California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 6 - ISSUER REPORTING REQUIREMENTS AND AUDIT INFORMATION › Section 58078 - Records Maintenance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Each Issuer shall maintain information as stipulated in subsection (f) on all
					 Policy or Certificate holders who have ever received any benefit under the
					 Policy or Certificate. Such information shall be updated at least Quarterly.
					 This requirement for updating shall not require the conduct of any assessment,
					 reassessment, or other evaluation of the Policy or Certificate holder's
					 condition which is not otherwise required by federal or State statute or
					 regulation.
(b) When a Policy or
					 Certificate holder who has received any benefit dies or lapses or his or her
					 Policy or Certificate for any reason, the Issuer must retain the stipulated
					 information for a period of at least five (5) years after the time when the
					 Policy ceases to be in force. Unless notified by the Department of Health
					 Services to the contrary during this period, after the five (5) years, the
					 Service Summary provided by the Issuer will be deemed to comply with all
					 Medi-Cal Property Exemption reporting, record keeping, auditing and quality
					 control requirements of this rule. The Issuer may use microfiche, microfilm,
					 optical storage media, or any other cost effective method of record storage as
					 alternatives to storage of paper copies of stipulated information.
(c) At the time the Policy or Certificate
					 ceases to be in force, the Issuer shall notify the Policy or Certificate holder
					 of his or her right to request his or her service records as stipulated in
					 subsection (f).
(d) The Issuer
					 shall also, upon request in writing, provide such Policy or Certificate holder
					 or the Policy or Certificate holder's Authorized Designee, if any, with a copy
					 of the Issuer's service records as required in subsection (f) which are
					 necessary to establish the Medi-Cal Property Exemption. These records shall be
					 provided to the Policy or Certificate holder or the Policy or Certificate
					 holder's Authorized Designee, if requested, within sixty (60) days of the
					 request. The Issuer may charge a reasonable fee to cover the costs of providing
					 each set of requested service record copies.
(e) The Issuer shall enclose with the records
					 a statement advising the former Policy or Certificate holder that it is in his
					 or her interest to retain the records if he or she may ever wish to establish
					 eligibility for the Medi-Cal Program.
(f) The information to be maintained includes
					 the following:
(1) evidence that the Benefit
					 Eligibility has taken place;
(A) Benefit
					 Eligibility must be documented by a Care Management Provider Agency, or its
					 Qualified Official Designee, as part of the initial assessment of the client or
					 as part of a subsequent reassessment.
(B) These assessments must be based on direct
					 observations and interviews in conjunction with a medical record review. The
					 Care Manager carrying out the assessment or their Care Management Supervisor
					 must sign and certify the completion of the assessment. Each individual who
					 completes a portion of such assessment shall sign and certify as to the
					 accuracy of that portion of the assessment.