18 Del. Admin. Code § 1403-12.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1403-12.0 - Recordkeeping and Reporting Requirements

12.1 Medical Records Retention

12.1.1 The MCO must maintain or provide for the maintenance of a medical records system which meets the accepted standards of the health care industry and State and federal regulations.

12.1.1.1 The MCO shall provide sufficient space and equipment for the processing and the safe storage of records.

12.1.1.2 Medical records shall be protected from loss, damage and unauthorized use.

12.1.2 Retention and Destruction

12.1.2.1 With the exception of medical records of minors (individuals under the age of 18 years),medical records shall be preserved as original records, on microfilm or electronically stored for no less than five years after the most recent patient care usage, after which time records may be destroyed at the discretion of the MCO.

12.1.2.2 Medical records of minors shall be preserved for the period of minority plus five years (i.e., 23 years) or as otherwise required by State law.

12.1.2.3 An MCO shall establish procedures for notification to patients whose records are to be destroyed prior to the destruction of such records.

12.1.3 The Department shall have access to medical records for purposes of monitoring and review of MCO practices.

12.2 Reporting Requirements and Statistics

12.2.1 Annual reports. In addition to the information required to be included in an MCO's annual report as specified in 18 Del.C. § 6406 or elsewhere in this regulation, an MCO shall submit the following information to the Department on an annual basis:

12.2.1.1 A statistical summary evaluating the network adequacy and accessibility to the enrolled population;

12.2.1.2 Annual appeal report of all grievances, petitions for arbitration and appeals under the Independent Health Care Appeals Program as required under Department Regulation 1301.

12.2.1.3 Evidence of compliance with the capital funds requirements of section 4.0 of this regulation.

12.2.2 An MCO shall submit the following information to the Department whenever there is a change:

12.2.2.1 Substantial changes in organization, bylaws, or governing board

12.2.2.2 Full name of the Chief Executive Officer

12.2.2.3 Full name of the Medical Director

12.2.2.4 Substantial changes in marketing materials, grievance procedures or the utilization management program

12.2.2.5 Any significant amendment to or revision relating to the text or subtext of an approved provider contract shall be submitted to and approved by the Department prior to the execution of an amended or revised contract with the providers of an MCO.

18 Del. Admin. Code § 1403-12.0