(1) Providers of services may request enrollment in the plan and may participate in the plan only upon approval of enrollment and according to the written provider agreement between the provider and the department and the requirements of this subchapter.

(a) The provisions of ARM 37.85.402 shall apply for purposes of provider enrollment in the plan. Providers must enroll with the department's Medicaid fiscal agent in the same manner and according to the same requirements applicable under the Montana Medicaid Program. The department may accept current Medicaid enrollment for purposes of enrollment under the plan, if the provider agrees, in a form acceptable to the department, to be bound by applicable plan requirements.

(b) For purposes of enrollment in the plan, providers must be and remain enrolled in the Montana Medicaid program for the same category of service and must meet the same qualifications and requirements that apply to the provider's category of service under the Montana Medicaid program.

(2) Providers in the following categories may request enrollment in the MHS plan:

(a) psychiatrists;

(b) primary care providers, as defined in ARM 37.86.5001;

(c) licensed psychologists;

(d) licensed clinical social workers;

(e) licensed professional counselors; and

(f) outpatient pharmacies.

(3) A provider who is denied enrollment has no right to an administrative review or fair hearing as provided in ARM 37.5.113 and ARM Title 37, chapter 5, subchapter 3, or any other department rule.

(a) Enrollment does not imply or create any guarantee of or right to any level of utilization or reimbursement for any provider.

(4) The provisions of ARM Title 37, chapter 85, subchapter 4 and other Medicaid program laws, rules, and regulations regarding particular categories of service apply to participating providers and the services provided under the plan, except as specifically provided in this subchapter or the provider agreement.

(a) The provisions of ARM 37.85.414 regarding maintenance of records and related issues applies to providers of mental health services under the plan.

(i) The department and any legally authorized agency of the state or federal government may inspect any facilities and records pertaining to services provided under the plan, including those of any provider participating in the plan.

(ii) Upon request, providers must provide complete copies of medical records to the department or its agents.

(b) For all enrolled youth, providers must comply with the same confidentiality requirements that apply to information regarding Medicaid recipients.

(c) The department may collect from a provider any overpayment under the plan as provided with respect to Medicaid overpayments in ARM 37.85.406. The department may recover overpayments by withholding or offset as provided in ARM 37.85.513.

(i) The notice and hearing provisions of ARM 37.5.310 and 37.85.512 apply to a department overpayment determination under (4)(c).

(d) The department may sanction a provider based upon the same grounds that sanctions may be imposed against a provider under the Montana Medicaid program, except that a sanction may not be imposed with respect to a provider's conduct or omission under the plan based upon a Medicaid requirement or prohibition that is not applicable to the plan under these rules.

(i) Sanctions imposed under (4)(d) may include termination or suspension from plan participation and required attendance at provider education sessions at the provider's expense.

(ii) The department must consider the factors listed in ARM 37.85.505 in determining whether to impose a sanction and what sanction, if any, to impose. The provisions of ARM 37.85.506 and 37.85.507 shall apply to any sanction imposed under (4)(d).

(iii) The notice and hearing provisions of ARM 37.5.310 and 37.85.512 apply to a department sanction determination under (4)(d).

(5) An enrolled provider has no right to an administrative review or fair hearing as provided in ARM 37.5.113 and 37.85.411 or any other department rule for:

(a) a determination by the department or its agent that a particular service, item, or treatment is not medically necessary; or

(b) any other issues related to the provider agreement, the provision of services to recipients, or the plan, except as specifically permitted by this subchapter.

(6) An enrolled provider shall be provided an opportunity for administrative review and fair hearing as provided in ARM 37.5.310 to contest a denial of correct payment by the department to the provider for a service provided to a youth if:

(a) the department has determined that the particular service, including the amount, duration, and frequency of the service, is medically necessary for the youth to treat a covered diagnosis and has authorized the particular service for the youth according to applicable requirements; and

(b) the department has determined that the youth is eligible for the plan according the requirements of ARM 37.87.1503.

(7) For purposes of applying the provisions of any Medicaid rule as required by this subchapter, references in the Medicaid rule to "Medicaid" or the "Montana Medicaid program" or similar references, shall be deemed to apply to the plan as the context permits.