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 |
| Public Law No: 116-39 (HR 3253) | Sustaining Excellence in Medicaid Act of 2019 |
| CMS-6058-FC | Program Integrity Enhancements to the Provider Enrollment Process |
| CMCS Informational Bulletin-12/17/2019 |
Guidance to State Medicaid Agencies on Dually Eligible Beneficiaries Receiving Medicare Opioid Treatment Services |
| SHO #20-001 | Guidance to State Medicaid Agencies on Access to Mental Health and Substance Use Disorder Services for Children and Pregnant Women in the Children’s Health Insurance Program |
| Public Law No: 116-136 | Coronavirus Aid, Relief, and Economic Security (CARES) Act |
| Public Law No: 116-172 | National Suicide Hotline Designation Act of 2020 |
| CMS–2408–F | Final Rule CMS Medicaid and Children’s Health Insurance Program (CHIP) Managed Care |
| SHO# 21-006 | Mandatory Medicaid and CHIP Coverage of COVID-19- Related Treatment |
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 |
| SB 413/SL 2019-186 | Raise the Age Modifications |
| SL 2019-188/HB 724 | Truth in Caller ID |
| SL 2019-240/SB 537/HB729 | Licensing & HHS Amends & Rural Health Stable |
| Executive Order No. 97 | Protecting Minors from Conversion Therapy |
| SL 2020-03/SB 704 | Aid Response to North Carolinians During COVID-19 Crisis |
| SL 2020-04 (HB 1043) | 2020 COVID-19 Recovery Act |
| Executive Order No. 130 | Meeting NC Human Service and Health Needs (COVID-19) |
| SB 808/SL 2020-88 | Medicaid Funding Act, Part III, IV, V, VII |
| SL 2020-83/SB 361 | Health Care Expansion Act of 2019, Part II |
| SL 2020-80/ HB 1023 | Coronavirus Relief Fund & Additions, Section 3.2. (67) |
| SB 808/SL 2020-97 | Coronavirus Relief Act 3.0 |
| Executive Order 171 | HOPE Program: Assisting North Carolinians At Risk of Eviction |
| SL 2021-3 / HB 196 | COVID-19 Response & Relief |
| SL 2021-77 / HB 734 | Department of Health & Human Services Revisions |
| SL 2021-62 / SB 594 | Medicaid Admin. Changes & Tech. Corrections |
| SL 2021-22/SB 103 | Reduce Regulations to Help Children with Autism |
| House Bill 96 / SL 2021-110 | Allow Pharmacists to Administer Injectable Drugs |
| SB 207/HB 252 /SL 2021-123 | Various Raise the Age Changes/JJAC Recs |
| SL 2021-171/SB 191 | No Patient Left Alone Act |
Listing updated on February 3, 2021