Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-049 - Child Health Management Services (CHMS) Provider Manual Update #122; Section V Update - Forms DMS-201 and DMS-202

Current through Register Vol. 49, No. 6, June, 2024
Section
			 IIChild Health Management Services
203.100
Required CHMS Medical/Clinical
			 Records
CHMS providers are required to maintain the following
				medical/clinical records.
A. A daily
			 log of patient visits shall be maintained by the CHMS clinic. The clinic staff
			 will record the entry and exit time of day of each client.
B. All CHMS services provided must be
			 recorded in the patient's record, dated and signed by the person performing the
			 service. The beginning and ending time of day of each service must be
			 recorded.
C. For CHMS
			 Diagnosis/Evaluation Services:
Complete and accurate clinical records must be maintained for
				any patient who receives direct services from the CHMS clinic. Each record must
				contain, at a minimum, the following information:
1. Identifying data and demographic
			 information;
2. Consent for service
			 and release of information forms required by law or local policy;
3. Referral source(s) as documented by a PCP
			 referral;
4. Reason(s) for referral
			 as documented on the PCP referral;
5. Content and results of all diagnostic
			 work-ups and/or problem assessments, including the source documents, e.g.,
			 social history, test protocols, mental status examination, history of
			 complaints, etc.;
6. Treatment plan
			 signed by a CHMS clinic physician;
7. Medication record of all prescribed and/or
			 administered medications;
8.
			 Progress notes and/or other documentation of:
a. Treatment received;
b. Referral for treatment;
c. Changes in the patient's situation or
			 condition;
d. Significant events in
			 the patient's life relevant to treatment and e. Response to
			 treatment.
9. Submittal
			 of prior authorization request (including intervention/treatment needed) to
			 CHMS prior authorization contractor when appropriate.
D. For CHMS Intervention/Treatment Services:
The following additional records must be maintained for
				patients receiving treatment in pediatric day programs.
1. Documentation of completion of intake
			 process.
2. Documentation of
			 interdisciplinary evaluation to address presenting diagnosis and establish base
			 line of functioning and subsequent submission of prior authorization
			 request.
3. CHMS physician's
			 enrollment orders, form DMS-201, signed treatment plan and 6 month records
			 review completed and signed by a CHMS physician.
4. PCP initial referral and 6 month pediatric
			 day treatment referral.
5. Daily or
			 weekly treatment records documenting services provided, relation of service to
			 treatment plan and level of completion of treatment goal. Services must be
			 provided in accordance with the treatment plan, with clear documentation of the
			 services rendered.
a. If a child does not
			 receive all services as outlined in the treatment plan, there must be clear
			 documentation regarding the reason the prescribed services were not provided
			 (e.g. child absent, therapist unavailable, etc.)
b. If a child does not receive the prescribed
			 amount of therapy due to the unavailability of CHMS therapy staff for a period
			 of more than 2 (two) weeks, the primary care physician and the child's
			 parent/guardian must be notified of the missed therapy and given an estimated
			 time frame in which therapy services should resume at the prescribed
			 rate.
6. Revisions of
			 treatment plan including treatment goals will be documented at a minimum of
			 each six months, or more often if warranted by the patient's progress or lack
			 of progress.