A3 Records Retention Schedule - DHHS-LTCOS.pdf

Item # Series Title Series Description Retention Period

Approval Date

STATE OF MICHIGAN

RECORDS RETENTION AND DISPOSAL SCHEDULE

DHHS

MSA - Long Term Care Services

Department of Health and Human Services

LTCOS

00000

Introduction

35075

Expanded Home

Help Requests

(supersedes item #

35077, 35078)

These records document requests for expanded home help services that are covered by Medicaid. They may include client needs assessments, plans, forms, doctor statements, correspondence, financial statements, activity records, supporting documentation, etc.

RETAIN UNTIL: Last date of actions

PLUS: 7 years

THEN: Destroy

8/16/2016

40335

Traumatic Brain

Injury Records

These records document the provision of services through MSA for people with traumatic brain injuries. They may include, but may not be limited to, requests, contracts, reports, medical information, evaluations, correspondence, and supporting documentation.

RETAIN UNTIL: No longer enrolled in program

PLUS: 10 years

THEN: Destroy

2/1/2022

40336

Nursing Facility

Transitions Requests

These records document requests to assist residents with transitions from a facility to a home. They may include applications, requests, release and consent forms, assessments, services received, status information, correspondence, supporting documentation, etc. ACT= until transition ends and follow-ups are completed.

RETAIN UNTIL: No longer active

(see last sentence of description) PLUS:

7 years THEN:

Destroy

8/16/2016

40337

Quality Assurance

Reviews

These records document reviews of MI

Choice and Home Help case files. They may include participant information, correspondence, reports, policies, procedures, etc.

RETAIN UNTIL:

Date created

PLUS: 7 years

THEN: Destroy

8/16/2016

This agency-specific schedule supplements the approved general schedules.

General schedules are available online at https://stateofmichigan.sharepoint.com/teams/insidemi/recordsmanagement/Pages/schedules.aspx .

Approval Date

STATE OF MICHIGAN

RECORDS RETENTION AND DISPOSAL SCHEDULE

DHHS

MSA - Long Term Care Services

Department of Health and Human Services

LTCOS

40338

NFT Service Claims These records document billing from non-waiver funds for nursing facility transitions and non-Medicaid claims for individual transitions. They may include case records, claims, receipts, correspondence, supporting documentation, etc.

RETAIN UNTIL:

Date created

PLUS: 7 years

THEN: Destroy

8/16/2016

40339

Nursing Facility

Level of Care

Determination

Records

These records document reviews of nursing facility level of care determination (LOCD) assessments.

They may include monthly contract reports, monthly invoices, denial notices, adverse action notices issued to providers, records of recoupment action from providers, change of

LOCD codes, date changes to

CHAMPS-based LOCDs, etc.

RETAIN UNTIL:

Date created

PLUS: 7 years

THEN: Destroy

8/16/2016

40355

Bed Certification

Approvals

These records document the certification of nursing homes for

Medicaid reimbursement for a specific number of beds. They may include provider requests, Department of

Licensing and Regulatory Affairs (LARA) correspondence, approval/denial letters, etc. ACT = until the approval or denial letter is issued.

RETAIN UNTIL: No longer active

(see last sentence of description) PLUS:

7 years THEN:

Destroy

8/16/2016

40356

Medicaid Vent Unit

Agreements

These records document agreements between DHHS and a nursing home to provide Medicaid-funded vent units.

They may include provider requests, LARA occupancy documentation, signed agreements, etc. ACT = until expiration of the agreement.

RETAIN UNTIL: No longer active

(see last sentence of description) PLUS:

7 years THEN:

Destroy

8/16/2016

This agency-specific schedule supplements the approved general schedules.

Approval Date

STATE OF MICHIGAN

RECORDS RETENTION AND DISPOSAL SCHEDULE

DHHS

MSA - Long Term Care Services

Department of Health and Human Services

LTCOS

40357

Nursing Facility

Isolation Bed

Authorizations

These records document authorizations for individual residents to receive Medicaid reimbursement for isolation beds. They may include provider requests and approval/denial letters, etc. ACT = until the approval or denial letter is issued.

RETAIN UNTIL: No longer active

(see last sentence of description) PLUS:

7 years THEN:

Destroy

8/16/2016

40358

Nursing Facility

Private Room

Authorizations

These records document authorizations for individual residents to receive Medicaid reimbursement for private rooms. They may include provider requests and approval/denial letters, etc. ACT = until the approval or denial letter is issued.

RETAIN UNTIL: No longer active

(see last sentence of description) PLUS:

7 years THEN:

Destroy

8/16/2016

40359

Civil Monetary

Penalty

Overpayment and

Payment Offset

Records

These records document the adjustment Medicaid reimbursement to nursing facilities because of penalties that were assessed against the facility. They may include CMS requests, accounting documentation, payment vouchers, etc. ACT = until the payment voucher is signed.

RETAIN UNTIL: No longer active

(see last sentence of description) PLUS:

10 years THEN:

Destroy

8/16/2016

40360

Civil Monetary

Penalty Funds

Grants

These records document proposals for funding and the distribution of grant funds from the penalties that are collected from nursing facilities. They may include proposals, internal review documents, correspondence, CMS approval/denial letters, etc. ACT = until the proposal is approved or denied.

RETAIN UNTIL: No longer active

(see last sentence of description) PLUS:

7 years THEN:

Destroy

8/16/2016

This agency-specific schedule supplements the approved general schedules.

Approval Date

STATE OF MICHIGAN

RECORDS RETENTION AND DISPOSAL SCHEDULE

DHHS

MSA - Long Term Care Services

Department of Health and Human Services

LTCOS

40361

Home Help Agency

Provider

Applications

These records document agencies that want to provide Medicaid funded home help services. They may include application letters, supporting documentation, approval/denial letters, correspondence, complaint documentation, etc. ACT = while provider is approved.

RETAIN UNTIL: No longer active

(see last sentence of description) PLUS:

7 years THEN:

Destroy

8/16/2016

40590

Medicaid State

Plan Files

(supersedes item #

5042.2)

These records document state plans for federally-approved Medicaid coverages. They may include proposed and approved amendments, correspondence, etc.

RETAIN UNTIL:

Date created

PLUS: 7 years

THEN: Destroy

5/9/2017

40591

Institutional and

Alternative Long

Term Care Policy

Files (supersedes item #5042.4)

These records document nursing homes, state mental health facilities, foster care, home health, personal care, and case management. They may include forms, memos, correspondence, laws, regulations, etc.

RETAIN UNTIL:

Date created

PLUS: 7 years

THEN: Destroy

5/9/2017

40592

Early and Periodic

Screening Diagnosis and Treatment

(EPSDT) Provider

Files (supersedes item #5042.5)

These records document providers of

EPSDT services. They may include contracts, correspondence, working files for physicians and screening providers, etc.

RETAIN UNTIL:

Date created

PLUS: 6 years

THEN: Destroy

5/9/2017

40593

Physician Primary

Sponsor Plan (PPSP)

Records

(supersedes item #

5042.6)

These records document the PPSP program. They may include correspondence, reports, supporting documentation, etc.

RETAIN UNTIL:

Date created

PLUS: 5 years

THEN: Destroy

5/9/2017

40594

Capitated

Ambulatory Plan

Files (supersedes item #5042.7)

These records document proposals to participate in the program. They may include proposals, contracts, correspondence, reports, supporting documentation, etc.

RETAIN UNTIL:

Date created

PLUS: 6 years

THEN: Destroy

5/9/2017

This agency-specific schedule supplements the approved general schedules.

Approval Date

STATE OF MICHIGAN

RECORDS RETENTION AND DISPOSAL SCHEDULE

DHHS

MSA - Long Term Care Services

Department of Health and Human Services

LTCOS

40595

Policy Bulletins and

Manual Updates

(supersedes item #

5042.8A)

These records document MSA policy bulletins and provider manuals. They may include updates, correspondence, supporting documentation, etc.

RETAIN UNTIL:

Date created

PLUS: 7 years

THEN: Destroy

5/9/2017

40596 - Explanation of

Benefits (EOB)

These records document the

Explanation of Benefits (EOB) process to confirm vendors are servicing clients who are receiving services by

Medicaid providers (42 CFR 438.3(u)).

They may include, but may not be limited to, vendor specifications, clients information, reports, correspondence, and supporting documentation.

RETAIN UNTIL: End of calendar year

PLUS: 10 Years

THEN: Destroy

8/13/2019

This agency-specific schedule supplements the approved general schedules.