Or. Admin. R. 410-141-0180 - Oregon Health Plan Prepaid Health Plan Record Keeping

Prepaid Health Plans (PHPs) and participating providers must have written policies and procedures to ensure that individually identifiable health information contained in a member of the Division of Medical Assistance Program (DMAP)’s clinical records are kept confidential and protected from unauthorized use and disclosure.  PHPs and providers may release or disclose member information without the member’s written consent in an emergency, and for purposes directly connected with the administration of the Medicaid program. Additionally, the following information may be shared without member authorization for the purpose of treatment activities:

• OHP Member name;
• Hospital provider name and attending physician name;
• Diagnosis;
• Dates of service;
• Procedure code;
• Quantity of units of service provided;
• Medication prescription and monitoring

PHPs must obtain a written authorization from a member before releasing any health service information or providing access to the member’s clinical records; the authorization will specify the type of information to be released and the recipient of the information, and will be placed in the member’s record.  PHPs will cooperate with the appropriate parties in the audit, inspection and examination of members’ clinical and administrative records.

PHPs must have policies and procedures that ensure the maintenance of a clinical record keeping system that assures completeness of clinical information that fully documents the client’s condition and the services received from providers.  All clinical records must be maintained for at least seven years after the date of service.  PHPs must have policies and procedures that accommodate client’s requests to review or amend their clinical record.