New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 308 - MANAGED CARE PROGRAM
Part 21 - QUALITY MANAGEMENT
Section 8.308.21.16 - MEDICAL RECORDS
Current through Register Vol. 35, No. 18, September 24, 2024
The member's medical records, as described in the medicaid managed care services agreement or the managed care policy manual, shall be legible, timely, current, detailed and organized to permit effective and confidential patient care and quality reviews. The MCO shall:
A. have medical record confidentiality policies and procedures and medical record documentation standards for its providers and subcontractors;
B. have a process to review medical records to ensure compliance with MCO policy, procedures and standards;
C. cooperate with the EQRO in its review of medical records to ensure compliance with its medical record policy and standards;
D. provide HSD or its designee access to a member's medical and behavioral health records;
E. include provisions in contracts with providers for MCO and HSD or its designee, access to member medical records for the purposes of compliance or quality review;
F. ensure that the assigned primary care provider (PCP), the patient centered medical home or the patient centered health home maintain a primary medical and as appropriate, behavioral health record for each member; this record must contain sufficient information from each provider involved in the member's care to ensure continuity of care;
G. ensure all providers involved in the member's care have access to the primary medical record; and
H. have policies and processes that ensure the confidential transfer of medical and behavioral health information between its providers, its agencies or other health plans.
