.11 Provider-Participant Service Agreement.

A. A provider shall enter into a written agreement with a participant on a form provided or approved by the Department that specifies the obligations of both parties, including:

(1) The services to be provided;

(2) The fees to be charged by the provider;

(3) If applicable, the amount of subsidy to be paid on behalf of the participant; and

(4) That the provider give at least 30 days notice of any proposed change in a fee charged by the provider for a particular service.

B. The provider shall give one copy of the executed agreement to the participant and keep a second copy on file for 3 years after the termination date of the agreement. Any modifications to the agreement shall be reflected in an addendum signed and dated by both parties.

C. A change in the amount of a participant's required contribution following a reassessment of the participant's financial eligibility:

(1) May be imposed immediately; and

(2) Is not subject to the 30 day notice requirement of §A(4) of this regulation.