Regulation detail

22-A3007

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22-A3007 RECORDS

Jurisdiction: DC Agency: DC Department of Behavioral Health (DBH) — Title 22-A; and DC Department of Health Care Finance (DHCF) — Title 29 Medicaid behavioral-health chapters
OUTPATIENT (80%)
Plain-English summary

This regulation requires each participating Freestanding Mental Health Clinic (FSMHC) in DC to maintain consumer records, individual plans of care, and financial/claims records in a manner that is auditable by federal, District, and Department personnel. Records must be made immediately available upon request, and failure to cooperate may result in payment suspension, referral to the Medicaid Fraud Control Unit, or contract termination. All required financial and treatment records must be retained for at least ten years from the date of treatment, until the consumer turns 18, or until any audit or litigation is completed, whichever is latest.

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Regulation text
3007 RECORDS

3007.1 In order to ensure that the treatment provided and reimbursed by the District is of the highest quality and fully meets all standards for certification and reimbursement, each participating FSMHC shall maintain consumer records and individual plans of care in a manner that will render them amenable to audit and review by authorized Federal, District, and Department personnel.

3007.2 The requirements of § 3007.1 shall comply with mandated access requirements in federal and local law. 

3007.3 The participating FSMHC shall maintain, and make immediately available upon request by the Department and local Medicaid personnel, complete financial, claims, and medical records. Failure to cooperate may result in suspension of payment(s), referral to the Medicaid Fraud Control Unit, and termination of the provider’s contract.

3007.4 All required financial and treatment records and information shall be properly maintained for a period of at least ten (10) years following the date of treatment for which a claim for reimbursement was made, or the date at which the consumer turns eighteen (18), or until an audit or litigation has been completed, whichever is the latest date.

3007.5 All medical records shall be retained in accordance with Federal and District law.

SOURCE: Final Rulemaking published at 67 DCR 11929 (October 16, 2020).

District of Columbia Municipal Regulations

 Mental Health
22-A DCMR § 3007