State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_122C > GS_122C-81

§ 122C‑81.  Nationalaccreditation benchmarks.

(a)        As used in thissection, the term:

(1)        "Nationalaccreditation" applies to accreditation by an entity approved by theSecretary that accredits mental health, developmental disabilities, andsubstance abuse services.

(2)        "Provider"applies to only those providers of services, including facilities, requiringnational accreditation, which services are designated by the Secretary pursuantto subsection (b) of this section.

(b)        The Secretary,through the Medicaid State Plan, Medicaid waiver, or rules adopted by theSecretary, shall designate the mental health, developmental disabilities, andsubstance abuse services that require national accreditation.

(c)        Providers enrolledwith the Medicaid program prior to July 1, 2008, and providing services thatrequire national accreditation approved by the Secretary pursuant to subsection(b) of this section, shall successfully complete national accreditationrequirements within three years of enrollment with the Medicaid program.Providers shall meet the following benchmarks to ensure continuity of care forconsumers in the event the provider does not make sufficient progress inachieving national accreditation in a timely manner:

(1)        Nine months prior tothe accreditation deadline – Formal selection of an accrediting agency asdocumented by a letter from the agency to the provider acknowledging theprovider's selection of that accrediting agency. A provider failing to meetthis benchmark shall be prohibited from admitting new clients to service. If aprovider fails to meet this benchmark, then the LMEs shall work with theprovider to transfer all the provider's entire case load to another providerwithin four months of the date of the provider's failure to meet the benchmark.The transfer of the case load shall be in increments such that not fewer thantwenty‑five percent (25%) of the provider's total caseload shall betransferred per month. The Department shall terminate the provider's enrollmentin the Medicaid program within four months of the provider's failure to meetthe benchmark.

(2)        Six months prior tothe accreditation deadline – An on‑site accreditation review scheduled bythe accrediting agency as documented by a letter from the agency to thefacility. A provider failing to meet this benchmark will be prohibited fromadmitting new clients to service. If a provider fails to meet this benchmark,then the LMEs shall work with the provider to transfer the provider's entirecase load to another provider within three months of the date of the provider'sfailure to meet the benchmark. The transfer of the case load shall be inincrements such that not fewer than thirty‑three percent (33%) of theprovider's total caseload shall be transferred per month. The Department shallterminate the provider's enrollment in the Medicaid program within three monthsof the provider's failure to meet the benchmark.

(3)        Three months priorto the accreditation deadline – Completion of an on‑site accreditationreview, receipt of initial feedback from accrediting agency, and submission ofa Plan of Correction for any deficiencies noted by the accrediting agency. Aprovider failing to meet this benchmark shall be prohibited from admitting newclients to service. If a provider fails to meet this benchmark, then the LMEsshall work with the provider to transfer the provider's entire case load toanother provider within two months of the date of the provider's failure tomeet the benchmark. The transfer of the case load shall be in increments such thatnot fewer than fifty percent (50%) of the provider's total caseload shall betransferred per month. The Department shall terminate the provider's enrollmentin the Medicaid program within two months of the provider's failure to meet thebenchmark.

(4)        Accreditationdeadline – Approval as fully accredited by the national accrediting agency. Aprovider failing to meet this requirement shall be prohibited from admittingnew clients to service. The LMEs will work with a provider failing to meet thisdeadline to transition clients currently receiving service to other providerswithin 60 days. The Department shall terminate the provider's enrollment in theMedicaid program within 60 days of the provider's failure to meet thebenchmark.

(5)        A provider that hasits enrollment terminated in the Medicaid program as a result of failure tomeet benchmarks for national accreditation or failure to continue to benationally accredited may not apply for re‑enrollment in the Medicaidprogram for at least one year following its enrollment termination.

(d)        Providers enrolledin the Medicaid program or contracting for State‑funded services on orafter July 1, 2008, and providing services which require national accreditationshall successfully complete all accreditation requirements and be awardednational accreditation within one year of enrollment in the Medicaid program orwithin two years following the provider's first contract to deliver a State‑fundedservice requiring national accreditation. Providers providing services thatrequire national accreditation shall be required to discontinue servicedelivery and shall have their Medicaid enrollment and any service contractsterminated if they do not meet the following benchmarks for demonstratingsufficient progress in achieving national accreditation following the date ofenrollment in the Medicaid program or initial contract for State‑fundedservices:

(1)        Three months – On‑siteaccreditation review scheduled by accrediting agency as documented by a letterfrom the agency to the provider and completion of self‑study and self‑evaluationprotocols distributed by the selected accrediting agency.

(2)        Six months – On‑siteaccreditation review scheduled by accrediting agency as documented by a letterfrom the agency to the provider.

(3)        Nine months – Completionof on‑site accreditation review, receipt of initial feedback fromaccrediting agency, plan to address any deficiencies identified developed.

(4)        If a provider'sMedicaid enrollment or service delivery contracts are terminated as a result offailure to meet accreditation benchmarks or failure to continue to benationally accredited, the provider will work with the LME to transitionconsumers served by the provider to other service providers in an orderlyfashion within 60 days of notification by the LME of such failure.

(5)        A provider that hasits Medicaid enrollment or service delivery contracts terminated as a result offailure to meet accreditation benchmarks or failure to continue to benationally accredited may not reapply for enrollment in the Medicaid program orenter into any new service delivery contracts for at least one year followingenrollment or contract termination.  (2008‑107, s. 10.15A(c).)