Notice of Regulatory Amendment related to Medicaid participating providers and facilities
Please note, this communication applies to Anthem HealthKeepers Plus, Medallion and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc.
This is to notify all participating Medicaid providers of a new regulatory requirement necessitating a Regulatory Amendment to the Anthem HealthKeepers Plus Provider Agreement and the Anthem HealthKeepers Plus Facility Agreement, as required by the Virginia Department of Medical Assistance Services.
Effective immediately, Section 2.13 of the Virginia HMO Medicaid Participation Attachment to the Anthem HealthKeepers Plus Provider Agreement and Section 2.19 of the Virginia HMO Medicaid Participation Attachment to the Anthem HealthKeepers Plus Facility Agreement shall be changed to read in its entirety as follows:
“RECORD RETENTION, INSPECTION, AND AUDITS: Consistent with Federal managed care regulations 42 CFR 438.3(u), the Provider shall maintain books, records, documents, and other evidence of administrative, medical, and accounting procedures and practices for ten (10) years. In accordance with 12VAC30-120-1730, for Members who are children under age 21 and enrolled in the Tech program, the Provider shall retain records for the greater period of a minimum of ten (10) years or at least six (6) years after the minor has reached 21 years of age. Consistent with Federal managed care regulations 42 CFR § 438.3(h), the Provider shall make the records maintained by the Provider as required by the Department and other regulatory agencies, available to the Department and its agents, designees or contractors or any other authorized representatives of the Commonwealth of Virginia or the United States Government, or their designees or contractors, at such times, places, and in such manner as such entities may reasonably request for the purposes of financial or medical audits, inspections, and examinations, provided that such activities are conducted during the normal business hours of the Provider. The right to audit exists for ten (10) years from the final date of the contract period or from the date of completion of any audit, whichever is later. The Provider further agrees that the Secretary of the U.S. Department of Health and Human Services or his or her designee, the Governor or his or her designee, Comptroller General, and the State Auditor or his or her designee have the right at reasonable times and upon reasonable notice to examine the books, records, and other compilations of data of the Provider and its subcontractors that pertain to: the ability of the Plan to bear the risk of potential financial losses; services performed; or, determinations of amounts payable. The Provider shall make available, for the purposes of record maintenance requirements, its premises, physical facilities and equipment, records relating to its Members, and any additional relevant information that the Department may require, in a manner that meets the Department’s record maintenance requirements. The Provider shall comply with the right of the U.S. Department of Health and Human Services, the Comptroller General, and their designees to inspect, evaluate, and audit records through ten (10) years from the final date of the Contract period or the completion of audit, whichever is later, in accordance with Federal and State requirements.”
These changes are made in accordance with Section 7.1 of the Virginia HMO Medicaid Participation Attachment to the Anthem HealthKeepers Plus Provider Agreement and Section 4.2 of the Virginia HMO Medicaid Participation Attachment to the Anthem HealthKeepers Plus Facility Agreement that states: “Notwithstanding the Amendment provision in the Agreement, this Attachment shall be automatically modified to conform to required changes to Regulatory Requirements related to Medicaid Programs without the necessity of executing written amendments.” Note, no action is required by you. If you are currently participating in the Anthem HealthKeepers Plus network, your Virginia HMO Medicaid Participation Attachment is automatically being updated to include the above provisions. If you are not participating in the Anthem HealthKeepers Plus network and would like to participate, please contact your network manager.
If you have any questions about this communication, please contact your local Provider Network Manager.
February 2022 Anthem Provider News - Virginia