D.C. Mun. Regs. tit. 29, r. 29-8812

Current through Register 71, No. 45, November 7, 2024

Rule 29-8812 - DATA COLLECTION, RECORD MAINTENANCE, AND REPORTING REQUIREMENTS

8812.1

The PACE organization must collect data, maintain records, and submit reports in accordance with the following:

(a) The PACE organization must collect data, maintain records, and submit reports as specified in the program agreement and as otherwise necessary to enable DHCF and CMS to monitor the operation, cost, quality, and effectiveness of the program and establish payment rates;

(b) DHCF and CMS must be granted free access to PACE organization data and records including, but not limited to, participant health outcomes data, financial books and reports, medical records, and personnel records; and

(c) The PACE organization must submit financial records and reports to DHCF according to the format and frequency specified by DHCF in the PACE program agreement.

8812.2

The PACE organization must establish written policies and implement procedures to safeguard all data, records, and financial books against loss, destruction, unauthorized use, or inappropriate alteration.

8812.3

The PACE organization must establish written policies and implement procedures to protect the privacy of participant records and any information that identifies a particular participant, in accordance with the following requirements:

(a) Information from, or copies of, records may be released only to authorized individuals. Original medical records may be released only in accordance with federal or District law, court orders, or subpoenas; and

(b) The PACE organization must abide by all federal and District laws regarding confidentiality and disclosure for medical records, mental health records, and other participant health information.

8812.4

The PACE organization must maintain a single, comprehensive medical record for each participant, in accordance with accepted professional standards and the following requirements:

(a) The medical record for each participant must be complete, accurately documented, readily accessible, systematically organized, available to all staff, and maintained and housed at the PACE center where the participant receives services;

(b) At minimum, the medical record must contain the following:

(1) Appropriate identifying information;

(2) Documentation of all services furnished, including but not limited to, a summary of emergency care and other inpatient or long-term care services; services rendered by employees of the PACE center; and services rendered by contractors and their reports;

(3) Interdisciplinary assessments, reassessments, plans of care, treatment and progress notes that include the participant's response to treatment;

(4) Laboratory, radiological and other test reports;

(5) Medication reports;

(6) Hospital discharge summaries, if applicable;

(7) Reports of contact with informal support (e.g., caregiver, legal guardian, or next of kin);

(8) PACE enrollment agreement;

(9) Physician orders;

(10) Discharge summary and disenrollment justification, if applicable;

(11) Advance directives, if applicable; and

(12) A signed release permitting disclosure of personal information;

(c) The PACE organization must promptly transfer copies of medical record information between treatment facilities;

(d) All entries in the medical record must be legible, clear, complete, and appropriately authenticated and dated. Acceptable types of authentication include signatures or secured computer entry by a unique identifier of the primary author who has reviewed and approved the entry; and

(e) The PACE organization must retain each participant medical record for the period of time required under § 8812.6.

8812.5

A participant must be granted timely access, upon request, to review and copy his or her own medical records and to request amendments to those records.

8812.6

The PACE organization must retain records for the longest of the following periods:

(a) For medical records of participants, ten (10) years from the last entry date;

(b) For medical records of disenrolled participants, ten (10) years from the

date of disenrollment from PACE; and

(c) For all other records, ten (10) years from the last entry date.

8812.7

The PACE organization must establish and maintain a health information system that collects, analyzes, integrates, and reports data necessary to measure the organization's performance, including outcomes of care provided to participants. The PACE organization must furnish data and information pertaining to its provision of participant care in the manner, and at the time intervals, specified by CMS and DHCF in the PACE program agreement.

8812.8

The PACE organization must participate in the District's Health Information Exchange (DC HIE) as specified in the PACE program agreement.

D.C. Mun. Regs. tit. 29, r. 29-8812

Final Rulemaking published at 69 DCR 6400 (6/3/2022)