Compliance & Regulations
Regulatory Compliance & Professional Standards
Rise and Reflect Community Services LLC is committed to operating in compliance with applicable HIPAA, NC Medicaid, Vaya Health, and North Carolina behavioral health requirements.
Federal Law
HIPAA Compliance
Rise & Reflect Community Services LLC is a HIPAA-covered entity subject to the Privacy Rule (45 CFR Part 164, Subpart E), the Security Rule (45 CFR Part 164, Subparts A and C), and the Breach Notification Rule (45 CFR Part 164, Subpart D). We are legally required to protect the privacy and security of all Protected Health Information (PHI).
Privacy Rule
We limit the use and disclosure of PHI to treatment, payment, healthcare operations, and other permitted purposes. All other disclosures require written client authorization.
Security Rule
We maintain administrative, physical, and technical safeguards to protect electronic PHI (ePHI), including access controls, audit logs, and encryption standards.
Breach Notification
In the event of an unauthorized disclosure of unsecured PHI, we notify affected individuals within 60 days, and the HHS Secretary annually or within 60 days for breaches affecting 500 or more individuals.
Minimum Necessary
Staff access to PHI is limited to the minimum amount necessary to perform their job functions. Role-based access controls are enforced across all systems.
Business Associates
We execute Business Associate Agreements (BAAs) with all third-party vendors who may access, store, or transmit PHI on our behalf, as required by 45 CFR 164.308(b).
Staff Training
All workforce members complete HIPAA privacy and security training at hire and annually. Training records are maintained per 45 CFR 164.530(b).
Managed Care
NC Medicaid Provider Compliance
Rise & Reflect Community Services LLC is a contracted NC Medicaid provider serving individuals across Eastern North Carolina. We adhere to all NC Medicaid provider standards, credentialing requirements, and quality assurance expectations established by NC DHHS.
Provider Credentialing
We maintain active credentialing and re-credentialing per NC DHHS and managed care requirements, including licensure verification, background checks, and insurance minimums.
NC Medicaid Compliance
All services are billed in accordance with NC Medicaid clinical coverage policies and the NC DHHS Behavioral Health Tailored Plan benefit plan.
Service Documentation
Clinical documentation meets NC Medicaid documentation standards, including individualized Person-Centered Plans (PCPs), service authorizations, and encounter records.
Quality & Utilization
We participate in NC Medicaid Quality Management programs, including HEDIS measures, utilization management requirements, and network performance expectations.
Appeals & Grievances
Members have the right to file appeals and grievances through our internal process and through NC DHHS. We cooperate fully with all appeals processes.
Fraud, Waste & Abuse
We maintain a compliance program to detect, prevent, and report fraud, waste, and abuse in accordance with NC Medicaid and federal requirements.
State Law
North Carolina State Compliance
Our operations comply with North Carolina General Statutes Chapter 122C (Mental Health, Developmental Disabilities, and Substance Abuse Act), the administrative rules in Title 10A of the NC Administrative Code, and all applicable NCDHHS regulations for licensed behavioral health service providers.
NC G.S. Chapter 122C
We operate in accordance with the NC Mental Health, Developmental Disabilities, and Substance Abuse Act, including client rights, confidentiality, and service standards.
10A NCAC 27G
Our programs meet the operational standards set forth in 10A NCAC 27G for community-based behavioral health services, including staffing, documentation, and facility requirements.
Client Confidentiality (G.S. 122C-52)
NC law prohibits disclosure of client-identifying information without written consent except in limited circumstances. We comply with both NC G.S. 122C-52 and HIPAA, following the stricter standard in all cases.
Mandatory Reporting
Staff are trained on and comply with mandatory reporting laws, including NC G.S. 7B (juvenile abuse/neglect), G.S. 108A (adult protective services), and duty-to-warn obligations.
Equal Opportunity (G.S. 168A)
We comply with the NC Persons with Disabilities Protection Act and do not discriminate in service delivery on the basis of disability, race, color, sex, national origin, religion, or age.
Licensure & Oversight
We maintain all required licensure under NCDHHS and are subject to regulatory review and audit by the NC Division of Health Benefits (DHB) and Division of Mental Health (DMH).
Your Rights
Client Rights Under NC & Federal Law
Every individual receiving services from Rise & Reflect Community Services LLC has the following rights, protected by NC G.S. 122C-51 through 122C-66 and federal law:
The right to receive services regardless of race, color, sex, national origin, religion, disability, or age.
The right to be treated with dignity, respect, and recognition of your individuality.
The right to privacy and confidentiality of your records and personal information (NC G.S. 122C-52).
The right to participate in the development of your own Person-Centered Plan (PCP) and to be informed of available services.
The right to refuse treatment and to be informed of the consequences of refusal.
The right to a current written copy of your treatment plan.
The right to have your complaints and grievances addressed promptly and without retaliation.
The right to access your records under HIPAA and NC G.S. 122C-53.
The right to receive services in the least restrictive environment appropriate to your needs.
The right to be free from abuse, neglect, exploitation, and unnecessary restraint.
The right to be informed of this notice of rights at the start of services.
Concerns & Appeals
Grievance & Appeals Process
Clients, guardians, and authorized representatives may file a grievance or appeal at any time. We will not retaliate against anyone who files a complaint or exercises their rights.
Step 1
Contact Us Directly
Call (252) 572-6547 or email info@riseandreflectnc.com. We acknowledge all grievances in writing within 5 business days and resolve within 30 days.
Step 2
Managed Care Appeal
If unresolved, contact your managed care organization's member services line. Members may also request a State Fair Hearing through NC DHHS.
Step 3
External Complaint
File a HIPAA complaint with HHS Office for Civil Rights at 1-800-368-1019 or hhs.gov/ocr. File a licensing complaint with NCDHHS at 1-800-662-7030.
Standards
Documentation & Quality Assurance
Documentation Integrity
All clinical records are accurate, timely, and maintained per NC Medicaid and 10A NCAC 27G requirements. Records are retained for a minimum of 10 years.
Internal Audits
We conduct regular internal audits of clinical documentation, billing practices, and compliance records. Findings are reviewed by leadership and addressed within 30 days.
Fraud, Waste & Abuse
We maintain a zero-tolerance policy for fraud, waste, and abuse. Staff are trained annually and may report concerns anonymously without fear of retaliation.