§ 122.619. Access to records; inspections of CCOs.
(a) The CCO shall permit the Department and its employes and agents complete and free access to the books, records, papers and documents of the CCO to enable the Department to perform its responsibilities under the act to ensure that the services provided by a CCO are in accordance with the plan for providing services included in its approved application, and that the services which are provided meet accepted professional standards for high quality, cost-effective care.
(b) The Department may review the actions or operations of a CCO to ensure its continuing compliance with standards, to address quality of care complaints or grievances or to validate data submitted in CCO reports. A review may include onsite inspection of the CCO’s facilities and records.
(c) The CCO shall permit the Department and its employes and agents access to the medical records of injured workers treated by or through a CCO for the purposes of assessing quality of care and for the purposes of reviewing injured worker grievances and complaints.
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