(1) Services for high risk pregnant women delivered on an allowable cost basis are subject to the financial records and reporting requirements of this rule.

(2) A case management provider for high risk pregnant women must maintain adequate financial and statistical records, in the form and containing the information required by the department, to allow the department and its agents to determine payment for services provided to Medicaid recipients and to provide a record that is auditable through the application of generally accepted audit procedures.

(3) Financial data must be maintained on an accrual basis. The provider must file a cost report for each of the provider's fiscal years.

(4) Financial records must be maintained for a period of six years, three months after a cost report is filed with respect to the period covered by the records or until the cost report is finally settled, whichever is later.

(5) The records described in (1) must be available at the facility at all reasonable times and shall be subject to inspection, review, and audit by the department or its agents, the United States Department of Health and Human Services, the General Accounting Office, the Montana Legislative Auditor, and other appropriate governmental agencies.

(6) Upon failure or refusal of the provider to make available and allow access to such records or upon failure or refusal to submit a required cost report or upon submission of an inadequate cost report, the department may recover in full all payments made to the provider during the reporting period to which such records relate.

(7) Within 90 days after the end of the provider's fiscal year, the provider must submit to the department or its agent in the form and detail required by the department, a cost report covering the reporting period and containing the following information:

(a) the allowable costs actually incurred in providing case management services for the period and the actual number of services provided during the period; and

(b) the amounts of all payments received or due from other payors, including but not limited to Medicare and private insurers, with respect to such services.

(8) Overpayments and underpayments are collected or paid as provided in ARM 37.86.2803 and references in that rule to a "hospital" shall be deemed to be references to a case management provider.

(9) A provider who is aggrieved by the department's interim rate determination, determination of overpayment or underpayment, or other adverse determination may request an administrative review or fair hearing in accordance with the requirements and procedures of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.