(a) Each provider shall keep, maintain, and
have readily retrievable, such records as are necessary to fully disclose the
type and extent of services provided to a Medi-Cal beneficiary. Required
records shall be made at or near the time at which the service is rendered.
Such records shall include, but not be limited to the following:
(1) Billings.
(2) Treatment authorization
requests.
(3) All medical records,
service reports, and orders prescribing treatment plans.
(4) Records of medications, drugs, assistive
devices, or appliances prescribed, ordered for, or furnished to
beneficiaries.
(5) Copies of
original purchase invoices for medication, appliances, assistive devices,
written requests for laboratory testing and all reports of test results, and
drugs ordered for or supplied to beneficiaries.
(6) Copies of all remittance advices which
accompany reimbursement to providers for services or supplies provided to
beneficiaries.
(7) Identification
of the person rendering services. Records of each service rendered by
nonphysician medical practitioners (as defined in Title 22, CCR, Section
51170) shall include the signature
of the nonphysician medical practitioner and the countersignature of the
supervising physician to the extent required by the applicable professional
licensing statutes and regulations.
(b) Records of institutional providers shall
include, in addition, the following:
(1)
Records of receipts and disbursements of personal funds of beneficiaries being
held in trust by the provider.
(2)
Employment records including shifts, schedules and payroll records of
employees.
(3) Book records of
receipts and disbursements by the provider.
(4) Individual ledger accounts reflecting
credit and debit balances for each beneficiary to whom services are
provided.
(c) Records of
providers shall document the meeting of Code I restrictions for medical
supplies in the list established by the Department and for drugs listed in the
Medi-Cal List of Contract Drugs as follows:
(1) The practitioner who issues a
prescription for a Code I supply or drug shall document, in the patient's
chart, the patient's diagnostic or clinical condition that fulfills the Code I
restriction.
(2) The dispenser
shall maintain readily retrievable documentation of the patient's diagnostic or
clinical condition information that fulfills the Code I restriction. If this
Code I diagnostic or clinical condition information is transmitted to the
dispenser other than by personal handwritten order from the prescriber, the
dispenser shall document the transmittal date and the name of prescriber or the
employee or agent who is legally authorized to transmit such information. The
documentation shall be personally signed by the dispenser.
(d) Every practitioner who issues
prescriptions for Medi-Cal beneficiaries shall maintain, as part of the
patient's chart, records which contain the following for each prescription:
(1) Name of the patient.
(2) Date prescribed.
(3) Name, strength and quantity of the item
prescribed.
(4) Directions for
use.
(e) Records of
medical transportation providers shall include, in addition to (a):
(1) Time and date of service for each
beneficiary.
(2) Odometer readings
at each pick-up and delivery location.
(3) The provider assigned vehicle
identification code and name of the operator providing the service.
(4) Names of beneficiaries transported in
total or partial group runs.
(f) Records of providers of psychiatric and
psychological services shall include in addition to (a), patient logs,
appointment books or similar documents showing the date and time allotted for
appointment of each patient or group of patients, and the time actually spent
with such patients.
(g) A provider
shall make available, during regular business hours, all pertinent financial
books and all records concerning the provision of health care services to a
Medi-Cal beneficiary, and all records required to be made and retained by this
section, to any duly authorized representative of the Department acting in the
scope and course of employment including, but not limited to, employees of the
Attorney General, Medi-Cal Fraud Unit duly authorized and acting within the
scope and course of their employment. Failure to produce records may result in
sanctions, audit adjustments, or recovery of overpayments, in accordance with
Section
51458.1 of this title.
Notes
Cal. Code Regs. Tit. 22, §
51476
1.
Amendment filed 8-10-84; effective upon filing pursuant to Government Code
Section
11346.2(d)
(Register 84, No. 32). For prior history, see Register 81, No.
48.
2. Amendment of subsection (c) and NOTE filed 1-9-95; operative
3-1-95 (Register 95, No. 2).
3. Change without regulatory effect
amending subsections (a)(7), (c) and (f) and amending NOTE filed 1-26-2009
pursuant to section
100, title 1, California Code of
Regulations (Register
2009,
No. 5).
4. Amendment of subsection (a)(7) and NOTE filed 5-17-2012;
operative 6-16-2012 (Register 2012, No. 20).
5. Change without
regulatory effect amending NOTE filed 12-16-2013 pursuant to section
100, title 1, California Code of
Regulations (Register 2013, No. 51).
Note: Authority cited: Section
20, Health and Safety Code; and
Sections
10725,
14105
and
14124.5,
Welfare and Institutions Code. Reference: Sections
14021,
14043.341,
14053,
14105.35,
14107,
14124.1,
14124.2,
14124.24,
14131,
14133,
14133.3
and
14170,
Welfare and Institutions Code; and Title 42, Code of Federal Regulations,
Sections 483.40(e) and
485.631(b)(iv).
1. Amendment filed
8-10-84; effective upon filing pursuant to Government Code Section
11346.2(d)
(Register 84, No. 32). For prior history, see Register 81, No.
48.
2. Amendment of subsection (c) and Note filed 1-9-95; operative
3-1-95 (Register 95, No. 2).
3. Change without regulatory effect
amending subsections (a)(7), (c) and (f) and amending Note filed 1-26-2009
pursuant to section 100, title 1, California Code of Regulations (Register
2009, No. 5).
4. Amendment of subsection (a)(7) and Note filed
5-17-2012; operative 6-16-2012 (Register 2012, No. 20).
5. Change
without regulatory effect amending Note filed 12-16-2013 pursuant to section
100, title 1, California Code of Regulations (Register 2013, No. 51).