441—88.45 (249A) Contracting for the provision of patient management.
	 88.45(1) Eligibility to contract. Only Medicaid-participating providers and clinics in good standing shall be eligible to contract with the department to provide patient management.
	 88.45(2) Contract provisions. The department shall enter into a contract arrangement with all providers who are eligible as specified in rule 441—88.44(249A) and who wish to provide patient management. Form 470-2615, Agreement for Participation as a Primary Care Physician Patient Manager in the Medicaid Patient Access to Service System, shall be the form designated as the contract. At a minimum, the contract shall include provisions as follows:
	  a.   	 The patient manager shall provide managed health care to enrolled recipients by providing primary health care and providing or referring the patient appropriately and authorizing payment for all other care covered under the program as specified in subrule 88.48(1). The patient manager is also responsible for monitoring and coordinating all covered care.
	  b.   	 The patient manager shall provide or arrange for 24-hour-per-day, seven-day-per-week provider availability to enrolled recipients.
	  c.   	 The patient manager shall maintain records that at a minimum:
	 (1) 	 Identify the patient as a patient management recipient.
	 (2) 	 Document all authorizations for medical services provided by other providers and the extent of those authorizations.
	 (3) 	 Contain the name, state identification number, age, sex and address of the patient.
	 (4) 	 Document services provided and where and by whom they are provided.
	 (5) 	 Contain medical diagnosis, treatment, therapy and drugs prescribed or administered.
	 (6) 	 Contain the name of the person making the entry and the date of the contact.
	  d.   	 The patient manager shall review and take action upon periodic utilization review reports, according to instructions that the department will provide each patient manager.
	  e.   	 The department shall specify the fees and method of payment to patient managers.
	  f.   	 The department shall specify the manner in which providers shall be notified of the recipients enrolled with them.
	 88.45(3) Contract compliance. The department shall put into place procedures for the monitoring of contract compliance on the part of patient managers to ensure appropriate access to adequate quality care. Those procedures may include, but are not limited to, on-site review of medical records by appropriate professional medical personnel and review of utilization patterns of participating patient managers. The procedures shall also include establishment of a grievance procedure defined in rule 441—88.49(249A).
	 88.45(4) Corrective action and sanctions. The department shall establish procedures for corrective action and sanctions when monitoring activities reveal possible contract noncompliance.
	 88.45(5) Termination of contract. The contract may be terminated in any of the following ways:
	  a.   	 The patient manager may terminate the contract or a clinic may remove a provider from a clinic contract by providing the department with written notice of the desire to terminate the contract 60 days in advance of the desired date of termination in order to allow the department or its designee time to disenroll and reenroll the MediPASS patients with other patient managers.
	 (1) 	 In no situation shall the provider stop providing patient management or primary care to the patient until the patient can be reenrolled with another provider except as specified in subrule 88.48(4).
	 (2) 	 Failure to provide the specified period of notice or failure to continue providing patient management or primary care before the reenrollment shall result in forfeiture of all remaining patient management fees that would otherwise have been due the patient manager.
	  b.   	 The department may terminate the contract with the patient manager with 60 days’ advance notice for any of the following reasons:
	 (1) 	 The department has imposed any sanction described at 441—subrule 79.2(3).
	 (2) 	 Recommendations of contract termination made in accordance with the procedures described in rule 441—88.51(249A), after opportunity for corrective action has been unsuccessful or rejected by the patient manager in question.
Sixty days’ advance notice is not required for situations described in subrule 88.48(4).
	  c.   	 Any patient manager who has had a contract terminated by the department shall have the right to appeal the termination as provided in 441—Chapter 7.