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and statistical data to allow the department to identify and verify the costs and charges associated with providing services at each site. (d) On or before the last day of the fifth month after the close of its fiscal year, a health clinic shall file an annual year-end report, even if the clinic did not provide medical services to recipients during that fiscal year. The annual year-end report must contain the items listed in the definition of “year-end report” in 7 AAC 150.990, except that

(1) worksheet A of the Medicare cost report must include separate cost centers for licensed marital and family therapists and for licensed professional counselors;

(2) Medicare home office cost statements are not required;

(3) the required reconciliation of the post-audit working trial balance must be to the Medicare cost report worksheets A, A-1, and A-2; reconciliation may not be made to the Medicare cost report worksheets A-8, C, and G series;

(4) the report must also include a worksheet detailing the total number of visits for the clinic’s fiscal year; the worksheet must include visits for dental, licensed marital and family therapist, licensed professional counselor, and other ambulatory services;

(5) full-time-equivalent numbers must be reported separately for a licensed marital and family therapist or licensed professional counselor following the same calculation requirements as other rendering providers on Worksheet S-3 Part Ill of the Medicare cost report; and

(6) rural health clinics may provide reviewed financial statements meeting the requirements of 7 AAC 150.190(j)(3)(A) and (B) instead of audited financial statements. (e) If no change in the scope of services occurred during the health clinic fiscal year, and the health clinic does not intend to request a change, the health clinic shall submit to the department, on or before the last day of the fifth of the month after the close of that fiscal year, a written statement indicating that no change in the scope of services occurred or is being requested. (f) If a change in scope of services occurred during the health clinic fiscal year, the health clinic shall submit to the department the additional reports listed in this subsection. The data contained in these reports will be used to evaluate the change in scope of service request made under 7 AAC 145.700(f), to adjust the health clinic payment rates in accordance with that subsection, and to ensure, in accordance with 7 AAC 145.700(c)(4), that the prospective payment rate does not exceed upper payment limits. The reports must be submitted on or before the last day of the fifth month after the close of the health clinic fiscal year during which the change in the scope of services occurred, and on or before the last day of the fifth month after 12 continuous months of operation with the change. The reports must include the following:

(1) a worksheet detailing the total number by which visits increased or decreased for the clinic’s fiscal year due to the change in the scope of services;

(2) a narrative report that

(A) identifies the date the change in the scope of services occurred; and