Managing Healthcare Compliance in North Carolina

As is the case with every state, there are distinctive challenges in the management of healthcare compliance in North Carolina, shaped by its own unique regulations. It’s essential for healthcare providers, facilities, and organizations within North Carolina to grasp and maneuver through this complex set of rules to provide ethical, high-quality healthcare services, while also avoiding legal and financial setbacks.

To manage compliance effectively, healthcare entities in North Carolina must establish an efficient system to monitor evolving regulations and apply the new standards as required. Keep scrolling for a summary of the crucial elements of healthcare compliance relevant to North Carolina.

North Carolina Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

• The North Carolina Department of Health and Human Services (NCDHHS) encompasses various divisions, including the Division of Public Health (NCDPH), which is responsible for promoting and protecting the health of individuals and communities through programs such as disease prevention, health promotion, and emergency preparedness. 
• The North Carolina Healthcare Association (NCHA) advocates for an array of health systems in the state, including teaching, rural, suburban, and specialty hospitals, along with facilities providing acute, rehabilitative, behavioral, psychiatric, and veterans’ services. Established in 1918, NCHA plays a pivotal role in enhancing healthcare by offering information, support, educational resources, policy guidance, and advocacy to its members.
• The Division of Health Benefits administers the state’s Medicaid program, which provides essential healthcare coverage to eligible individuals and families.
• The North Carolina Medical Board (NCMB) regulates the practice of medicine and ensures that medical professionals meet licensing requirements, adhere to ethical standards, and maintain competency in their field. 
• The North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC) is responsible for mental/behavioral provider licensing and oversight of policies and regulations that pertain to mental/behavioral health services.

These agencies help maintain the integrity and quality of healthcare services in North Carolina, protecting the public and promoting patient safety. The resources provided by these North Carolina state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of North Carolina.

Regulations Unique to North Carolina

To meet the standards of healthcare compliance in North Carolina, there are a few additional regulations.

Telemedicine Requirements

In North Carolina, telemedicine is the use of electronic communication and technology for medical care, and providers are held to the same standards as in traditional in-person settings. Providers must be licensed in North Carolina, except under certain conditions, and must ensure that services align with their scope of practice. Proper patient identification, confidentiality, and comprehensive medical record-keeping are essential to maintaining compliance. Telemedicine encounters require evaluations that meet standard care levels, and static online questionnaires alone are insufficient for diagnosis or treatment. Prescribing medications, including controlled substances, via telemedicine must comply with state and federal laws. Lastly, providers are responsible for facilitating appropriate follow-up care or in-person referrals when necessary.

Certificate of Need Required

The goal of North Carolina’s Certificate of Need (CON) law is to mitigate the rise in healthcare costs through government-imposed limitations on the unnecessary replication of medical facilities. Under this law, it is mandated that no individual or entity can start or offer a new institutional health service unless they have secured a certificate of need (CON). This requirement extends to all new developments, including hospitals, psychiatric and chemical dependency treatment facilities, nursing and adult care homes, kidney disease treatment centers, facilities for individuals with intellectual disabilities, rehabilitation centers, home health agencies, hospices, diagnostic centers, and ambulatory surgery centers. Furthermore, any significant replacements, upgrades, or expansions of existing healthcare facilities or services that require substantial investment, must obtain a CON before proceeding.

Medicaid Expansion Law

In March 2023, North Carolina passed House Bill 76, “Access to Healthcare Options,” an initiative to expand Medicaid. Included in the the law are reforms to the Certificate of Need (CON), which specifically address requirements for chemical dependency beds, psychiatric beds, and adjusts thresholds for diagnostic centers, MRI machines, and ambulatory surgery centers (ASCs). The bill, however, excluded the SAVE ACT, which aimed to enhance nurse practitioners’ autonomy. Medicaid expansion under H.B. 76 enables approximately 600,000 residents to gain health coverage, significantly boosting the state’s healthcare system and economy. This development is particularly beneficial for rural hospitals due to increased Medicaid reimbursement revenues, marking a substantial shift in North Carolina’s approach to healthcare access and modernization.

Tips To Manage Healthcare Compliance in North Carolina

Effectively managing healthcare compliance in North Carolina is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

• Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers North Carolina-approved training.
• Organize Policies By Requirement: Including “NC” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
• Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
• Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in North Carolina

In North Carolina, there are several pathways for medical credentialing and physician licensing, managed by the North Carolina Medical Board (NCMB). There are specific procedures for graduates from United States/Canadian medical schools and international graduates, with or without a Federation Credentials Verification Service (FCVS) profile. The licensing process entails an online application, supplemental documents, annual license renewal within 30 days of the physician’s birthday, and a mandatory criminal background check. Denied applications can be appealed, and establishing an FCVS profile is recommended, particularly for international graduates.

Meet North Carolina Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in North Carolina. 

MedTrainer’s all-in-one compliance platform can streamline management of North Carolina healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!