D.C. Mun. Regs. tit. 29, r. 29-5315

Current through Register Vol. 71, No. 44, November 1, 2024
Rule 29-5315 - ACCESS TO INFORMATION
5315.1

Each prepaid, capitated provider and its subcontractors shall maintain all records required by the Medicaid managed care provider agreement, at cost, for five (5) years or until all audits are completed, whichever is longer. The records shall include all physical records originated or prepared in connection with the performance of the Medicaid managed care provider agreement, including but not limited to, books, reports, working papers, documents, financial records, medical records and charts, and the other documentation pertaining to costs, payments received and made, and services provided to covered enrollees.

5315.2

Each prepaid, capitated provider shall permit authorized personnel of the Department, the United States Department of Health and Human Services, the Controller General of the United States and any of their duly authorized representatives full access to the records for audit purposes.

5315.3

The Department may examine the records of any prepaid, capitated provider and its subcontractors which were prepared in the course of carrying out the prepaid, capitated provider's obligation under its Medicaid managed care provider agreement. The Department may conduct on-site inspections and periodic medical audits of such records of as often as is necessary to protect the interests of the Department and AFDC and AFDC -related Medicaid recipients in the District.

D.C. Mun. Regs. tit. 29, r. 29-5315

Final Rulemaking published at 42 DCR 1566, 1585 (March 31, 1995)