(a) The Department of Human Services shall publish and maintain all protocols, procedures, and requirements used in making adverse decisions on the website of the department.
(b) The publication shall include:(1) The current version of each protocol, procedure, or requirement;(2) Prior versions of each protocol, manual, or published requirement maintained in an archive for reference for a period equivalent to state law and rule regarding retention of medical records; and(3) An effective date for each version of the protocol, manual, or published requirement to ensure providers have access to historical and current policy requirements.
(1) The current version of each protocol, procedure, or requirement;
(2) Prior versions of each protocol, manual, or published requirement maintained in an archive for reference for a period equivalent to state law and rule regarding retention of medical records; and
(3) An effective date for each version of the protocol, manual, or published requirement to ensure providers have access to historical and current policy requirements.
(c) (1) The department shall not use or enforce any policy, protocol, or requirement that is not publicly disclosed and accessible to providers.(2) Any internal, undisclosed, or unpublished protocol, procedure, or requirement shall be deemed invalid for the purpose of making an adverse decision.(3) Subdivisions (c)(1) and (c)(2) of this section do not apply to:(A) Any information, protocol, procedure, or requirement for which disclosure is prohibited by state law or rule or by federal law or regulation;(B) Research regarding the latest medical standard of care or advancement of practice that is conducted by the department on a specific request for payment or claim; or(C) Adverse actions associated with licensure or certification of providers.
(1) The department shall not use or enforce any policy, protocol, or requirement that is not publicly disclosed and accessible to providers.
(2) Any internal, undisclosed, or unpublished protocol, procedure, or requirement shall be deemed invalid for the purpose of making an adverse decision.
(3) Subdivisions (c)(1) and (c)(2) of this section do not apply to:(A) Any information, protocol, procedure, or requirement for which disclosure is prohibited by state law or rule or by federal law or regulation;(B) Research regarding the latest medical standard of care or advancement of practice that is conducted by the department on a specific request for payment or claim; or(C) Adverse actions associated with licensure or certification of providers.
(A) Any information, protocol, procedure, or requirement for which disclosure is prohibited by state law or rule or by federal law or regulation;
(B) Research regarding the latest medical standard of care or advancement of practice that is conducted by the department on a specific request for payment or claim; or
(C) Adverse actions associated with licensure or certification of providers.