chapter 13 – NC medical care commission
subchapter 13A – executive committee
section .0100 – executive committee
10A NCAC 13A .0101EXECUTIVE COMMITTEE
(a) There shall be an executive committee of the North Carolina Medical Care Commission composed of five members of the commission in addition to the chairman and vicechairman of the commission. Three members shall be appointed by a vote of the commission at the December meeting of each odd year and two members shall be appointed by the chairman of the commission at the December meeting of each even year. No member of the executive committee, except the chairman and vicechairman, shall serve more than two twoyear terms in succession. The chairman and vicechairman of the commission shall also be chairman and vicechairman of the executive committee.
(b) The functions of the executive committee shall be to:
(1)transact business in behalf of the commission, consistent with established policy, which in the opinion of the chairman is of such urgency that action is required before the next regularly scheduled commission meeting and the impact of the action would not justify the convening of a special meeting of the commission;
(2)transact business in behalf of the commission when a quorum is not obtained at any commission meeting for which prior notice of at least ten days has been given;
(3)review periodically the activities of the commission and the assignments and recommendations of the various committees for the purpose of developing policy recommendations for commission consideration.
(c) All actions of the executive committee shall be reviewed at the next commission meeting and if disagreement is expressed by a simple majority of the members present and voting at any commission meeting in which a quorum is present, the functions of the executive committee shall be suspended until resolved by later action of the commission.
(d) The initial approval of all projects under the Health Care Facilities Finance Act must be given by a quorum of the full commission.
(e) A quorum of the executive committee shall consist of at least four members of the executive committee.
History Note:Authority G.S. 131A4; 143B165; 143B166;
Eff. January 1, 1989;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 22, 2015.
SECTION .0200 RULEMAKING
10A NCAC 13A .0201PETITIONS
(a) Any person wishing to submit a petition requesting the adoption, amendment or repeal of a rule by the North Carolina Medical Care Commission shall address the petition to Office of the Director, Division of Health Service Regulation, 2701 MailServiceCenter, Raleigh, North Carolina, 27699-2701.
(b) The petition shall contain the following information:
(1)either a draft of the proposed rule or a summary of its contents and the statutory authority for the agency to promulgate the rule;
(2)reason for proposal;
(3)effect on existing rules or orders;
(4)any data supporting the proposal;
(5)effect of the proposed rule on existing practices in the area involved, including cost factors, if known;
(6)names of those most likely to be affected by the proposed rule, with addresses, if known;
(7)name(s) and address(es) of petitioner(s).
(c) The Chairman of the Medical Care Commission will determine, based on a study of the facts stated in the petition, whether the public interest will be served by granting the petition. He will consider all the contents of the submitted petition, plus any additional information he deems relevant.
(d) Within 30 days of submission of the petition, the Chairman will render a final decision. If the decision is to deny the petition, the Chairman will notify the petitioner in writing, stating the reasons for the denial. If the decision is to approve the petition, the Chairman will initiate a rulemaking proceeding by issuing a rulemaking notice, as provided in these rules.
History Note:Authority G.S. 143B165;
Eff. February 1, 1976;
Readopted Eff. December 19, 1977;
Amended Eff. November 1, 1989;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 22, 2015.
10A NCAC 13A .0202RULEMAKING PROCEDURES
(a) The rulemaking procedures for the Secretary of the Department of Health and Human Services codified in 10A NCAC 01 are hereby adopted by reference pursuant to G.S. 150B14(c) to apply to the actions of the Commission, with the following modifications:
(1)Correspondence related to the Commission's rulemaking actions shall be submitted to:
APA/Rule-making Coordinator
Office of the Director
Division of Health Service Regulation
2701 MailServiceCenter
Raleigh, North Carolina27699-2701
(2)The Secretary's designee shall mean the Director of the Division of Health Service Regulation (hereinafter referred to as the Division).
(3)The "Division" shall be substituted for the "Office of General Counsel" in 10A NCAC 01.
(4)"Hearing officer" shall mean the Chairman of the Medical Care Commission or his designee.
(b) Copies of 10A NCAC 01 may be inspected in the Division at the address shown in (a)(1) of this Rule. Copies may be obtained from the Office of Administrative Hearings, 424 North Blount Street, Raleigh, North Carolina, 27601.
History Note:Authority G.S. 143B165; 150B11; 150B14;
Eff. November 1, 1989;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 22, 2015.
10A NCAC 13A .0203DECLARATORY RULINGS
(a) The Commission shall have the power to make declaratory rulings. All requests for declaratory rulings shall be written and submitted to: Chairman, Medical Care Commission, 2701 MailServiceCenter, Raleigh, North Carolina, 27699-2701.
(b) All requests for a declaratory ruling must include the following information:
(1)name and address of the petitioner;
(2)statute or rule to which petition relates;
(3)concise statement of the manner in which petitioner is aggrieved by the rule or statute or its potential application to him;
(4)the consequences of a failure to issue a declaratory ruling.
(c) Whenever the Commission believes for good cause that the issuance of a declaratory ruling will not serve the public interest, it may refuse to issue one. When good cause is deemed to exist, the Commission will notify the petitioner of the decision in writing stating reasons for the denial of a declaratory ruling.
(d) The Commission may refuse to consider the validity of a rule and therefore refuse to issue a declaratory ruling:
(1)unless the petitioner shows that the circumstances are so changed since adoption of the rule that such a ruling would be warranted;
(2)unless the rulemaking record evidences a failure by the agency to consider specified relevant factors;
(3)if there has been similar controlling factual determination in a contested case, or if the factual context being raised for a declaratory ruling was specifically considered upon adoption of the rule being questioned as evidence by the rulemaking record;
(4)if circumstances stated in the request or otherwise known to the agency show that a contested case hearing would presently be appropriate.
(e) Where a declaratory ruling is deemed to be in the public interest, the Commission will issue the ruling within 60 days of receipt of the petition.
(f) A declaratory ruling procedure may consist of written submissions, oral hearings, or such other procedure as may be appropriate in a particular case.
(g) The Commission may issue notice to persons who might be affected by the ruling that written comments may be submitted or oral presentations received at a scheduled hearing.
(h) A record of all declaratory ruling procedures will be maintained for as long as the ruling has validity. This record will contain:
(1)the original request,
(2)reasons for refusing to issue a ruling,
(3)all written memoranda and information submitted,
(4)any written minutes or audio tape or other record of the oral hearing, and
(5)a statement of the ruling.
This record will be maintained in a file at the Director's office at Division of Health Service Regulation, 2701 MailServiceCenter, Raleigh, North Carolina, 27699-2701 and will be available for public inspection during regular office hours.
History Note:Authority G.S. 143B165; 150B-4;
Eff. November 1, 1989;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. March 22, 2015.
subchapter 13b – licensing of hospitals
10a ncac 13B .0100reserved for future codification
Section .0200 – reserved for future codification
10A NCAC 13B .0200Reserved for future codification
section .0300 – reserved for future codification
10A NCAC 13B .0300Reserved for future codification
section .0400 – reserved for future codification
10A NCAC 13B .0400Reserved for future codification
section .0500 – reserved for future codification
10A NCAC 13B .0500Reserved for future codification
section .0600 – reserved for future codification
10A NCAC 13B .0600Reserved for future codification
section .0700 – reserved for future codification
10A NCAC 13B .0700Reserved for future codification
section .0800 – reserved for future codification
10A NCAC 13B .0800Reserved for future codification
section .0900 – reserved for future codification
10A NCAC 13B .0900Reserved for future codification
section .1000 – reserved for future codification
10A NCAC 13B .1000Reserved for future codification
section .1100 – reserved for future codification
10A NCAC 13B .1100Reserved for future codification
section .1200 – reserved for future codification
10A NCAC 13B .1200Reserved for future codification
section .1300 – reserved for future codification
10A NCAC 13B .1300Reserved for future codification
section .1400 – reserved for future codification
10A NCAC 13B .1400Reserved for future codification
section .1500 – reserved for future codification
10A NCAC 13B .1500Reserved for future codification
section .1600 – reserved for future codification
10A NCAC 13B .1600Reserved for future codification
section .1700 – reserved for future codification
10A NCAC 13B .1700Reserved for future codification
section .1800 – reserved for future codification
10A NCAC 13B .1800Reserved for future codification
SECTION .1900 SUPPLEMENTAL RULES FOR THE LICENSURE OF THE SKILLED: INTERMEDIATE: adult care home BEDS IN A HOSPITAL
10A NCAC 13b .1901SUPPLEMENTAL RULES
When a hospital offers nursing facility or adult care home longterm care services, the services shall be included under one hospital license as provided in Rule .0201(c).The general requirements included in this Subchapter shall apply when applicable but in addition the nursing facility care and adult care home care unit must meet the supplemental requirements of this Section.
History Note:Authority G.S. 131E79; 42 U.S.C. 1396 r (a);
Eff. February 1, 1986;
Temporary Amendment Eff. October 1, 1990 For a Period of 142 Days to Expire on February 28, 1991;
Amended Eff. March 1, 1991;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. July 22, 2017.
10A NCAC 13b .1902DEFINITIONS
The following definitions shall apply throughout this Section, unless text otherwise clearly indicates to the contrary:
(1)"Accident" means something occurring by chance or without intention which has caused physical or mental harm to a patient, resident or employee.
(2)"Administer" means the direct application of a drug to the body of a patient by injection, inhalation, ingestion or other means.
(3)"Administrator" means the person who has authority for and is responsible to the governing board for the overall operation of a facility.
(4)"Brain injury longterm care" is defined as an interdisciplinary, intensive maintenance program for patients who have incurred brain damage caused by external physical trauma and who have completed a primary course of rehabilitative treatment and have reached a point of no gain or progress for more than three consecutive months. Services are provided through a medically supervised interdisciplinary process and are directed toward maintaining the individual at the optimal level of physical, cognitive and behavioral functioning.
(5)"Capacity" means the maximum number of patient or resident beds which the facility is licensed to maintain at any given time. This number shall be determined as follows:
(a)Bedrooms shall have minimum square footage of 100 square feet for a single bedroom and 80 square feet per patient or resident in multibedded rooms. This minimum square footage shall not include space in toilet rooms, washrooms, closets, vestibules, corridors, and builtin furniture.
(b)Dining, recreation and common use areas available shall total no less than 25 square feet per bed for skilled nursing and intermediate care beds and no less than 30 square feet per bed for adult care home beds. Such space must be contiguous to patient and resident bedrooms.
(6)"Combination Facility" means any hospital with nursing home beds which is licensed to provide more than one level of care such as a combination of intermediate care and/or skilled nursing care and adult care home care.
(7)"Convalescent Care" means care given for the purpose of assisting the patient or resident to regain health or strength.
(8)"Department" means the North Carolina Department of Health and Human Services.
(9)"Director of Nursing" means the nurse who has authority and direct responsibility for all nursing services and nursing care.
(10)"Dispense" means preparing and packaging a prescription drug or device in a container and labeling the container with information required by state and federal law. Filling or refilling drug containers with prescription drugs for subsequent use by a patient is "dispensing". Providing quantities of unit dose prescription drugs for subsequent administration is "dispensing".
(11)"Drug" means substances:
(a)recognized in the official United States Pharmacopoeia, official National Formulary, or any supplement to any of them;
(b)intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals;
(c)intended to affect the structure or any function of the body of man or other animals, i.e., substances other than food; and
(d)intended for use as a component of any article specified in (a), (b), or (c) of this Subparagraph; but does not include devices or their components, parts, or accessories.
(12)"Duly Licensed" means holding a current and valid license as required under the General Statues of North Carolina.
(13)"Existing Facility" means a licensed facility; or a proposed facility, proposed addition to a licensed facility or proposed remodeled licensed facility that will be built according to plans and specifications which have been approved by the department through the preliminary working drawings stage prior to the effective date of this Rule.
(14)"Exit Conference" means the conference held at the end of a survey, inspection or investigation, but prior to finalizing the same, between the department's representatives who conducted the survey, inspection or investigation and the facility administration representative(s).
(15)"Incident" means an intentional or unintentional action, occurrence or happening which is likely to cause or lead to physical or mental harm to a patient, resident or employee.
(16)"Licensed Practical Nurse" means a nurse who is duly licensed as a practical nurse under G.S. 90, Article 9A.
(17)"Licensee" means the person, firm, partnership, association, corporation or organization to whom a license has been issued.
(18)"Medication" means drug as defined in (12) of this Rule.
(19)"New Facility" means a proposed facility, a proposed addition to an existing facility or a proposed remodeled portion of an existing facility that is constructed according to plans and specifications approved by the department subsequent to the effective date of this Rule. If determined by the department that more than one half of an existing facility is remodeled, the entire existing facility shall be considered a new facility.
(20)"Nurse Aide" means any individual providing nursing or nursingrelated services to patients in a facility, and is not a licensed health professional, a qualified dietitian or someone who volunteers to provide such services without pay, and who is listed in a nurse aide registry approved by the Department.
(21)"Nurse Aide Trainee" means an individual who has not completed an approved nurse aide training course and competency evaluation and is demonstrating knowledge, while performing tasks for which they have been found proficient by an instructor. These tasks shall be performed under the direct supervision of a registered nurse. The term does not apply to volunteers.
(22)"Nursing Facility" means that portion of a nursing home certified under Title XIX of the Social Security Act (Medicaid) as in compliance with federal program standards for nursing facilities. It is often used as synonymous with the term "nursing home" which is the usual prerequisite level for state licensure for nursing facility (NF) certification and Medicare skilled nursing facility (SNF) certification.
(23)"Nurse in Charge" means the nurse to whom duties for a specified number of patients and staff for a specified period of time have been delegated, such as for Unit A on the 73 or 311 shift.
(24)"On Duty" means personnel who are awake, dressed, responsive to patient needs and physically present in the facility performing assigned duties.
(25)"Patient" means any person admitted for care to a skilled nursing or intermediate care facility.
(26)"Physician" means a person licensed under G.S. Chapter 90, Article 1 to practice medicine in North Carolina.
(27)"Qualified Dietitian" means a person who meets the standards and qualifications established by the Committee on Professional Registration of the American Dietetic Association included in "Standards of Practice" seven dollars and twenty-five cents ($7.25) or "Code of Ethics for the Profession of Dietetics" two dollars and fifteen cents ($2.15), American Dietetic Association, 216 W. Jackson Blvd., Chicago, IL 606066995.
(28)"Registered Nurse" means a nurse who is duly licensed as a registered nurse under G.S. 90, Article 9A.
(29)"Resident" means any person admitted for care to an adult care home.
(30)"Sitter" means an individual employed to provide companionship and social interaction to a particular resident or patient, usually on a private duty basis.
(31)"SupervisorinCharge" means a duly licensed nurse to whom supervisory duties have been delegated by the Director of Nursing.
(32)"Ventilator dependence" means physiological dependency by a patient on the use of a ventilator for more than eight hours a day.
History Note:Filed as a Temporary Amendment Eff. October 1, 1990 For a Period of 142 Days to Expire on February 28, 1991;
Authority G.S. 131E79;
Eff. February 1, 1986;
Amended Eff. February 1, 1993; December 1, 1991; March 1, 1991; March 1, 1990.
10A NCAC 13B .1903INSPECTIONS
(a) Any hospital with beds licensed by the Department under Section .1900 of these Rules may be inspected by one or more authorized representatives of the Department at any time.Generally, inspections will be conducted between the hours of 8:00 a.m. and 6:00 p.m., Monday through Friday.However, complaint investigations shall be conducted at the most appropriate time for investigating allegations of the complaint.
(b) At the time of inspection, any authorized representative of the Department shall make his presence known to the administrator or other person in charge who shall cooperate with such representative and facilitate the inspection.
History Note:Authority G.S. 131E79; 42 U.S.C. 1396 r (a);
Eff. February 1, 1986;
Amended Eff. March 1, 1990;
Temporary Amendment Eff. October 1, 1990 For a Period of 142 Days to Expire on February 28, 1991;
Amended Eff. March 1, 1991;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. July 22, 2017.
10A NCAC 13B .1904PROCEDURE FOR APPEAL