The provider agency must comply with the following requirements for recordkeeping:
(1) Maintain all records according to:
(A) Chapter 49 of this title (relating to Contracting for Community Care Services);
(B) Chapter 69 of this title (relating to Contracted Services); and
(C) the provider agency's plan of operation.
(2) Maintain records of compliance with the requirements of this chapter.
(3) Maintain financial records:
(A) to support billings to DHS for payment under §58.137 of this chapter (relating to What must the provider agency do to get paid by DHS?);
(B) to document reimbursements made by DHS. The documentation must include:
(i) amount of reimbursement;
(ii) voucher number;
(iii) warrant number;
(iv) date of receipt; and
(v) any other information necessary to trace deposits of reimbursements and payments made from the reimbursements in the provider agency's accounting system; and
(C) in accordance with generally accepted accounting principles (GAAP) and DHS procedures. A provider agency's financial records must include:
(i) deposit slips, bank statements, cancelled checks, and receipts;
(ii) purchase orders;
(iv) journals and ledgers;
(v) timesheets, payroll, and tax records;
(vi) Internal Revenue Service, Department of Labor, and other government records and forms;
(vii) records of insurance coverage, claims, and payments (for example, medical, liability, fire and casualty, and workers' compensation);
(viii) equipment inventory records;
(ix) records of the provider agency's internal accounting procedures;
(x) chart of accounts, as defined by GAAP; and
(xi) records of company policies.
(4) Maintain invoices, contracts, and service delivery records of all subcontractors. Maintaining all records to support claims is the responsibility of the prime contractor.
The provider agency must maintain service delivery documentation that contains:
(1) the name of the person delivering the services;
(2) the client's name;
(3) the client's Medicaid number;
(4) the specific coverage period, including month, day, and year, as applicable;
(5) the tasks assigned;
(6) the units of service delivered;
(7) the dates of service delivery; and
(8) certification that the documented services were delivered.
(a) For electronic service delivery documentation systems, each person delivering services inputs a unique identifier to certify the services delivered.
(b) For paper service delivery documentation systems, each person delivering services signs the timesheet to certify the services delivered.
(1) The person must sign his or her name or a mark representing his or her name on the timesheet to certify that it is correct. Initials are not an acceptable substitute for a signature.
(2) A person delivering the services who is unable to sign the timesheet may designate another person to sign the timesheet. The provider agency must maintain written documentation of the:
(A) reason the person delivering the services is unable to sign the timesheet; and
(B) identity of the person authorized to sign the timesheet on behalf of the person delivering the services.
(a) The provider agency must provide services as required in its contract, comply with all requirements in this subchapter and in its contract, and comply with the following requirements to receive reimbursement:
(1) Bill for services provided as described in §49.9 of this title (relating to Billings and Claims Payment).
(2) Agree to accept the unit rate DHS authorizes.
(3) Maintain the documentation for reimbursement required in this chapter.
(4) Document services as required by the agency's plan of operation described in §58.23 of this chapter (relating to What must the provider agency's plan of operation include?).
(5) Bill for services provided as required by the agency's plan of operation described in §58.23 of this chapter.
(b) Provider agencies that do not meet these requirements will not be paid or will be required to reimburse DHS for incorrect payments in accordance with §49.9 of this title.