Current through Register Vol. 39, No. 12, December 1, 2024
(a) The Local
Management Entity shall develop and implement written policies governing local
monitoring of Category A and B providers. The written policies shall address:
(1) the frequency and extent of local
monitoring based on the following:
(A) number
and severity of level II or level III incidents reported by the
provider;
(B) the provider's
response to the incidents;
(C) the
provider's compliance with the reporting requirements as set forth in Rule
.0604 of this Section;
(D) the
number and types of complaints received concerning a provider;
(E) the provider's response to the
complaints;
(F) the conclusions
reached from investigation of the complaints;
(G) the results of reviews conducted by the
Division of Health Service Regulation, the Division of Mental Health,
Developmental Disabilities and Substance Abuse Services or the Division of
Social Services;
(H) compliance
with the requirements of the provision of public services;
(I) the provider's quality improvement
activities as required pursuant to
10A NCAC
27G .0201(7), and trends in
improvement;
(J) compliance with
the contract or Memorandum of Agreement with the Local Management
Entity;
(K) the addition of a new
service; and
(L) accreditation by
an accreditation agency approved by the Secretary such as the Council on
Accreditation (COA), the Council on Quality and Leadership (CQL), the Council
on Accreditation of Rehabilitation Facilities (CARF), or The Joint
Commission;
(2) The
quality of the mental health, developmental disabilities and substance abuse
services of all providers;
(3) For
Category A service providers, the LME shall defer to the Division of Health
Service Regulation in the monitoring of any component of services provided
which is an element of rule that is monitored by the Division of Health Service
Regulation. For Category A providers, the LME shall monitor all components of
services provided which are not found in Rule; and
(4) If an investigation discloses issues that
could affect either the provider's licensure if a Category A provider, or the
provider's suspension according to
10A NCAC
26C .0501 through
26C .0504, the Local Management
Entity shall refer the provider to either the Division of Health Service
Regulation or the Division of Mental Health, Developmental Disabilities and
Substance Abuse Services pursuant to Rule .0606 of this Section.
(b) When local monitoring occurs,
the Local Management Entity shall communicate the results to the provider
within 15 calendar days of completion. The communication of the results shall
constitute a local monitoring report that includes:
(1) identification of each service
monitored;
(2) identification of
any issues requiring correction; and
(3) the timelines for implementing the
corrections which shall not exceed 60 days from the date the provider receives
the local monitoring report.
(c) A Local Management Entity that conducts
the local monitoring of a provider serving another Local Management Entity's
client shall provide a copy of the local monitoring report to the client's home
Local Management Entity within 15 calendar days of completion.
