  Within two weeks of receiving a positive screening, PQCNC shall report the above information from the CCHD database to the NC Birth Defects Monitoring Program using a unique identifier generated by the CCHD database for the neonate or infant.  The unique identifier shall be retained by the source medical facility or attending provider for help with identification of the neonate or infant. 

(c)  All medical facilities and attending providers of neonates or infants performing critical congenital heart defect screening shall report aggregate information described in Subparagraphs (e)(1) through (e)(7) of this Rule quarterly and no later than 15 days after the end of each quarter of the state fiscal year to a statewide CCHD database maintained by the Perinatal Quality Collaborative of North Carolina (PQCNC).

(d)  PQCNC shall report the aggregate information described in Sub-paragraphs (e)(1) through (e)(7) to the NC Birth Defects Monitoring Program within 30 days after the end of each quarter of the state fiscal year.

(e)  The required quarterly aggregate information from medical facilities and attending providers of neonates or infants reported to PQCNC and that PQCNC reports to the NC Birth Defects Monitoring Program shall include the total unduplicated counts of:

(1)           live births;

(2)           neonates and infants who were screened;

(3)           negative screenings;

(4)           positive screenings;

(5)           neonates or infants whose parents or guardians objected to the critical congenital heart defect screenings;

(6)           transfers into the medical facility, not previously screened; and

(7)           neonates and infants not screened and the reasons if known which include a diagnostic echocardiogram being performed after birth and prior to discharge, transfer out of the medical facility before screening, or death .

 

History Note:        Authority G.S. 130A-125;

Temporary Adoption Eff. July 25, 2014;

Eff. April 1, 2015.