Federal / State Rules & Regulations

Federal Rules/Regulations

Rule/Regulation Brief Description
Public Law No: 114-255 21st Century Cures Act Grants to Address Opioid Abuse Crisis
CMS Policy per 42 CFR §438 State Guide to CMS Criteria for Medicaid Managed Care Contract Review
42 CFR §455.410 Enrollment and screening of providers
42 CFR §455.434 Criminal background checks – fingerprints for “high” risk providers”
42 CFR 455.450  Screening levels for Medicaid providers
Public Law 114–10 Remove Social Security Numbers from Medicare cards by April 2019
21 NCAC 63.0505 SW regulations concerning relationships with colleagues, professional authority and responsibilities for reporting incompetent and unethical behavior
Public Law 114-198 (Senate Bill 524) Award US DHHS grants to address the prescription opioid abuse and heroin use crisis
and for other purposes
Section 1557 of the Affordable Care Act Prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities, particularly with respect on the basis of sex in health programs
28 CFR Parts 20,  71 and 85  Civil monetary penalties inflation adjustment for false claims penalties
Public Law No: 114-198 Pain management best practices
Section 14(c) of the Fair Labor Standards Act Rules changes regarding paying subminimum wage to persons with disabilities
28 CFR 35 & 36 Americans with Disabilities Act Amendments of 2008 Statutory changes to the ADA set forth in the ADA Amendments Act of 2008
CMS–3277–P Fire Safety Requirements for Certain Health Care Facilities including ICF-IID (sprinkler systems)
42 CFR, Part 438 Final rule modernizes  Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems.
SECTION 2707 OF THE AFFORDABLE CARE ACT OF 2010 Medicaid Emergency Psychiatric Demonstration Project for IMDs
Title 41 U.S.C. Public contracts, conflicts of interest, procurement…
Title XIX Grants to States for Medical Assistance – Section 1900 -1946 of the Social Security Act (SSA) Federal Medicaid regulations
Sections 1128 of the SSA Exclusion of certain individuals/entities and prohibited affiliations from any Federal health program
42 CFR 438.610(a) and (b) Relationships with individuals debarred by Federal Agencies
42 CFR 438.114(d) Payment of emergency services
Section 1867 of the SSA Coordination of appropriate maintenance. and post-stabilization care
42 CFR 438.10 Location and appropriate use of emergency services
42 CFR 438.208 Choice of health professional
42 CFR 483.430(a)  Intermediate Care Facility (ICF) for the Mental Retarded (MR) Facility Staffing (Qualified Mental Retardation Professional)
42 CFR 483.10(f)(6) and (g) New enrollee information to be provided as managed care program
42 CFR 438.10(c)(5) Interpreter Services – special needs
Public Law 111-5, Section 5006 of the ARRA  Services by Indian Health Care Providers
42 CFR 438.240 QA/QI Program
42 CFR 456  and 438 Subpart D Utilization Management
Executive Order 13410 Promoting Quality and Efficient Healthcare in Federal Government Administered or Sponsored Health Care Programs.  CMS Quality Framework
42 CFR 438.310 through 438.370 3rd party external Quality Reviews
42 CFR 438.22 and 438 Subpart F Grievances and Appeals
42 CFR 434.6 and 438.6 Subcontract Requirements
Section 1902(a)(37)(A) of the SSA and 42 CFR 447.45 Timeliness of provider payments
Public Law 103-227 Part C Smoking prohibition
Section 1905(r)(5) EPSDT Services
42 CFR 438.20 QA/QI Performance Improvement Projects
Sections 1903(m)(2)(A)(viii) and 1903(m)(4) of the Public Health Service Act Disclosure of business transaction information – parties of interest
45 CFR Parts 160 & 164 Health Insurance Portability & Accountability Act (HIPAA)
45 CFR Part 162 HIPAA Administrative Simplification (NPI, Coding, Taxonomy, Health Plan Identifier…)
42 CFR Part 2 Federal Substance Abuse Confidentiality Regulations
HITECH Act Health Information Technology for Economic and Clinical Health (HITECH) Act
HIPAA Omnibus Rule Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules; Final Rule
42 CFR §§ 438.206, 438.207, 438.208 and 438.210 Access to Care
42 CFR §§ 438.214, 438. 218, 438.224, 438.226, 438.228, and 438.2300 Structure and Operations, Provider Selection
42 CFR §§ 438.236, 438.240 and 438.242 Quality Measurement and Improvement
42 CFR 455 subpart A Federal Medicaid Audit Regulations
Federal Law 31 U.S.C. 3729-3733 False Claims
Public Law 109-171 Deficit Reduction Act
Public Law No: 115-119 RAISE (Recognize, Assist, Include, Support, and Engage) Family Caregivers Act
Program Fraud Civil Remedies Act 31 USC 3801-3812 Administrative remedy against any person who makes, or causes to be made, a false claim or written statement to any of certain Federal agencies
42 U.S.C. 1320a-7b (Section 1128B of the SSA) Anti-kickback law
42 U.S.C. 1395 (Section 1877 of the SSA) Stark law – Self Referral Law
CMS Medicaid Integrity Program Established to combat provider fraud, waste, and abuse of the Medicaid program.
U.S. Sentencing Guidelines   Sentencing guidelines, legal offenses, penalties
CMS-2333 Application of MHPAEA parity requirements to: Medicaid MCOs
U.S. Sentencing Guidelines Manual Ch. 8 – Sentencing of Organizations (§8B2) Effective Compliance and Ethics Program
Public Law No: 115-398/HR 767/S 256 SOAR to Health and Wellness Act of 2017
Public Law 115-271/HR 6 SUPPORT Act
Public Law No: 115-119 RAISE (Recognize, Assist, Include, Support, and Engage) Family Caregivers Act
Public Law No: 116-3 (H.R.259) Medicaid Extenders Act of 2019
Public Law No: 116-16 (H.R.1839) Medicaid Services Investment and Accountability Act of 2019
CMS–2413–F Reassignment of Medicaid Provider Claims

NC State Rules/Regulations

Rule/Regulation Brief Description
S.L. 2017-41 Rylan’s Law/Family/Child Protect. & Acc. Act. – Part VII.
S.L. 2017-115 Revised Schedule of Controlled Substance
S.L. 2017-133 DHHS Study and Recommend Telemedicine Policy
S.L. 2017-32 Required experience for MH/DD/SAS QPs
S.L. 2017-41 Rylan’s Law/Family/Child Protect. & Acc. Act. – Part VII.
S.L. 2017-32 Required Experience MH/DD/SAS QPs
S.L. 2017-74 Strengthen Opioid Misuse Prevention (STOP) Act.
21 NCAC 46 .2401  Dispensation of Opioid Antagonists by Registered Nurses at Local HD
S.L. 2016-121 (SB 838) (HB 968) Medicaid transformation modifications
NCGS 147-64.7 State auditor access to persons and records
NCGS 122-C MH/DD/SA Act of 1985
NCGS 132 and NCGS 121 Section 5 Record retention, management, disposal
NC Division of MH/DD/SAS Policies NC Division of MH/DD/SAS Policies
North Carolina Health Care Personnel Registry Registry of unlicensed health care workers, reportable allegations registry
10A NCAC 27G (APSM 30-1) North Carolina Rules for MH/DD/SA facilities and services
NCGS 108A-70.10 NC Medicaid Fraud
NCGS 108C Medicaid and Health choice Provider Requirements
10A NCAC 26B NC Mental Health Confidentiality Rules
SL 2013-85 (SB 208)  Ensure effective statewide operation of the 1915(b)(c)Medicaid Waiver
SL 2013-145 (SB 137)  Prohibit the regular business practice of waiving required Medicaid & Health Choice recipient co-payments by certain providers
SL 2013-258 (HB 543)  Addressing permissible guardianship roles for corporations and individuals that provide MH/DD/SAS
SL 2015-36 (SB 445) Burt’s Law: ACT to enhance protections for clients of BH facilities from client abuse or exploitation.
SL 2015-245 Transform and reorganize North Carolina’s Medicaid and NC Health Choice Programs.
S.L. 2015-241 (HB 97) Streamlines out-of-network agreement between a single provider and an LME/MCO.
S.L. 2015-203 (HB 556/SB 367) Achieving a Better Life Experience (Able) act
SL 2011-185 (S.B. 597/H.B. 863) Ensure the BH needs of military, veterans and their families are met. Requires LME to establish Care Coordination point of contact and training on BH needs of this population for Customer Services staff.
Executive Order No. 76: Governor’s Task Force on Mental Health and Substance Use   Executive Order establishing Governor’s Task Force on Mental Health and Substance Use.
SL 2015-271 (SB 676) Coverage for the treatment of autism spectrum disorder.
SL 2016-17 (§ 90-106.2.) Treatment of overdose with opioid antagonist; immunity
S.L. 2016-80 (HB 1033) ID Card Fee Waiver for Developmental Disability
S.L. 2016-88 (HB 972) Section 5 § 90-113.27 Needle and hypodermic syringe exchange programs authorized.
SL 2015-118 (N.C.G.S. 147-86.55-69) Iran Divestment Act of 2015
SL 2018-48 Medicaid Transformation Legislation
SL 2018-33 Revise IVC Laws to Improve Behavioral Health
SL 2018-76 Local Confinement/Prison HealthConnex
10A NCAC 13P .0506 EMS Personnel Practice with Psychological Illness
10A NCAC 22J .0106 Provider Billing of Patients Who are Medicaid Recipients
Final Rule 10A NCAC Chapter 21 and 22 Rules,10 NCAC 22F DHHS Rule Clarification to 10A NCAC 22F and 22J t
SL 2018-136/SB 3/HB 4 2018 Hurricane Florence Disaster Recovery Act
SL 2018-5/SB 99 Appropriations Act of 2018
SL 2018-49/HB 156 Prepaid Health Plan Licensing Act
SL 2017-57 Juvenile Justice Reinvestment Act
SL 2018-33; SB 630 /HB 564 Revised IVC Laws to Improve Behavioral Health
Executive Order No. 92 Employment First for North Carolinians with Disabilities
SL 2019-81/ HB 656/SB 548 Medicaid and NC Health Choice Changes for Medicaid Transformation
SL 2019-23/HB 70 Delay NC HealthConnex for Certain Providers
SL 2019-76, SB 556 People First Language

Listing updated on July 16, 2019