[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR431.108]



[Page 31]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 431_STATE ORGANIZATION AND GENERAL ADMINISTRATION--Table of Contents

 

        Subpart C_Administrative Requirements: Provider Relations

 

Sec.  431.108  Effective date of provider agreements.



    (a) Applicability--(1) General rule. Except as provided in paragraph 

(a)(2) of this section, this section applies to Medicaid provider 

agreements with entities that, as a basis for participation in 

Medicaid--

    (i) Are subject to survey and certification by CMS or the State 

survey agency; or

    (ii) Are deemed to meet Federal requirements on the basis of 

accreditation by an accrediting organization whose program has CMS 

approval at the time of accreditation survey and accreditation decision.

    (2) Exception. A Medicaid provider agreement with a laboratory is 

effective only while the laboratory has in effect a valid CLIA 

certificate issued under part 493 of this chapter, and only for the 

specialty and subspecialty tests it is authorized to perform.

    (b) All requirements are met on the date of survey. The agreement is 

effective on the date the onsite survey (including the Life Safety Code 

survey if applicable) is completed, if on that date the provider meets--

    (1) All applicable Federal requirements as set forth in this 

chapter; and

    (2) Any other requirements imposed by the State for participation in 

the Medicaid program. (If the provider has a time-limited agreement, the 

new agreement is effective on the day following expiration of the 

current agreement.)

    (c) All requirements are not met on the date of survey. If on the 

date the survey is completed the provider fails to meet any of the 

requirements specified in paragraph (b) of this section, the following 

rules apply:

    (1) An NF provider agreement is effective on the date on which--

    (i) The NF is found to be in substantial compliance as defined in 

Sec.  488.301 of this chapter; and

    (ii) CMS or the State survey agency receives from the NF, if 

applicable, an approvable waiver request.

    (2) For an agreement with any other provider, the effective date is 

the earlier of the following:

    (i) The date on which the provider meets all requirements.

    (ii) The date on which a provider is found to meet all conditions of 

participation but has lower level deficiencies, and CMS or the State 

survey agency receives from the provider an acceptable plan of 

correction for the lower level deficiencies, or an approvable waiver 

request, or both. (The date of receipt is the effective date of the 

agreement, regardless of when CMS approves the plan of correction or 

waiver request, or both.)

    (d) Accredited provider requests participation in the Medicaid 

program--(1) General rule. If a provider is currently accredited by a 

national accrediting organization whose program had CMS approval at the 

time of accreditation survey and accreditation decision, and on the 

basis of accreditation, CMS has deemed the provider to meet Federal 

requirements, the effective date depends on whether the provider is 

subject to requirements in addition to those included in the accrediting 

organization's approved program.

    (i) Provider subject to additional requirements. For a provider that 

is subject to additional requirements, Federal or State, or both, the 

effective date is the date on which the provider meets all requirements, 

including the additional requirements.

    (ii) Provider not subject to additional requirements. For a provider 

that is not subject to additional requirements, the effective date is 

the date of the provider's initial request for participation if on that 

date the provider met all Federal requirements.

    (2) Special rule: Retroactive effective date. If the provider meets 

the requirements of paragraphs (d)(1) and (d)(1)(i) or (d)(1)(ii) of 

this section, the effective date may be retroactive for up to one year, 

to encompass dates on which the provider furnished, to a Medicaid 

recipient, covered services for which it has not been paid.



[62 FR 43935, Aug. 18, 1997]



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