Centralized Enrollee Record Clause Samples
The Centralized Enrollee Record clause establishes a unified system for maintaining all records related to individuals enrolled in a program or service. This clause typically requires that all enrollee data, such as personal information, enrollment status, and service history, be stored and updated in a single, centralized database accessible to authorized parties. By consolidating records in one location, the clause ensures consistency, reduces duplication, and streamlines access to information, ultimately improving administrative efficiency and minimizing errors.
Centralized Enrollee Record. A centralized and comprehensive record documenting each Covered Person’s medical, functional, and social status, and containing information relevant to maintaining and promoting each Covered Person’s general health and well being, as well as clinical information concerning illnesses and chronic medical conditions.
Centralized Enrollee Record. To coordinate care, the Contractor must maintain a single, centralized, comprehensive record that documents the Enrollee's medical, prescription, functional, and social status. The Contractor must ensure that the PCP and all members of the ICT, as well as any other appropriate providers, including First Tier, Downstream and Related Entities, make appropriate and timely entries describing the care provided, diagnoses determined, medications prescribed, and treatment plans developed. The Centralized Enrollee Record must contain the following:
a. Enrollee-identifying information and demographic information (including race, ethnicity, disability type, primary language and homelessness), and family caregiver contact information;
b. Documentation of each service provided, including the date of service, the name of both the authorizing provider and the servicing provider (if different), and how they may be contacted; and for prescribed medications, including dosages and any known drug contraindications;
c. Documentation of physical access and programmatic access needs of the Enrollee, as well as needs for accessible medical equipment;
d. Documentation of communication access needs, including live interpreting services, access to telephone devices and advanced technologies that are hearing aid compatible, and video relay service or point-to-point video, for Enrollees who are Deaf or hard of hearing;
e. Documentation of Comprehensive Assessments, including diagnoses, prognoses, plans of care, and treatment and progress notes, signed and dated by the appropriate provider;
f. Laboratory and radiology reports;
g. Updates on the Enrollee’s involvement and participation with community agencies that are not part of the Provider Network, including any services provided;
h. Documentation of contacts with family members and persons giving informal support, if any;
i. Physician orders;
j. Enrollee's individual advance directives and health care proxy, recorded and maintained in a prominent place;
k. Plan for Emergency Conditions and Urgent Care, including identifying information about any emergency contact persons;
l. Emergency psychiatric crisis plans;
m. Allergies and special dietary needs; and
n. Information that is consistent with the utilization control requirement of 42 C.F.R. 456 et. seq.
Centralized Enrollee Record. As applicable, Provider shall comply with Subcontractor’s and Health Plan’s policies and statutory and regulatory requirements applicable to the Centralized Enrollee Record and other Covered Person medical records. This shall include, at a minimum, compliance with all federal and State legal requirements as they pertain to the confidentiality of Covered Person records (as further set forth in Section 3.8 of this Appendix) and all confidentiality protections established by Subcontractor or Health Plan. Provider shall make appropriate and timely entries in the Centralized Enrollee Record describing the care provided, diagnoses determined, medications prescribed, and treatment plans developed (as applicable). The documentation included in the Centralized Enrollee Record must be consistent with current professional standards and be current, detailed, and organized in a manner that permits effective patient care and quality review. If Provider is a PCP, Provider shall be responsible for maintaining the Centralized Enrollee Record for Covered Persons residing in the community. Nursing home Providers will be responsible for maintaining the Centralized Enrollee Record for Covered Persons who reside in such nursing home. Additional requirements for the Centralized Enrollee Record are set forth in the provider manual.
Centralized Enrollee Record. 2.6.6.2.1. To coordinate care, the Contractor must maintain a single, centralized, comprehensive record that documents the Enrollee's medical, prescription, functional, and social status. The Contractor must ensure that the PCP and all members of the ICT, including the LTS Coordinator, as well as any other appropriate providers, including First Tier, Downstream, and Related Entities, make appropriate and timely entries describing the care provided, diagnoses determined, medications prescribed, and treatment plans developed. The Centralized Enrollee Record must contain the following:
2.6.6.2.1.1. Enrollee-identifying information and demographic information (including race, ethnicity, disability type, primary language and homelessness), and family caregiver contact information;
2.6.6.2.1.2. Documentation of each service provided, including the date of service, the name of both the authorizing provider and the servicing provider (if different), and how they may be contacted; and for prescribed medications, including dosages and any known drug contraindications;
2.6.6.2.1.3. Documentation of physical access and programmatic access needs of the Enrollee, as well as needs for accessible medical equipment;
2.6.6.2.1.4. Documentation of communication access needs, including live interpreting services, access to telephone devices and advanced technologies that are hearing aid compatible, and video relay service or point-to-point video, for Enrollees who are Deaf or hard of hearing;
2.6.6.2.1.5. Documentation of Comprehensive Assessments, including diagnoses, prognoses, plans of care, and treatment and progress notes, signed and dated by the appropriate provider;
2.6.6.2.1.6. Laboratory and radiology reports;
2.6.6.2.1.7. Updates on the Enrollee‘s involvement and participation with community agencies that are not part of the Provider Network, including any services provided;
2.6.6.2.1.8. Documentation of contacts with family members and persons giving informal support, if any;
2.6.6.2.1.9. Physician orders;
2.6.6.2.1.10. Enrollee's individual Advance Directives and health care proxy, recorded and maintained in a prominent place;
2.6.6.2.1.11. Plan for Emergency Conditions and Urgent Care, including identifying information about any emergency contact persons;
2.6.6.2.1.12. Emergency psychiatric crisis plans; 2.
Centralized Enrollee Record. The ICDS Plan must use information technology systems and processes to integrate the following data elements, at a minimum, into a single, centralized, comprehensive record for each Beneficiary: demographic data; Enrollment data; Care Management data, including assessment results, the ICP, waiver service plan, case notes, Care Manager assignment, etc.; claims and pharmacy data; and authorizations and referrals. The ICDS Plan must ensure that the centralized enrollee record is current, available and accessible twenty-four (24) hours a day, seven (7) days a week in entirety and/or as a summary of key clinical/Care Management data to members of the Trans-Disciplinary Care Team or other authorized personnel in order to facilitate Care Management needs, respond to urgent/emergent needs, and to ensure effective, safe service delivery. In the event that the ICDS Plan is unable to implement the information technology systems and processes necessary to meet this requirement prior to the Contract Operational Start Date, then ODM and CMS may temporarily waive this requirement to allow the ICDS Plan additional time to bring itself into compliance. The decision to grant additional time to the ICDS Plan, and the duration of such time, will be determined by, and at the discretion of, ODM and CMS. In all cases, the ICDS Plan is expected to make all reasonable efforts to achieve compliance with this requirement as timely as possible.
Centralized Enrollee Record. To coordinate care, the Contractor must maintain a single, centralized, comprehensive record that documents the Enrollee's medical, functional, and social status. The Contractor must ensure that the PCP and all members of the PCT as well as any other appropriate Providers, including subcontracted Providers, make appropriate and timely entries describing the care provided, diagnoses determined, medications prescribed, and treatment plans developed. The organization and documentation included in the Centralized Enrollee Record must meet all applicable professional requirements. The Centralized Enrollee Record must contain the following:
a. Enrollee identifying information;
b. Documentation of each service provided, including the date of service, the name of both the authorizing Provider and the servicing Provider (if different), and how they may be contacted;
c. Multidisciplinary assessments, including diagnoses, prognoses, reassessments, plans of care, and treatment and progress notes, signed and dated by the appropriate Provider;
d. Laboratory and radiology reports;
e. Prescribed medications, including dosages and any known drug contraindications;
f. Reports about the involvement of community agencies that are not part of the Provider Network, including any services provided;
g. Documentation of contacts with family members and persons giving informal support, if any;
h. Physician orders;
i. Disenrollment agreement, if applicable;
j. Enrollee’s individual advance directives and health care proxy, recorded and maintained in a prominent place;
k. Plan for Emergency Conditions and Urgent Care, including identifying information about any emergency contact persons; and
l. Allergies and special dietary needs.
Centralized Enrollee Record. (CER) - Centralized and comprehensive documentation, containing information relevant to maintaining and promoting each Enrollee's general health and well-being, as well as clinical information concerning illnesses and chronic medical conditions. See Section 2.5 for more information about the contents of the Centralized Enrollee Record.