Ala. Admin. Code r. 560-X-54-.09

Current through Register Vol. 42, No. 12, September 30, 2024

Section 560-X-54-.09 - Records

(1) The Alabama Medicaid Agency shall maintain all information regarding claims submitted and paid for services provided eligible recipients. Said records shall be retained for the period of time required by state and federal laws.

(2) A sign-in log, service receipt, or some 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 three-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 and the operating agencies 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-54-.09

New Rule: Filed May 12, 2003; effective June 16, 2003. Amended: Filed August 11, 2008; effective September 15, 2008.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 09, June 29, 2018, eff. 7/26/2018.

Author: Ginger Wettingfield, Director LTC Healthcare Reform Division

Statutory Authority: Section 1915 (c), Social Security Act, 42C.F.R.

Section 441, Subpart G.