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M0110.400 Retention of Case Information

A. Introduction The agency must maintain case records that contain information necessary to support the facts essential to the determination of initial and continuing eligibility as well as any basis for discontinuing or denying assistance. The case record shall consist of a hard (i.e. paper) record, an electronic record, or a combination of the two. To be stored electronically in the individual’s case record in the Virginia Case Management System (VaCMS), a document is scanned into VaCMS using the Document Management Imaging System (DMIS). Records of active cases must be maintained for as long as the client receives benefits. Closed records must be maintained for a minimum of three years from the date of closure. B. Policy Case records must contain the following elements: • the date of application, • the date of and basis for the disposition of the application, • facts essential to the determination of initial and continuing eligibility, • the provision of medical assistance (i.e. enrollment), • the basis for discontinuing medical assistance, • the disposition of income and eligibility verification information, and • the name of the agency representative taking action on the case and the date of the action. The agency must include in each applicant’s case record documentation to support the agency’s decision on his application and the fact that the agency gave recipients timely and adequate notice of proposed action to terminate, discontinue or suspend their eligibility or to reduce or discontinue services they may receive under the medical assistance programs. Types of documentation that support the agency’s decision include evaluations of eligibility, case narratives, and permanent verifications. Verifications of earned and unearned income, documentation of reasonable compatibility and the current value of resources (if applicable) must be maintained in the record. Notes by the eligibility worker that the verifications were viewed are not sufficient; income reasonable compatibility and electronic verification of income should be documented in case comments. The case record must contain a duplicate, either electronically or in writing, of all notices sent to the client. Copies of the documents used for verification of citizenship and identity, such as birth certificates, must also be maintained within the case record. Active cases may be purged with the exception of documentation that supports the information shown in the paragraphs above. Agencies may wish to retain other information used in future eligibility determinations, such as resource assessments and burial contracts. Closed cases are required to be retained by the agency for a period of no less than three years from the date of closure. The case record shall be organized as to enable audit and program integrity entities to properly discharge their respective responsibilities for reviewing the manner in which the MA programs are being administered.

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 October 2019 Subchapter Subject Page ending with Page M0110.000 GENERAL INFORMATION M0110.400 15