Ala. Admin. Code r. 560-X-53-.15

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

Section 560-X-53-.15 - Data Collection, Record Maintenance, Report

(1) A PO must collect data, maintain records, and submit reports as specified by AMA and CMS in the PACE agreement to enable monitoring of the operation, cost, quality, and effectiveness of the program and establishment of payment rates.

(2) Written procedures must be established to safeguard all data, records, and financial books against loss, destruction, unauthorized use, or alteration.

(3) All federal and state laws are to be followed regarding the confidentiality and disclosure of health information and records for Participants. Written procedures must be established to ensure that confidentiality is maintained. Records should be updated timely in order to maintain accurate records. Each Participant has the right to review their record and must be allowed timely access to review and copy his or her records. Each Participant may also request amendments to his or her records. Only authorized individuals may receive information or copies of a record. Original medical records are to be released only in accordance with federal and state laws, court orders, or subpoenas.

(4) Records are to be retained as specified in 42 CFR 460.200.

(5) At a minimum, AMA and CMS are to have access to data and records pertaining to participant health outcomes, financial information, medical records, and personnel records.

(a) A health information system must be established and maintained by a PO. The system is to be utilized to collect, analyze, integrate, and report data needed to measure the PO's performance and outcome of care furnished to Participants.

(b) Accurate financial reports are to be prepared using an accrual basis of accounting that can be verified by qualified auditors. Standardized accounting, statistical, and reporting practices and definitions that are widely accepted in the health care industry must be followed. The financial system must accurately document all financial transactions, provide audit trails to source documents, and have the ability to generate financial statements. CMS and AMA must be allowed access to any financial information and records of an original entry that pertain to any aspect of services furnished, reconciliation of benefit liabilities for participants, and determinations of Medicare and Medicaid payments.

(c) Quarterly financial statements are to be submitted by the PO within 4 5 days of the last day of each quarter during the trial period. Monthly and quarterly statements may be required if CMS and AMA determine that more frequent monitoring is required. A financial statement certified by an independent CPA must be submitted no later than 180 days of the end of the PO's fiscal year. Required contents for the statements are listed in 460.208.

(d) Complete and accurately documented comprehensive medical records are to be maintained for each Participant following accepted professional standards. All entries must be legible, clear, complete, dated, and appropriately authenticated as specified in 460.210 (d). Each medical record must contain the information and documentation specified in 460.210. Medical records are to be systematically organized, readily accessible, available to all staff, and maintained at the PO where services are received by the Participant. A copy of medical information must be transferred promptly between treatment facilities as needed.

Ala. Admin. Code r. 560-X-53-.15

New Rule: Filed November 10, 2011; effective December 15, 2011.

Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit.

Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 4 2 CFR 460 Subpart L.