Ala. Admin. Code r. 560-X-44-.10

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-44-.10 - Records

(1) The operating agency shall make available to the Alabama Medicaid Agency at no charge, all information regarding claims submitted and paid for services provided eligible recipients and shall permit access to all records and facilities for the purpose of claims audit, program monitoring, and utilization review by duly authorized representatives of federal and state agencies. Said records shall be retained for the period of time required by state and federal laws.

(2) A sign-in log, service receipt, or other record shall be used to show the date and nature of services; this record shall include the recipient's signature or designated signature authority.

(3) Providers must retain records that fully disclose the extent and cost of services provided to the eligible recipients for a five-year period. These records must be accessible to the Alabama Medicaid Agency and appropriate state and federal officials.

(4) There must be a clear differentiation between waiver services and non-waiver services. There must be a clear audit trail from the point a service is provided through billing and reimbursement. The Alabama Medicaid Agency and Centers for Medicare and Medicaid Services (CMS) must be able to review the Plan of Care to verify the exact service and number of units provided, the date the service was rendered, and the direct service provider for each recipient. There must be a detailed explanation of how waiver services are segregated from ineligible waiver costs.

Ala. Admin. Code r. 560-X-44-.10

New Rule: Filed February 10, 2012; effective March 16, 2012.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 08, May 31, 2018, eff. 6/25/2018.

Author: Ginger Wettingfeld, Director, LTC Healthcare Reform

Statutory Authority: Social Security Act §1915(c); 42 CFR Section 441, Subpart G-Home and Community-Based Services: Waiver Requirements.