This report is a result of a complaint investigation conducted on October 1, 2020, by staff from the Department of Drug and Alcohol Programs, Bureau of Quality Assurance for Prevention & Treatment. Based on the findings of the investigation, Cove Forge Behavioral Health System at Williamsburg, was found not to be in compliance with the applicable chapters of 28 PA Code which pertain to the facility. The following deficiencies were identified during this investigation and a plan of correction is required.
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Plan of Correction
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Observations
The facility failed to limit correspondence to the funding source of client #1 to what is permitted by 4 Pa. Code 255.5 (a) 7. Client #1 was admitted on June 19, 2020 and was discharged AMA on June 22, 2020.Based on a review of documentation and a conversation with the facility staff the facility submitted electronic copies of the client record to the funding source of client #1 on September 25, 2020; this release was for the purpose of a " virtual review " following a complaint received by the funding source. This record contained progress notes, treatment plans, psychiatric evaluation, medication records consent to release information and nursing notes.
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Plan of Correction
Moving forward, if a managed care organization requests records, the facility will offer one of three possibilities.
The first possibility will be for the MCO to come on campus to review records.
The second possibility will be to print and redact all patient identifying information and make the record non-identifiable prior to submission. Patient identifying information may include any and/or all of the following: name, social security number, date of birth, Cove Forge record number, MA number and address.
The third possibility will be to offer to meet the MCO auditor in a neutral location for review of the electronic medical record.
The above suggestions were given by Jodi Skiles on Dec 21, 2020 during a telephonic conversation in relation to a MCO requesting records be sent. Should the MCO continue to request the release of records, the Department of Drug and Alcohol Program licensure will be contacted and we will report the continuous request to DDAP.
In the event a request for documentation does not exceed PA 255.5, we will follow the 255.5 standard and submit information that only relates to the five points.
The CEO will ensure that the above protocol is followed.
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