N.J. Admin. Code § 10:74-10.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:74-10.1 - Medical information

(a) Each contractor shall maintain medical information on each member who has received medical services while enrolled in the contractor's plan, and shall retain such records in accordance with 45 CFR Part 74 and applicable Federal and State law and rule.

(b) Each enrollee's medical information shall be kept in detail consistent with applicable Federal and State requirements and good medical and professional practice, based on the service provided.

(c) Each contractor shall conform to the standards of confidentiality of information mandated for Federal and State officials (Section 1902(a)(7) of the Federal Social Security Act, 42 CFR Part 438 as included herein by reference, as amended and supplemented, 30:4D-7(g), and 10:49-9.7 and 9.8).

(d) Medical information of enrollees shall be sufficiently complete to permit subsequent medical and quality audits. All required records, either originals or reproductions thereof, shall be maintained in legible form and readily available to appropriate Division professional staff or its agents, upon request for review, audit and evaluation by professional medical, nursing and investigative staff, in accordance with appropriate Federal and State laws, rules and regulations.

(e) The contractor shall release medical records/information of enrollees, as may be directed by authorized personnel of the Division, appropriate agencies of the State of New Jersey or the United States Government, consistent with the provisions of confidentiality ( 42 CFR Part 438, 30:4D-7(g) and 10:49-9.7) .

(f) The contractor and/or its MCO participating servicing providers shall agree to release the comprehensive medical records/information of enrollees upon termination of their coverage, as may be directed by the enrollee, authorized personnel of the Division, appropriate agencies of the State of New Jersey or of the United States Government.

N.J. Admin. Code § 10:74-10.1

Amended by R.2006 d.17, effective 1/3/2006.
See: 37 N.J.R. 2787(a), 38 N.J.R. 294(d).
In (a), substituted "applicable Federal and" for "appropriate"; in (c) and (e), amended CFR and N.J.S.A. references and deleted Federal Social Security Act reference in (e); added (f).
Amended by R.2012 d.041, effective 2/21/2012.
See: 43 N.J.R. 257(b), 44 N.J.R. 494(a).
Section was "Medical records". In (a), substituted "medical information" for "a medical record"; in (b) and (d), substituted "information" for "records"; in (d), substituted "medical and quality audits" for "peer review or medical audit"; in (e) and (f), inserted "/information"; in (e), deleted a comma following "30:4D-7(g)"; and in (f), deleted a comma following "New Jersey".