Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-53 - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Section 560-X-53-.15 - Data Collection, Record Maintenance, Report

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A PO must collect data, maintain records,
			 and submit reports as specified by AMA and CMS in the PACE agreement to enable
			 monitoring of the operation, cost, quality, and effectiveness of the program
			 and establishment of payment rates.
(2) Written procedures must be established to
			 safeguard all data, records, and financial books against loss, destruction,
			 unauthorized use, or alteration.
(3) All federal and state laws are to be
			 followed regarding the confidentiality and disclosure of health information and
			 records for Participants. Written procedures must be established to ensure that
			 confidentiality is maintained. Records should be updated timely in order to
			 maintain accurate records. Each Participant has the right to review their
			 record and must be allowed timely access to review and copy his or her records.
			 Each Participant may also request amendments to his or her records. Only
			 authorized individuals may receive information or copies of a record. Original
			 medical records are to be released only in accordance with federal and state
			 laws, court orders, or subpoenas.
(4) Records are to be retained as specified
			 in
			 42 CFR
			 460.200.
(5) At a minimum, AMA and CMS are to have
			 access to data and records pertaining to participant health outcomes, financial
			 information, medical records, and personnel records.
(a) A health information system must be
			 established and maintained by a PO. The system is to be utilized to collect,
			 analyze, integrate, and report data needed to measure the PO's performance and
			 outcome of care furnished to Participants.
(b) Accurate financial reports are to be
			 prepared using an accrual basis of accounting that can be verified by qualified
			 auditors. Standardized accounting, statistical, and reporting practices and
			 definitions that are widely accepted in the health care industry must be
			 followed. The financial system must accurately document all financial
			 transactions, provide audit trails to source documents, and have the ability to
			 generate financial statements. CMS and AMA must be allowed access to any
			 financial information and records of an original entry that pertain to any
			 aspect of services furnished, reconciliation of benefit liabilities for
			 participants, and determinations of Medicare and Medicaid payments.
(c) Quarterly financial statements are to be
			 submitted by the PO within 4 5 days of the last day of each quarter during the
			 trial period. Monthly and quarterly statements may be required if CMS and AMA
			 determine that more frequent monitoring is required. A financial statement
			 certified by an independent CPA must be submitted no later than 180 days of the
			 end of the PO's fiscal year. Required contents for the statements are listed in
			 460.208.
(d) Complete and
			 accurately documented comprehensive medical records are to be maintained for
			 each Participant following accepted professional standards. All entries must be
			 legible, clear, complete, dated, and appropriately authenticated as specified
			 in 460.210 (d). Each medical record must contain the information and
			 documentation specified in 460.210. Medical records are to be systematically
			 organized, readily accessible, available to all staff, and maintained at the PO
			 where services are received by the Participant. A copy of medical information
			 must be transferred promptly between treatment facilities as needed.