10A NCAC 43C .0302. APPLICATION FOR FUNDS

(a)  Application for funds allocated under this Section shall be sent to the Division.  A copy of the application shall be sent to the respective Regional Perinatal Committee.  The application shall include the following components:

(1)           an assessment of the need for high risk maternity services, including the area to be served by the clinic;

(2)           a description of any problems identified and strategies for addressing them;

(3)           measurable program objectives to include, but not to be limited to the following:

(A)          estimates of the annual number of patients to be served from each county of the service area;

(B)          estimates of the annual number of patient visits to the clinic; and

(C)          if funds are being requested for outpatient diagnostic, medical consultative services prescribed medications, and patient transportation, an estimate of the numbers of patients to receive this assistance and how the funds are to be utilized.

(4)           a description of the medical eligibility requirements for clinic admission to include a list of medical conditions which list has been negotiated with referring clinics;

(5)           a description of financial eligibility requirements, if any, for admission;

(6)           a plan to implement and maintain multidisciplinary team care, as described in Section .0308 of these Rules;

(7)           a description of how high risk maternity clinic services will be coordinated with existing medical and community resources;

(8)           identification of the local hospital where high risk clinic deliveries will be performed and the specialties of physicians who will perform the deliveries of the high risk maternity clinic patients;

(9)           a description of the applicant's local quality assurance program, which must include the following:

(A)          provisions for an internal, periodic high risk maternity program assessment to be conducted at least once a year, which shall include:

(i)            an audit of clinical records;

(ii)           a review of delivery funds or high risk maternity clinic reimbursement records;

(iii)          a review of state or local reports and statistics to monitor progress in meeting stated objectives;

(iv)          documentation of review findings;

(v)           development of updated objectives and a timetable for corrective action toward making necessary improvements;

(B)          involvement in the quality assurance program of each discipline providing high risk maternity clinic services; and

(C)          provisions for staff development and training opportunities.

(10)         a proposed budget; and

(11)         letters from the following providers which state their commitment to participate in the delivery of services supported through these grants:

(A)          the hospital at which it is anticipated that most high risk maternity clinic deliveries will be performed;

(B)          those local obstetricians and pediatricians who will participate in the delivery of services supported through these grants;

(C)          the local health departments of all counties to be included in the service area; and

(D)          other human service organizations and agencies that will provide support services for high risk maternity clinic patients.

(b)  Technical assistance in preparing an application or updating a plan is available from the central and regional Maternal and Child Health staff.

(c)  The Regional Perinatal Committee shall review the proposal and make recommendations to the Division within 45 days of the committee's receipt of the application.  These recommendations may include proposed conditions of acceptance.

(d)  The Division shall review the application along with the recommendation of the Regional Perinatal Committee.  The Division shall approve or deny an application for grant funds or request additional information within 60 days after receipt of an application.  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 within 45 days.

(e)  Once approved and funded by the Division, the application becomes the clinic plan.  The plan shall be updated at least every three years and shall incorporate all changes occurring in staffing, facility and operating policies and procedures.  Updated plans shall be reviewed and approved by the Division.

 

History Note:        Authority G.S. 130A‑127;

Eff. July 1, 1988;

Amended Eff. September 1, 1990.