(1)INDIVIDUAL RECORD REQUIREMENTS. The Brokerage must maintain current, up-to-date records for each individual receiving brokerage and support services and must make these records available to the Department upon request. The individual or the legal representative of the individual may access any portion of the record upon request. Individual records must include, at minimum:
(a)Application and eligibility information received from the referring CDDP; and
(b)Documents related to determining eligibility for brokerage and support services;
(2)CONFIDENTIALITY AND DISCLOSURE.
(a)Individual records must be kept confidential in accordance with ORS 179.505 (Disclosure of written accounts by health care services provider) and any Department rules or policies pertaining to individual records.
(b)For the purpose of disclosure from individual medical records under these rules, Brokerages are considered “providers” as defined in ORS 179.505 (Disclosure of written accounts by health care services provider)(1) and ORS 179.505 (Disclosure of written accounts by health care services provider) is applicable.
(c)Access to records by the Department does not require authorization by an individual or the legal or designated representative or family of the individual.
(d)For the purpose of disclosure of non-medical individual records, all or portions of the information contained in the non-medical individual records may be exempt from public inspection under the personal privacy information exemption to the public records law set forth in ORS 192.502(2).
(3)GENERAL FINANCIAL POLICIES AND PRACTICES. The Brokerage must:
(a)Maintain up-to-date accounting records consistent with generally accepted accounting principles that accurately reflect all revenue by source, all expenses by object of expense, and all assets, liabilities, and equities;
(b)As a Brokerage offering services to the general public, establish and revise, as needed, a fee schedule identifying the cost of each service provided. Billings for Medicaid funds may not exceed the customary charges to private individuals for any like item or services charged by the Brokerage; and
(c)Develop and implement written statements of policy and procedure as are necessary and useful to assure compliance with any Department rule pertaining to fraud and embezzlement.
(4)RECORDS RETENTION. Records must be retained in accordance with OAR chapter 166, division 150, Secretary of State, Archives Division.
(a)Financial records, supporting documents, statistical records, and all other records (except individual records) must be retained for at least three years after the close of the contract period.
(b)Individual records must be kept for at least seven years.
Rule 411-340-0080 — Record Requirements,