. The DH provider must maintain records
in compliance with the requirements set forth in 130 CMR 450.000:
and all other
applicable state and federal laws. All records, including, but not limited to,
the following, must be accessible and made available on site for inspection by
the MassHealth agency or its designee.
(a)
Member Records. The record must contain information
necessary to identify the member. Each member's record also must include all
documentation pertaining to the DHSP and the design of an appropriate DHSP,
including, but not limited to, the following:
1. the member's name, member identification
number, address, telephone number, sex, age, marital status, next of kin or
authorized representative, school or employment status, the date of initial
contact with the program, and the emergency fact sheet in accordance with
130
CMR 419.430(D);
2. a member profile that includes a brief
history, including diagnoses and clinical and behavioral needs. If applicable,
the member profile must also include specialized service needs, the name of the
DHSM assigned to the member, and the name and contact information of the DDS
service coordinator, if applicable;
3. an educational, social, medical, and
vocational history with assessment reports from providers, as
applicable;
4. an updated record of
past and present immunizations and tuberculin tests or screening, based on the
recommendations of the CDC;
5. a
copy of the initial clinical assessment, and copies of any
reassessments;
6. a report of the
member's most recent annual physical examination or wellness visit;
7. the name, address, and telephone number of
the PCP serving the member;
8.
written approval of the DHSP from the IDT and the member or the member's
authorized representative;
9.
documentation that the PCP was notified in writing of the approved
DHSP;
10. documentation supporting
the level of payment associated with services provided to the member;
11. DH staff documentation of all conferences
with the member, the member's authorized representatives, and with outside
professionals;
12. daily attendance
records;
13. transportation records
when MassHealth DH or subcontracted transportation is provided;
14. progress notes updated monthly by the
DHSM when appropriate and available, and by other people significantly involved
in implementing the DHSP;
15.
progress notes written by the health care supervisor, updated quarterly or more
often as necessary to address any significant changes in member's
status;
16. reports of all
semi-annual reviews conducted in accordance with
130
CMR 419.405(A)(1)(d) and
419.419(C)(3)
and any other reports generated in
compliance with 130 CMR 419.000;
17. written authorization from the member or
the member's authorized representative for the release of information, as
applicable;
18. the discharge
notice, if the member is discharged;
19. a copy of the Level II PASRR notice, if
applicable;
20. documentation that
the PA approval supporting the need for DH ISS was obtained prior to billing,
if applicable;
21. documentation of
each 15-minute unit of ISS delivered to the member, if applicable;
and
22. documentation received from
a hospice provider, if applicable, affirming DH services are not related to the
member's terminal illness.
(b)
Administrative
Records. The DH provider must maintain
1. payroll records;
2. personnel records, including requirements
set forth in
130
CMR 419.421(A), including
evidence of completed staff orientation and training;
3. financial and billing records;
4. member utilization records, including the
number of members being served and, if applicable, number of individuals on a
waiting list;
5. records of
staffing levels and staff qualifications;
6. records of complaints and grievances;
and
7. contracts for subcontracted
services.