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Repealed Eff.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Repealed Eff.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Repealed Eff.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Repealed Eff.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Repealed Eff.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
The North Carolina Hemophilia Assistance Plan
(NCHAP) shall be administered by Children's Special Health Services with funds
appropriated by the North Carolina General Assembly to assist individuals with
hemophilia or other congenital bleeding disorders.
History Note: Authority G.S. 130A‑124;
Eff. January 1, 1982;
Amended Eff. January 1, 1996; July 1, 1986.
10A NCAC 43F .1102 ALLOCATION OF FUNDS
(a) NCHAP funds shall be allocated to the
following institutions based upon number of eligible patients that were seen at
the institution during the previous calendar year:
(1) University of North Carolina Hospitals;
(2) North Carolina Baptist Hospital;
(3) Duke University Medical Center;
(4) Eastern Carolina University Medical Center; and,
(5) Carolinas Medical Center.
(b) The institutions listed in Paragraph (a)
of this Rule shall use NCHAP funds to purchase services for individuals in
accordance with the rules of this Section.
History Note: Authority G.S. 130A‑124;
Eff. January 1, 1982;
Amended Eff. January 1, 1996.
10A NCAC 43F .1103 ELIGIBILITY
To be eligible for assistance under NCHAP, an
individual must meet the following requirements:
(1) The individual must be a resident of
North Carolina. For the purposes of this Rule, in order to be a resident of
North Carolina, a person must not only live in the State but also have the
intention of making his permanent home in this State to which, whenever absent,
he intends to return;
(2) The individual must be diagnosed as
having hemophilia or another congenital bleeding disorder;
(3) The individual must seek assistance
in funding care from one of the institutions receiving NCHAP funds.
History Note: Authority G.S. 130A‑124;
Eff. January 1, 1982;
Amended Eff. January 1, 1996.
10A NCAC 43F .1104 PAYMENT LIMITATIONS
(a) Assistance as provided for under this
Section is subject to the availability of NCHAP funds.
(b) Assistance as provided for under this
Section shall be extended only after all third party payments have been made.
NCHAP funds shall be used only for that portion of services not covered by
third party payments. For the purpose of this Rule, third party means any
person or entity that is indirectly liable for the cost of medical or dental
care, appliances, products, or special therapies.
(c) When determining patient eligibility,
institutions receiving NCHAP funds shall require each patient to supply
information concerning third party coverage and to apply for benefits extended
under such coverage. Any patient who either fails to disclose this information
or fails to apply for any third party benefits shall be ineligible for
assistance under this Section.
History Note: Authority G.S. 130A‑124;
Eff. January 1, 1982.
10A NCAC 43F .1105 SERVICES
(a) The following services shall be provided
to patients eligible for assistance under NCHAP:
(1) provision of blood
replacement products; and
(2) provision of other services
related to hemophilia or other congenital bleeding disorders and their
sequelae, and cost of transportation in obtaining this care.
(b) The individual per patient allocation for
services may not exceed the sum of three thousand seven hundred fifty dollars
($3,750) per state fiscal year.
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, 1983.
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.
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.
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.
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.
