Iowa Admin. Code r. 441-73.18

Current through Regsiter Vol. 46, No. 26, June 12, 2024

Rule 441-73.18 - Records and reports

(1)Records system. The MCPs shall document and maintain clinical and fiscal records in accordance with federal and state requirements, including 441-Chapter 79 and 42 CFR 456 as amended to July 19, 2022, throughout the course of the contract. The records system shall:

a. Identify transactions with or on behalf of each enrollee by the state identification number assigned to the enrollee by the department.

b. Provide a rationale for, and documentation of, decisions made by the MCP based upon medical necessity.

c. Permit effective professional review for medical audit processes.

d. Facilitate an adequate system for monitoring treatment reimbursed by the managed care organization including follow up of the implementation of discharge plans and referral to other providers.

(2)Content of individual treatment record. The MCP shall ensure that participating providers maintain an adequate record-keeping system that includes a complete medical, dental, or service record for each enrolled member including documentation of all services provided to each enrollee in compliance with the contract and provisions of 441-Chapter 79 and pursuant to federal funding requirements, including 42 CFR 456 as amended to July 19, 2022. Beginning January 1, 2021, the managed care organization shall require use of an electronic visit verification system for personal care services.

(3)Confidentiality of health care, mental health care, and substance abuse information. The MCP shall protect and maintain the confidentiality of health care, mental health care, dental care and substance abuse information by implementing policies for staff and through contract terms with participating providers. The policies must comply with applicable state and federal laws.

Iowa Admin. Code r. 441-73.18

Adopted by IAB January 6, 2016/Volume XXXVIII, Number 14, effective 1/1/2016

Amended by IAB May 5, 2021/Volume XLIII, Number 23, effective 7/1/2021

Amended by IAB April 5, 2023/Volume XLV, Number 20, effective 6/1/2023