[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR442.12]



[Page 286-287]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 442_STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE 

CARE FACILITIES FOR THE MENTALLY RETARDED--Table of Contents

 

                      Subpart B_Provider Agreements

 

Sec. 442.12  Provider agreement: General requirements.



    (a) Certification and recertification. Except as provided in 

paragraph (b) of this section, a Medicaid agency may not execute a 

provider agreement with a facility for nursing facility services nor 

make Medicaid payments to a facility for those services unless the 

Secretary or the State survey agency has certified the facility under 

this part to provide those services. (See Sec. 442.101 for 

certification by the Secretary or by the State survey agency).

    (b) Exception. The certification requirement of paragraph (a) of 

this section does not apply with respect to religious nonmedical 

institutions as defined in Sec. 440.170(b) of this chapter.

    (c) Conformance with certification condition. An agreement must be 

in accordance with the certification provisions set by the Secretary or 

the survey agency under subpart C of this part for ICFs/MR or subpart E 

of part 488 of this chapter for NFs.



[[Page 287]]



    (d) Denial for good cause. (1) If the Medicaid agency has adequate 

documentation showing good cause, it may refuse to execute an agreement, 

or may cancel an agreement, with a certified facility.

    (2) A provider agreement is not a valid agreement for purposes of 

this part even though certified by the State survey agency, if the 

facility fails to meet the civil rights requirements set forth in 45 CFR 

parts 80, 84, and 90.



[45 FR 22936, Apr. 4, 1980, as amended at 56 FR 48865, Sept. 26, 1991; 

59 FR 56235, Nov. 10, 1994; 64 FR 67052, Nov. 30, 1999]