Subsection 144-101-II-23.06 - POLICIES AND PROCEDURES23.06-1Setting. The services described in this Section must be provided in settings which are appropriate to the member's needs.23.06-2Professional Staff. Developmental and Behavioral Evaluations, Child Abuse Evaluations, and CHAs are reimbursable services when provided by appropriately licensed providers acting within the scope of their licensure. Providers shall collect and retain copies of current licenses of professional staff and shall produce them for purposes of enrollment.
23.06-3Member's Records. The Developmental and Behavioral Evaluation, Child Abuse Evaluation, and CHA services must be performed under the direct supervision of a physician and that fact must be documented in the member's record. There shall be a specific record for each member which shall include but not be limited to:
A. The evaluation components provided, the provider(s) of each component, the goal(s) of the evaluation, and the method(s) or action(s) to achieve that goal.B. Complete results of all Developmental and Behavioral Evaluations, Child Abuse Evaluation, and CHA services, including reports of each individual assessment and reports of any consultations held.C. A closing summary signed and dated by the physician who supervised the Developmental and Behavioral Evaluation, Child Abuse Evaluation, and CHA service. The closing summary shall contain, at minimum: (2) medical considerations,(3) functional strengths and limitations,23.06-4Program IntegrityA. The Division of Program Integrity monitors the medical services provided and determines the appropriateness and necessity of the services.B. The Department and its professional advisors regard the maintenance of adequate clinical records as essential for the delivery of quality care. In addition, providers should be aware that clinical records are key documents for post-payment audits. In the absence of proper and complete clinical records, no payment will be made, and payments previously made may be recovered in accordance with Chapter I of this Manual.C. Upon request, the provider must furnish to the Department, without additional charge, the clinical records, or copies thereof, corresponding to and substantiating services billed by that provider.D. The Department requires the clinical records and other pertinent information shall be transferred upon request with the member's signed release of information to other clinicians involved in the member's care. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-23, subsec. 144-101-II-23.06