Office of Medical Assistance Programs - Records Retention Schedule

Organizational Placement:

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Program: Policy Development

Program Description:

The Policy program is responsible for fee-for-service program and policy development for various health care services covered under the medical assistance program to ensure compliance with state and federal requirements. The program translates federal and state requirements into policy and administrative rules that govern the practitioners who provide services to eligible clients and the reimbursement for those services. Drug and medical procedure codes are also maintained and updated as needed by this program.

The program also provides support services for and receives recommendations from the Drug Use Review Board relating to criteria and standards for appropriate and medically necessary drug utilization (drug prescribing, drug dispensing, and patient medication usage). The Board, operating under ORS 414.350 to 414.415, is comprised of twelve members appointed by the director of OMAP for two year terms. In addition, the Policy program develops and maintains state plans, required by the U.S. Health Care Financing Administration under 42 CFR 433, which coordinate all Medicaid activities for DHR's Divisions. Program staff also participate in a variety of agency, state, and national committees relating to medical assistance policy issues.

Records Description:

Records documenting federal communications are Federal Medicaid Correspondence. Records documenting the development and analysis of fee-for-service policy are Policy Development and Analysis Records, Hospital and Pharmaceutical Claims Payment Reports, and Program Specific Expenditure Reports. Maintenance and updates to medical procedure and drug codes in the Medicaid Management Information System (MMIS) are documented by Reference File Update Records and Drug File Records. Records documenting the actions and activities of the Drug Use Review Board are Drug Use Review Board Records. The development and maintenance of the federally required state plans are Title XIX State Plan Records (Medical Assistance - Social Security Act) and Title XXI State Plan Records (Children's Health Insurance Program - Social Security Act).

Below is a record series list designating their retention:

026 Federal Medicaid Correspondence, 1975 - [ongoing] - Retain policy related correspondence permanently, transfer to State Archives after 25 years. Retain all other records 3 years, destroy.

027 Policy Development and Analysis Records, 1987 - [ongoing] - Retain records relating to policy development unique to Oregon permanently, transfer to State Archives after 25 years. Retain all other records 5 years after implemented or abandoned, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

028 Hospital and Pharmaceutical Claims Payment Reports - Retain 5 years, destroy.

029 Program Specific Expenditure Reports - Retain 5 years, destroy.Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

030 Reference File Update Records - Retain 5 years, destroy.

031 Drug File Records - Retain 5 years, destroy.

032 Drug Use Review Board Records - Retain 5 years, destroy. Some information may be restricted from public disclosure as authorized by ORS 414.390, for life of the records.

033 Title XIX State Plan Records, 1967 - [ongoing] - Retain permanently, transfer to State Archives after 25 years.

034 Title XXI State Plan Records, 1998 - [ongoing] - Retain permanently, transfer to State Archives after 25 years.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Administrative rule preparation records and correspondence (Administrative Records - OAR 166-300-0015).

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Program: Communications

Program Description:

The Communications program is responsible for producing and disseminating educational and informational materials explaining OMAP rules, policies, medical program coverage, and billing procedures. The program develops materials for clients and providers such as provider guides for each provider type (pharmacy, hospital, dental, etc.) and notices of plan or procedure changes, as well as materials used for outreach purposes such as brochures and pamphlets. The program also produces published materials such as budgets, reports, training materials, weekly staff updates (from the Director), and OMAP's quarterly U.S. Health Care Financing Administration report. Program staff monitor and coordinate the printing orders and maintain a historical reference library of OMAP publications. In addition, the program coordinates administrative rule development for the agency.

Records Description:

Records documenting the preparation and development of publications are Publication and Provider/Client Notices Preparation Records. Weekly staff updates are documented by Weekly Updates. Production project tracking is documented by Production Calendar Records and the database PRODUCTION CALENDAR. Quarterly reporting to the U.S. Health Care Financing Administration is documented by U.S. Health Care Financing Administration Quarterly Reports. Records that document a summary of the history, accomplishments, and impact of the OHP and OMAP are documented by Progress Reports. The program also uses a variety of mailing list databases for disseminating information.

Below is a record series list designating their retention:

035 Publication and Provider/Client Notices Preparation Records - Retain 1 year after final document published (printed), destroy.

036 Weekly Updates - Retain 1 year, destroy.

037 Production Calendar Records - Retain 10 years, destroy.

038 U.S. Health Care Financing Administration Quarterly Reports for Oregon Health Plan, Medicaid Demonstration Project, 1993 - [ongoing] - Retain one copy of report permanently, transfer to State Archives after 25 years. Retain preparation records 1 year after report published, destroy.

039 Progress Reports, 1997 - [ongoing] - Retain one copy of report permanently, transfer to State Archives after 25 years. Retain preparation records 1 year after report published, destroy.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Administrative rule preparation records, correspondence, and mailing lists (Administrative Records - OAR 166-300-0015).

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Program: Ombudsman

Program Description:

The Ombudsman program is responsible for advocacy and problem resolution for Oregon Health Plan eligible clients who have disabilities or are aged 65 or older (per ORS 414.712). Through facilitation, communication, and coordination with all parties involved, program ombudsmen resolve issues and problems relating to quality of care, access to care, and limitations on care. If a problem cannot be resolved to the satisfaction of the client, the client has the right to an appeal and hearing (see separate description for the Hearings Program, Medical Director Unit). In addition, the program responds to various inquiries related to advocacy from both internal and external sources.

It is anticipated that the Ombudsman and Client Assistance Hotline (see separate description) programs will be combined in the Program and Policy section in September 1998.

Records Description:

Records documenting inquiries and cases relating to individual clients are Call Intake Records, Ombudsman Case Files, and the tracking databases CALLS and CASES. Records documenting program statistics are Quarterly Statistical Reports.

Below is a record series list designating their retention:

040 Call Intake Records - Retain 5 years, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

041 Ombudsman Case Files - Retain 5 years after final disposition of case, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

042 Quarterly Statistical Reports - Retain 10 years, destroy.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Correspondence, scheduling records (Administrative Records - OAR 166-300-0015).

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Section: Delivery Systems
Program: Administration

Program Description:

The Delivery Systems' Administration program is responsible for coordination and planning activities related to delivery of services under health care plan contracts, as well as providing leadership and direction for the Delivery Systems' Unit. The program coordinates health plan contractor meetings to facilitate and communicate about contract compliance and delivery of services to clients. The program is also responsible for coordinating and facilitating a variety of special projects for OMAP, relating to various medical assistance analysis and planning issues. Project activities may include facilitating task forces, committees, or other work groups. Project results may be implemented as strategic plans, policies, or procedures. In addition, the program conducts planning research and analysis, and facilitates strategies and teams to implement them, as well as tracks and monitors legislation.

Records Description:

Facilitation and communication with health plan contractors are documented by Health Plan Contractor Correspondence and Health Plan Contractor Meeting Records. Records documenting special project and research and analysis activities are Special Project Records and Diversity Task Force Records.

Below is a record series list designating their retention:

043 Health Plan Contractor Correspondence - Retain 6 years after contract expiration, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.501 (2), for life of the records.

044 Health Plan Contractor Meeting Records - Retain 5 years, destroy.

045 Special Project Records - Retain 5 years after project ends, destroy.

046 Diversity Task Force Records - Retain diversity strategic plan 5 years after superseded, destroy. Retain all other records 5 years, destroy.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Correspondence, legislative tracking records, mailing lists, and scheduling records (Administrative Records - OAR 166-300-0015).

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Section: Delivery Systems
Program: Health Plans Financial Solvency

Program Description:

The Health Plans Financial Solvency program is responsible for monitoring, analyzing, and communicating about the financial solvency and status of managed care health plans to OMAP management. The plans provide services under the Oregon Health Plan. The program develops policy on financial solvency issues; maintains contracts between the state and health plans, including contract amendments; researches and analyzes a variety of information which are provided by the plans as required by the U.S. Health Care Financing Administration; produces quarterly reports on each plan; performs health research; and provides technical assistance to plans about financial issues and policy. The program also performs on-site visits to ensure that plans meet state standards and requirements, and develops financial corrective plans if needed. In addition, the program also performs financial analysis for agency requests for applications. Program staff also participate in a variety of work groups related to financial issues.

Records Description:

Records documenting financial and utilization status and statistics for managed care health plans are Quarterly Financial and Utilization Final Reports; Quarterly Financial and Utilization Report-Working Copy Records; Quarterly Financial and Utilization Report-Editing Copy; Health Plan Records (Financial Files); Provider Capacity Reports; and the FINANCIAL, UTILIZATION, and PROVIDER CAPACITY databases. Records documenting a variety of financial information related to specific plans are Health Plan Records (Financial Files); Maternity/Newborn Pool Working Records; and Unusual Events Plan Records. Records documenting historical plan information are Enrollment Histories and Historical OMAP Eligibility, Enrollment, Claims, and Provider Records (LANTASTIC database). Records documenting general health plan financial topics are Financial Topics Working Records. Records documenting the analysis of requests for applications are Financial Analysis for Request for Application Records.

Below is a record series list designating their retention:

047 Quarterly Financial and Utilization Final Reports, 1994 - [ongoing] - Retain permanently, transfer to State Archives after managed care program ends in the state.

048 Quarterly Financial and Utilization Report - Working Copy Records - Retain incentive relations records 3 years, destroy. Retain restricted reserve banking documents 7 years, destroy. Retain all other records 10 years, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.501(2) and 192.502(3) for life of the records.

049 Quarterly Financial and Utilization Report - Editing Copy Records - Retain records relating to plans that have had unusual events 10 years, destroy. Retain all other records 9 months, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.501(2) and 192.502(3) for life of the records.

050 Health Plan Records (Financial Files) - Retain until managed care program ends in the state and permission is received from the U.S. Health Care Financing Administration, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.501(2) and 192.502(3) for life of the records.

051 Unusual Events Plan Records - Retain 7 years after plan reaches stabilization, destroy.

052 Provider Capacity Reports - Retain 7 years, destroy.

053 Maternity/Newborn Pool Working Records - Retain 7 years, destroy.

054 Enrollment Histories - Retain until managed care program ends in the state, destroy.

055 Historical OMAP Eligibility, Enrollment, Claims, and Provider Records (Lantastic) - Retain 50 years, destroy.

056 Financial Topics Working Records - Retain 10 years, destroy.

057 Financial Analysis for Request for Application Records - Retain 10 years, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.501(2) and 192.502(3) for life of the records.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Correspondence (Administrative Records - OAR 166-300-0015).

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Section: Delivery Systems
Program: Pre-paid Health Plan Contract Coordination

Program Description:

The Pre-paid Health Plan Coordination program is responsible for developing, coordinating and managing the contracts between pre-paid health plans and the state. The program develops and monitors contracts (which are renewed on an annual basis), responds to a variety of inquiries from health plans/providers, provides technical assistance, and resolves problems and issues. Issues include policy interpretation, contract or rule violations, quality improvement, access to care issues, and specific client issues. The program also updates contracts when plan or service area changes occur; approves retroactive enrollment payment requests from plans; ensures that all activities necessary to implement the contracts are completed; and ensures that current enrollment activities and strategies are effective. In addition, the program monitors plan marketing activities and maintains plan outreach facilities statistics (as required by the U.S. Health Care Financing Administration).

Records Description:

Records documenting contract related actions and assistance by OMAP for pre-paid health plans are Pre-paid Health Plan Contract Related Records (the official copy of plan contracts are maintained in DHR's Financial Services section). Records documenting assistance to the plans for client related issues are Client Specific Interpretation Records. Records documenting plan marketing activities are Plan Specific Marketing Records. Plan outreach facility statistics are documented by Outreach Facilities Statistics Records. Updates to contracts are documented by Contract Files Updates. Approval and processing of retroactive enrollment payment requests are documented by Retroactive Enrollment Payment Request Records.

Below is a record series list designating their retention:

058 Pre-paid Health Plan Contract Related Records - Retain 6 years after contract expiration, destroy.

059 Client Specific Interpretation Records - Retain 6 months after resolved, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

060 Plan Specific Marketing Records - Retain 5 years, destroy.

061 Outreach Facilities Statistics Records - Retain 5 years, destroy.

062 Contract File Updates - Retain 6 years after contract expiration, destroy.

063 Retroactive Enrollment Payment Request Records - Retain 4 years, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Contracts and agreements, correspondence (Administrative Records - OAR 166-300-0015).

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Section: Delivery Systems
Program: Primary Care Case Management

Program Description:

The Primary Care Case Management (PCCM) program is responsible for recruiting physicians in Oregon to participate in the PCCM program as part of the Oregon Health Plan. A primary care case manager is a physician or other OMAP approved medical provider who is responsible for providing primary care and maintaining the continuity of care, supervising and coordinating care to patients, initiating referrals for consultations and specialist care. The program initiates calls and provides technical assistance by answering a variety of inquiries from physicians and other providers. Any physician applications that are received are forwarded to the Provider Enrollment section for processing (see separate description).

Records Description:

Records documenting PCCM enrollment statistics are Monthly Primary Care Case Management Enrollment Reports. Records documenting the recruitment of PCCM physicians are Primary Care Case Management Working Records.

Below is a record series list designating their retention:

064 Monthly Primary Care Case Management Enrollment Reports - Retain 10 years, destroy.

065 Primary Care Case Management Working Records - Retain 2 years, destroy.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Correspondence (Administrative Records - OAR 166-300-0015).

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Section: Analysis and Evaluation
Program: Evaluation

Program Description:

The Evaluation program is responsible for conducting qualitative research related to quality assurance for all managed care plans operating under the Oregon Health Plan. The program monitors and evaluates the plans for compliance to state and federal regulations for quality assurance. Program staff conduct on-site reviews of plan administrative practices; develop rules and methods for quality improvement; monitor and evaluate plan preventive services; coordinate external quality reviews by outside contractors; and monitor sterilization and hysterectomy services for informed consent compliance. Program staff also participate in a variety of committees related to quality improvement issues. In addition, the program monitors and maintains litigation records for OMAP.

Records Description:

Records documenting evaluation analysis and research are Evaluation/Research Records. Records documenting plan specific materials used for evaluation including site visit reports and action plans are Plan Specific Records. Reviews by external organizations are documented by External Quality Review Organization Records. Records that document plan preventive services are Project Prevention Records. Evaluation reports from federal sources are documented by the Health Care Cost Containment Oversight Committee Evaluation Reports (Client Committee Form 3013) and U.S. Health Care Financing Administration Evaluation Reports. Records documenting the evaluation of sterilization and hysterectomy services are Sterilization/Hysterectomy Records. Records documenting OMAP litigation are Litigation Records.

Below is a record series list designating their retention:

066 Evaluation/Research Records - Retain 5 years after demonstration project ends, destroy.

067 Plan Specific Records - Retain policies, procedures, and manuals 3 years, destroy. Retain all other records 5 years after demonstration project ends, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

068 External Quality Review Organization Records (EQRO) - Retain 5 years after demonstration project ends, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

069 Project Prevention Records - Retain 5 years after demonstration project ends, destroy.

070 Quality Improvement Committee Records - Retain minutes 5 years after demonstration project ends, destroy. Retain all other records 3 years, destroy.

071 Health Care Cost Containment Oversight Committee Evaluation Reports (Client Committee Form 3013) - Retain 5 years after demonstration project ends, destroy.

072 U.S. Health Care Financing Administration Evaluation Reports - Retain 5 years after demonstration peoject ends, destroy.

073 Sterilization/Hysterectomy Records - Retain 20 years, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

074 Litigation Records - Retain 10 years after final disposition of case, destroy.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Contracts and agreements, and correspondence (Administrative Records - OAR 166-300-0015).

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Section: Analysis and Evaluation
Program: Research and Analysis

Program Description:

The Research and Analysis program is responsible for analyzing qualitative as well as quantitative data for statistical and information purposes. Reports are produced on enrollment, eligibility, utilization, and outcome of medical services provided to clients, compiled from surveys of Oregon's Medicaid population. The program designs and develops satisfaction and population surveys, compiles and analyzes data, produces final reports, and distributes them to wide variety of internal and external recipients. The program also develops databases for all analytical studies, using the DATA ELEMENT MANAGEMENT SYSTEM (a sub-system of the MEDICAID MANAGEMENT INFORMATION SYSTEM).

Records Description:

Records documenting the development, design, and use of surveys are Survey Records. The actual data compiled from surveys is documented by Raw Survey Data and the DATA ELEMENT MANAGEMENT SYSTEM. Records documenting the analysis and reporting of information compiled from surveys are Final Reports (and Support Records).

Below is a record series list designating their retention:

075 Survey Records - Retain survey design records until superseded, destroy. Retain survey instruments 2 years, destroy.

076 Raw Survey Data - Retain 12 years, destroy.

077 Final Reports (and Support Records) - Retain 25 years, destroy.Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Correspondence (Administrative Records - OAR 166-300-0015); computer system program documentation and other information management records (Information Management Records - OAR 166-300-0030).

Agency: Department of Human Services (DHS)
Office: Office of Medical Assistance Programs (OMAP)
Division: Program and Policy
Section: Analysis and Evaluation
Program: Provider Audits

Program Description:

The Provider Audits program is responsible for reviewing and auditing medical providers' fee-for-service claims that have been paid by OMAP to ensure appropriate billing amounts. Providers audited include hospitals, pharmacies, physicians, private duty nurses, home health care agencies, therapists (physical, occupational, and speech), and others. Program auditors produce audit reports that outline billing and other issues, and overpayment amounts. After an audit is completed, the program follows through on corrective action, including overpayment recovery, referral to the Department of Justice Medicaid Fraud Unit if fraud is suspected, or referral to the appropriate licensing board. In rare cases, a provider may be assessed triple damages. The program also interacts with providers to resolve disputed audit findings and represents OMAP at pre-hearings or hearings when providers appeal audit findings (see separate description for the Hearings Program). In addition, the program also ensures that any federal portion of an overpayment is repaid to the U.S. Health Care Financing Administration. Program staff also participate in work groups related to financial issues and assist in administrative rule development related to audits.

Records Description:

Records documenting provider audit cases are Provider Audit Case Records and Audit Master Log. The record that documents which audit case records are stored and what has been destroyed at close of an audit case is the Purge Log. Quarterly reports from the MEDICAID MANAGEMENT INFORMATION SYSTEM (MMIS) are SURS (Surveillance and Utilization Review) Quarterly Reports. Records used for detecting and cross checking client and provider payments and services are Recipients Explanation of Medical Benefits Reports (REOMB) and Provider 1099 Reports. The record documenting the referral of provider licensure problems to the appropriate licensing board from 1979-1986 is the Licensing Board Referral Log (this is no longer being created). The record documenting the referral of potential fraud cases to the Department of Justice is the Medicaid Fraud Unit Referral Log.

Below is a record series list designating their retention:

078 Provider Audit Case Records - Retain final audit report; provider information sheet; narrative; correspondence; WMMS 420 R-A report; printout of MMIS provider review screen (PRV); summary report; summary/detail/sample request form; matrix of findings; calculation of overpayment (extrapolation); notice of underpayment/overpayment form; copies of overpayment refund checks; auditor's notes; copy of rule; hearing notes; correspondence confirming outcome of hearing; and preliminary audit report 20 years, destroy. Retain all other records until close of case, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

079 Audit Master Log - Retain 20 years, destroy.

080 Purge Log - Retain 20 years, destroy.

081 SURS Quarterly Reports - Retain excepted provider summary profile report (WMMS 430 R-A) 5 years after quarter ending date of report, destroy. Retain white calculation form until federal system performance review is completed, destroy.

082 Recipients Explanation of Medical Benefits Reports (REOMB) - Retain 2 years, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

083 Provider 1099 Reports - Retain 7 years, destroy.

084 Licensing Board Referral Log - Retain 20 years from date of referral, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

085 Medicaid Fraud Unit Referral Log - Retain 20 years from date of referral, destroy. Some information may be restricted from public disclosure as authorized by ORS 192.502 (2), for life of the records.

In addition, the following records may be found in the State Agency General Records Retention Schedule: Administrative rule preparation records, correspondence, and staff meeting minutes (Administrative Records - OAR 166-300-0015).