441—88.69 (249A) Records and reports.
	 88.69(1) Records system. The contractor shall document and maintain clinical and fiscal records throughout the course of the contract. The record system shall:
	  a.   	 Identify transactions with or on behalf of each enrollee by the state identification number assigned to the enrollee by the department.
	  b.   	 Provide a rationale for and documentation of clinical care decisions made by the contractor based upon psychosocial necessity for mental health services and service necessity for substance abuse services.
	  c.   	 Permit effective professional review for medical audit processes.
	  d.   	 Facilitate an adequate system for monitoring treatment reimbursed by the contractor including follow-up of the implementation of discharge plans and referral to other providers.
	  e.   	 Meet contract reporting requirements and federal reporting requirements applicable to prepaid health plans.
	 88.69(2) Content of individual treatment record. The contractor shall have contractual requirements with participating providers which ensure an adequate record-keeping system, including documentation of all Iowa Plan services provided to each enrollee, in compliance with the provisions of rule 441—79.3(249A).
	 88.69(3) Confidentiality of mental health information. The contractor shall protect and maintain the confidentiality of mental health information by implementing policies for staff and through contract terms with participating providers which allow release of mental health information only as allowed by Iowa Code chapter 228.
	 88.69(4) Confidentiality of substance abuse information. The contractor shall protect and maintain the confidentiality of substance abuse information by implementing policies for staff and through contract terms with participating providers which allow release of substance abuse information only in compliance with policies set forth in the Code of Federal Regulations at Title 42, Part 2, as amended to May 5, 1995, and other applicable state and federal law and regulations.
	 88.69(5) Reports to the department. The contractor shall submit reports to the department as follows:
	  a.   	 Encounter data on a monthly basis.
	  b.   	 Annual audited financial statements no later than 180 days after the close of each contract year.
	  c.   	 Periodic financial, utilization, and statistical reports as required by the department in the contract.
	  d.   	 Other reporting requirements as specified in the contract.
	 88.69(6) Audits. The department or its designee and the U.S. Department of Health and Human Services (HHS) may evaluate through inspections or other means the quality, appropriateness, and timeliness of services performed by the contractor, participating providers, nonparticipating providers, and subcontractors pertaining to services performed and reimbursed under the contract. The department or its designee or HHS may audit and inspect any records of the contractor, participating providers, nonparticipating providers and subcontractors of the contractor, pertaining to services performed and the determination of amounts paid under the contract. These records shall be made available at times, places, and in a manner as authorized representatives of the department, its designee, or HHS may request.