SUBCHAPTER 43B - MATERNAL HEALTH SECTION LOCAL HEALTH DEPARTMENT PROGRAM AND FUNDING

Transcription

1 SUBCHAPTER 43B - MATERNAL HEALTH SECTION 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 Mail Service Center, Raleigh, North Carolina A 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 (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, A 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. 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. Amended Eff. August 1, A NCAC 43B.0106 SCOPE OF SERVICES (a) Local providers may utilize MCH child health program funds to provide the following services and programs: (1) Community outreach including education, recruitment, and follow-up of infants and children; (2) Immunizations;

2 (3) Child health assessment, follow-up diagnostic and treatment services; (4) School health services including the School Health Fund; (5) Identification and tracking of infants and children at risk for developmental delays and other handicapping conditions; (6) Accident and injury prevention services; (7) Sudden Infant Death Syndrome grief counseling services and public information activities; (8) Lead poisoning prevention and abatement activities; (9) Dental services for children; (10) Nutrition and social work services; and (11) Other activities that promote the health of children that are not otherwise prohibited by federal and state laws and regulations. (b) Local providers may utilize MCH maternal health program funds to provide the following services and programs: (1) Community outreach including education, recruitment, and follow-up of women; (2) Prenatal and postpartum services; (3) MCH Delivery Fund; (4) Family planning services; (5) Sudden Infant Death Syndrome grief counseling services and public information activities; (6) Nutrition and social work services; and (7) Other activities that promote the health of women of childbearing years that are not otherwise prohibited by federal and state laws and regulations. (c) Local providers may not utilize MCH maternal health program funds and child health program funds for the following: (1) Purchase of inpatient care other than that authorized under (a)(4) and (b)(3) of this Rule. (2) Cash payments to direct recipients of health services; (3) Purchase or improvement of land; (4) Purchase, construction, or permanent improvement (other than minor remodeling) of any building or other facility; (5) Purchase of major medical equipment; and (6) Abortion. (d) Within the service limitations of this Section and commensurate with funds available to pay for those services as specified in the approved contract budgets, the number and type of services offered will by negotiated annually with each local provider, approved by the program, and detailed in the addendum to the contract. Amended Eff. September 1, 1990; February 1, A NCAC 43B.0107 ALLOCATION OF FUNDS: CONTRACT (a) A minimum of twenty thousand dollars ($20,000) per year of maternal health program funds and twenty thousand dollars ($20,000) per year of child health program funds shall be allocated to each county of the state. (b) Additional amounts shall be allocated to each local provider based upon their level of MCH funding as of July 1, (c) Any new state or federal funds to be distributed statewide to local providers shall be allocated based upon the following: (1) A minimum base allocation for each county - the sum total of which shall not be more than 50 percent or less than 25 percent of the total amount to be allocated; (2) For maternal health program fund allocations, each county's number of low income pregnant women, and for child health program fund allocations, each county's number of low income children, both as indicated by the most recent information available from the North Carolina Department of Administration; (3) Each county's five year infant mortality rate as compared to the state five year infant mortality rate; (4) For maternal health program fund allocations, each county's percentage of total state need for maternal health services, and for child health program fund allocations, each county's percentage of total state need for child health services, both compared to their percentage of total MCH funding for local providers; (5) Service delivery gaps in given localities; and (6) Actual utilization of funds in previous fiscal years, special population groups, and other management considerations that relate to a local provider's ability to effectively and efficiently use additional funds. (d) Any new state or federal funds that are not distributed statewide shall be distributed for special projects in accordance with Rules.0406 through.0408 of this Subchapter.

3 (e) In order to maximize the utilization of maternal and child health funds, in the event a local provider is expending funds at a rate which will, if continued, result in an underexpenditure of funds at the end of the contract period, MCH may after consulting with the local provider reduce the amount of funds budgeted by an amount consistent with the projected level of underexpenditure. Funds projected to be unexpended may be reallocated to other local providers in accordance with community needs and performance records. MCH shall notify the local provider in writing prior to any reduction of funds. (f) A contract is signed annually with each local provider. Contracts for maternal and child health funds are subject to annual renewal and are subject to the availability of funds. Amended Eff. February 1, A NCAC 43B.0108 EVALUATION AND MONITORING (a) Local providers receiving funds from MCH must report client and service data through the Health Services Information System (HSIS). Data may be submitted on hard copy forms provided by the division, diskette or magnetic tape. Data must be submitted on no less than a monthly basis. (b) The Division shall make site reviews of local providers to assess program performances. (c) A local provider that consistently fails to meet acceptable levels of performance as determined through site reviews or data from the Health Services Information System and has been offered state consultation and technical assistance, may have MCH funding reduced or discontinued. Recommendations to reduce or discontinue funding provided to a local service provider must be reviewed and approved by the Director, Maternal and Child Health and the State Health Director. 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. SECTION MISCELLANEOUS PROGRAM/PROJECT FUNDING 10A NCAC 43B.0201 GENERAL (a) The Maternal and Child Health Program provides grant funds for special projects of local, regional, or statewide significance including service delivery, special studies, continuing education and consultation and technical assistance. (b) The initiation and annual renewal of contracts for special projects is subject to the availability of funds. 10A NCAC 43B.0202 PROVIDER ELIGIBILITY (a) Local health departments are eligible to receive MCH special project funds from the division. (b) MCH special project funds may be awarded to any public or private nonprofit agency in the event a local health department is unwilling or unable to provide the needed service.

4 10A NCAC 43B.0203 APPLICATION FOR FUNDS (a) Grants for special projects shall be awarded through a request for proposal (RFP) process that includes notification of all local providers of the eligibility criteria and requirements for funding. (b) Grant proposals for maternal and child health special project funds shall be sent to the Division of Public Health, 1915 Mail Service Center, Raleigh, North Carolina (1) A project plan which includes an assessment of the need for the special project, measurable project objectives, and strategies for meeting the project objectives; (2) A proposed budget; and (3) An evaluation plan. (c) Technical assistance in preparing a grant proposal shall be available from central and regional office MCH staff. (d) The Division shall approve or deny a grant proposal for special project funds or request additional information within 60 days after receipt of a grant proposal. If additional information is requested, the local provider shall have 45 days to submit the information. Failure by the local provider to submit the additional information requested within 45 days shall be grounds for denying the grant proposal. Upon receipt of the additional information, the Division shall approve or deny a grant proposal for special project funds within 45 days. (e) Within the service limitations of this Section and commensurate with funds available to pay for those services as specified in the approved contract budget, the number and type of services offered will be negotiated annually with each local provider, approved by the program, and detailed in the addendum to the contract. 10A NCAC 43B.0204 BUDGETING OF GRANT FUNDS Upon approval of an application for grant funds a budget will be negotiated and a contract will be signed between the grantee and the Division. 10A NCAC 43B.0205 ANNUAL REPORT The contractor shall submit an annual report to the Division within 45 days from the close of the contract period. The report shall include an evaluation addressing progress in meeting the objectives outlined in the application. 10A NCAC 43B.0206 RENEWAL OF GRANT FUNDS Contracts for special projects are subject to annual renewal based upon the extent to which objectives are met as described in progress reports or site reviews and to which contract requirements are met. SECTION RURAL OBSTETRICAL CARE INCENTIVE FUNDS 10A NCAC 43B.0301 GENERAL Rural Obstetrical Care Incentive Funds are administered by the Division of Public Health. The funds shall be used to reimburse physicians and nurse-midwives for a portion of malpractice insurance premiums as an incentive to physicians and nurse-midwives to practice obstetrics in underserved counties. Authority S.L. 1989, c. 1066, s. 49; Temporary Rule Eff. October 20, 1988, for a period of 180 Days to expire on April 18, 1989;

5 Amended Eff. February 1, 1991; December 1, A NCAC 43B.0302 APPLICATION FOR FUNDS (a) Local health departments in counties that are underserved with respect to obstetrical care may apply to the Division of Public Health for Rural Obstetrical Care Incentive Funds. A physician or a nurse-midwife may request a local health department to apply for the funds. (b) A county is considered underserved with respect to obstetrical care if the county meets one or more of the following criteria, listed in order of priority: (1) there are no public or private prenatal services available within the county; (2) there is no public prenatal clinic available within a health department, hospital or primary care center that serves low income pregnant women within the county; (3) there is a public prenatal clinic, but no physician or nurse-midwife to staff the clinic or no physician back-up for physician extenders; (4) the county has inadequate obstetrical coverage, demonstrated by such factors as: a waiting list of 28 calendar days or more for an appointment at the public prenatal clinic; 50 percent or more of resident live-births occur outside the county; the five year infant mortality or premature birth rate is greater than the five year state rate; the percentage of resident live births to women who received no prenatal care or inadequate prenatal care exceeds the state rate; 50 percent or less of physicians who practice obstetrics in the county serve Medicaid recipients in their private practice; more than 15 percent of resident live births are to women who receive their prenatal care from public clinics; the percentage of resident live births to women who initiated prenatal care in the first trimester is lower than the state rate; or the percentage of resident live births to women who initiated prenatal care in the third trimester is greater than the state rate. (c) The Division of Public Health shall send a request for applications to local health departments that includes a deadline for receipt of applications. (d) Local health departments that apply for Rural Obstetrical Care Incentive Funds shall include in the application: (1) a coverage plan, developed in cooperation with eligible physicians, nurse-midwives, and community, migrant, or rural health centers that addresses prenatal and delivery care for low income women in the county, and quality of care; (2) contracts with eligible physicians and contracts with eligible nurse-midwives and their supervising physician who agree to participate in the local health department's coverage plan and provide the services required by Rule.0306; the contracts may be contingent upon the availability of Rural Obstetrical Care Incentive Funds; and (3) evidence that receipt of these funds will improve or rectify the problems with obstetrical coverage in the county. Authority S.L. 1989, c. 1066, s. 49; Amended Eff. February 1, 1991; February 1, A NCAC 43B.0303 PHYSICIANS AND NURSE-MIDWIVES ELIGIBLE TO PARTICIPATE (a) A physician or nurse-midwife is eligible to receive Rural Obstetrical Care Incentive Funds if the physician or nurse-midwife: (1) is licensed to practice medicine or approved to practice midwifery in North Carolina; and (2) carries malpractice liability insurance that is not being totally or partially paid for the physician or nurse-midwife as an employee of the federal government or by an institution of higher learning or an affiliate of the institution. (b) A physician or nurse-midwife does not have to reside in the underserved county to be eligible to participate. (c) A general surgeon is eligible to receive Rural Obstetrical Care Incentive Funds if the general surgeon meets the participation requirements in S.L. 1991, Chapter 689, Section 232. Temporary Rule Eff. October 20, 1988, for a period of 180 days to expire on April 18, 1989; Authority S.L. 1989, c. 1066, s. 49;

6 Amended Eff. July 1, 1992; February 1, A NCAC 43B.0304 DISBURSEMENT OF FUNDS (a) Subject to the availability of funds, the Maternal Health Branch shall disburse Rural Obstetrical Care Incentive Funds to local health departments that have submitted an approved application as follows: (1) first priority shall be given to those counties that meet the criteria in Rule.0302(b)(1), second priority shall be given to those counties that meet the criteria in Rule.0302(b)(2), third priority shall be given to those counties that meet the criteria in Rule.0302(b)(3), and fourth priority shall be given to those counties that meet one or more of the criteria in Rule.0302(b)(4); (2) the Division of Public Health shall rank and disburse funds to underserved counties within each priority group according to the anticipated improvement in obstetrical coverage that will result from funding; and (3) Counties funded shall receive ongoing funding based upon a renewal application that has been reviewed and approved by the Division of Public Health. (b) For each eligible physician with whom the local health department contracts, the health department will be paid either the difference between the physician's premiums with obstetrical care coverage and without obstetrical care coverage, or seven thousand five hundred dollars ($7,500), whichever is less. Payment shall be based upon a maximum of one million/one million dollars ($1,000,000/$1,000,000) coverage. The local health department will then pay this amount to the physician to cover a portion of the physician's annual malpractice insurance premiums. The total payments to one physician cannot exceed the amount stated in this Paragraph. (c) For each eligible nurse-midwife with whom the local health department contracts, the health department will be paid the total amount of the nurse-midwife's premium or four thousand dollars ($4,000), whichever is less. The local health department will then pay this amount to the nurse-midwife to cover a portion of the nurse-midwife's annual malpractice insurance premiums. The total payments to one nurse-midwife cannot exceed the amount stated in this Paragraph. (d) No more than thirty thousand dollars ($30,000) may be disbursed to any underserved county. (e) No funds may be disbursed to a health department in the absence of a contract with an eligible physician or nurse-midwife. Authority S.L. 1993, c. 321, s. 283; Amended Eff. January 4, 1994; February 1, 1991; February 1, A NCAC 43B.0305 PARTICIPATION REQUIREMENTS FOR LOCAL HEALTH DEPARTMENTS A local health department that receives Rural Obstetrical Care Incentive Funds shall: (1) maintain statistical and fiscal information required by the Division of Public Health to document participation by eligible physicians or nurse-midwives under the contract; and (2) assure that physicians and nurse-midwives participate in the coverage plan for the duration of the contract period. Authority S.L. 1989, c. 1066, s. 49; Amended Eff. February 1, A NCAC 43B.0306 PARTICIPATION REQUIREMENTS FOR PHYSICIANS AND NURSE-MIDWIVES (a) A participating physician or nurse-midwife shall: (1) provide prenatal care to low-income women by: (A) staffing a public prenatal clinic (physicians may provide medical back-up and supervision of physician extenders providing services in a public prenatal clinic); (B) providing prenatal care in a private office. (2) take part in an on-call arrangement for coverage of obstetrical care, including deliveries, for low income women who are residents of the underserved county; (3) not refuse to provide prenatal or delivery care for any patient based on economic status or ability to pay; and (4) participate in data collection efforts required by the Division of Public Health;

7 (5) agree to serve Medicaid recipients who request prenatal care. These services may be provided through a private practice, the local health department or other public clinic. (b) No participating physician or nurse-midwife shall be required to assume management of the care of any obstetrical patient if the level of care required for that patient is beyond the professional competence of that physician or nurse-midwife. (c) No participating physician or nurse-midwife shall be required to provide delivery services if the underserved county does not have a facility for obstetrical delivery. Authority S.L. 1989, c. 1066, s. 49; Amended Eff. February 1, 1991; February 1, 1990.