5013 RECORDS

5013.1 Each Provider shall maintain complete and accurate records reflecting the specific PCA services provided to each beneficiary for a service billed. Such records must be:

(a) Maintained for a period of at least ten (10) years. If DHCF notifies the provider of an impending audit prior to the end of the ten (10) year record maintenance period, or if an audit is underway at the end of the ten (10) year record maintenance period, records must be maintained until the audit is completed; and

(b) Recorded pursuant to § 5006.4(c).

5013.2 Each Provider shall be responsible for maintaining the confidentiality of each beneficiary's care, treatment, and records. The disclosure of personal health information by the Provider is subject to all of the provisions set forth in applicable District and Federal laws and rules.

5013.3 Each beneficiary's record shall be readily retrievable and shall be kept in a locked room or file maintained and safeguarded against loss or unauthorized use at the location of the Provider's place of business that is identified on the Provider's Medicaid Provider application.

5013.4 Each Provider shall permit reviews and on-site inspections to be conducted by CMS and its agents, and DHCF, and its agents to determine Provider compliance with all applicable laws.

5013.5 Each Provider shall comply with the terms of its Medicaid Provider Agreement with respect to the maintenance of all beneficiary and financial records.

5013.6 Each beneficiary's record shall include, but is not limited to, the following information:

(a) General information including the beneficiary's name, Medicaid identification number, address, telephone number, age, sex, name and telephone of emergency contact person, authorized representative (if applicable), and primary care physician's or advanced practice registered nurse's name, address, and telephone number;

(b) Health care information, including all referrals, assessments, service authorizations, plans of care, and progress notes;

(c) Dates and description of PCA services rendered, including the name and

NPI of the personal care aide performing the services;

(d) Documentation of each supervisory visit of the R.N., including signed and dated clinical progress notes;

(e) Discharge summary, if applicable;

(f) Copies of any written notices given to the beneficiary; and

(g) Any other appropriate identifying information that is pertinent to beneficiary care.

SOURCE: Final Rulemaking published at 60 DCR 15537 (November 8, 2013); as amended by Final Rulemaking published at 63 DCR 14134 (November 18, 2016); as amended by Final Rulemaking published at 73 DCR 007348 (May 15, 2026).