D.C. Mun. Regs. tit. 29, r. 29-6903

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-6903 - HEALTH HOME RECORD RETENTION, PROTECTION AND ACCESS

6903.1

Health Home records shall contain sufficient information which readily identifies and supports Medicaid billing. As set forth in 22-A DCMR § 2516.3, Health Homes shall document each Health Home service and activity in the beneficiary's record in DBH's approved electronic record system. Any claim for Health Home services shall be supported by written documentation which clearly identifies the following:

(a) The specific service type rendered;

(b) The date, duration, and actual time, a.m. or p.m., including the beginning and ending time, during which the services were rendered;

(c) The name, title, and credentials of the person who provided the services;

(d) The setting in which the services were rendered;

(e) A confirmation that the services delivered are contained in the beneficiary's comprehensive care plan;

(f) Identification of any further actions required for the beneficiary's well-being raised as a result of the service provided;

(g) A description of each encounter or service by the Health Home team member which is sufficient to document that the service was provided in accordance with this chapter; and

(h) Dated and authenticated entries, with their authors identified, which are legible and concise, including the printed name and the signature of the person rendering the service, diagnosis and clinical impression recorded in the terminology of the International Statistical Classification of Diseases and Related Health Problems, 10^th Revision (ICD-10 CM) or its subsequent revision, and the service provided.

6903.2

Each Health Home shall establish procedures for safeguarding beneficiary information pursuant to 42 CFR § 431.305, and shall ensure, that except as otherwise provided by federal or District law or rules, the use or disclosure of beneficiary information shall be restricted to purposes related to the administration of the Medicaid Program, as set forth in 42 CFR § 431.302.

6903.3

Each Health Home shall allow appropriate DHCF personnel and other authorized agents of the District of Columbia government and the federal government full access to Health Home records.

6903.4

Each Health Home shall maintain all records, including, but not limited to, financial records, medical and treatment records, and other documentation pertaining to costs, billings, payments received and made, and services provided, for ten (10) years or until all audits are completed, whichever is longer.

6903.5

In addition to the Health Home service documentation standards listed in § 6903.1, a Health Home that is a public entity shall also maintain all documentation pertaining to costs necessary to perform cost reconciliation in accordance with Office of Management and Budget Circular A-87.

D.C. Mun. Regs. tit. 29, r. 29-6903

Final Rulemaking published at 65 DCR 7933 (7/5/2019)