42 C.F.R. § 431.107

Required provider agreement

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(a) Basis and purpose. This section sets forth State plan requirements, based on sections 1902(a)(4), 1902(a)(27), 1902(a)(57), and 1902(a)(58) of the Act, that relate to the keeping of records and the furnishing of information by all providers of services (including individual practitioners and groups of practitioners).

(b) Agreements. A State plan must provide for an agreement between the Medicaid agency and each provider or organization furnishing services under the plan in which the provider or organization agrees to:

(1) Keep any records necessary to disclose the extent of services the provider furnishes to beneficiaries;

(2) On request, furnish to the Medicaid agency, the Secretary, or the State Medicaid fraud control unit (if such a unit has been approved by the Secretary under § 455.300 of this chapter), any information maintained under paragraph (b)(1) of this section and any information regarding payments claimed by the provider for furnishing services under the plan;

(3) Comply with the disclosure requirements specified in part 455, subpart B of this chapter; and

(4) Comply with the advance directives requirements for hospitals, nursing facilities, providers of home health care and personal care services, hospices, and HMOs specified in part 489, subpart I, and § 417.436(d) of this chapter.

(5)(i) Furnish to the State agency its National Provider Identifier (NPI) (if eligible for an NPI); and

(ii) Include its NPI on all claims submitted under the Medicaid program.

[44 FR 41644, July 17, 1979, as amended at 57 FR 8202, Mar. 6, 1992; 75 FR 24449, May 5, 2010]

Notes of Decisions

Cited in 34 cases (4 in the last 5 years), 1980–2024 · leading case: Planned Parenthood of Indiana v. Carter, 854 N.E.2d 853 (Ind. Ct. App. 2006).

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Planned Parenthood of Indiana v. Carter, 854 N.E.2d 853 (Ind. Ct. App. 2006). · cites it 3× “§ 1396b(q)(2), it appears that 42 CFR. § 431.107(b) expands the scope of 42 U.”

Pennsylvania Dep't of Pub. Welfare v. River Street Assocs., 798 A.2d 260 (Pa. Commw. Ct. 2002). · cites it 2× “” 42 C.F.R. § 431.107 (a). Federal law specifies the mandatory contents of the provider agreements and does not require the state to include payment provisions in the provider agreements.”

Homestyle Direct, LLC v. Dep't of Human Servs., 311 P.3d 487 (Or. 2013). “See 42 CFR 431.107(b). Such agreements must include commitments by the providers to keep adequate records, make certain disclosures, and comply with other standards.”

Psychiatric Solutions of Virginia, Inc. v. Finnerty, 676 S.E.2d 358 (Va. Ct. App. 2009). · cites it 2× “” 42 C.F.R. § 431.107 (b)(1) (emphasis added).”

Psychiatric Healthcare Corp. v. Dep't of Soc. Servs., 100 S.W.3d 891 (Mo. Ct. App. 2003). “The specific Federal regulations pertinent to this case are 42 CFR § 431.107 , governing agreements between the State and the service providers; 42 CFR § 433.”

Dep't of Pub. Welfare v. Presbyterian Med. Ctr., 826 A.2d 34 (Pa. Commw. Ct. 2003). · cites it 2× “The contractual nature of the relationship between Oakmont and DPW is demonstrated by more than one authority.”

In re Zyprexa Prods. Liab. Litig., 254 F.R.D. 50 (E.D.N.Y 2008). “The ability of the States to collect Medicaid patient records is confirmed by an implementing regulation, which parrots section 1396a(a)(27) in somewhat broader terms, and requires service providers to “[k]eep any records necessary to disclose the extent of services the provider…”

State v. Dorn, 496 A.2d 451 (Vt. 1985). “§ 2032(e); 42 C.F.R. §§ 431.107 (b), 455.18; Vt. Medicaid Reg.”

Hidden Heights Assisted Living, Inc. v. State, Dep't of Health & Soc. Servs., Div. of Health Care Servs., 222 P.3d 258 (Alaska 2009). “42 C.FR. § 431.107(b) (2008); see also 42 U.”

In Re Grand Jury Investigation, 441 A.2d 525 (R.I. 1982). “300 of this chapter), any in *531 formation maintained under paragraph (b)(1) of this section and any information regarding payments claimed by the provider for furnishing services under the plan * * 42 C.F.R. § 431.107 (b). It is very clear from the federal statutes and…”

Commonwealth v. Kobrin, 479 N.E.2d 674 (Mass. 1985). “” 42 C.F.R. § 431.107 (b) (1984). 11 Under Massachusetts regulations, providers “must keep such records as are necessary to disclose fully the extent of services furnished to recipients, and must furnish to the Department or the Medicaid Fraud Control Unit on request such…”

Medicare&medicaid Gu 35,373 Eugene Hollander v. Stanley Brezenoff, Comm'r of the Dep't of Soc. Servs. of the City of New York, 787 F.2d 834 (2d Cir. 1986). “The district court correctly concluded that Congress — when enacting section 1396a(a)(27) of the Social Security Act — did not aim to create a contract cause of action for the benefit of providers, but simply sought to facilitate the processing and transmission of information by…”

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— 42 C.F.R. § 431.107(b) — 4 cases

Planned Parenthood of Indiana v. Carter, 854 N.E.2d 853 (Ind. Ct. App. 2006). “§ 1396b(q)(2), it appears that 42 CFR. § 431.107(b) expands the scope of 42 U.”

Hidden Heights Assisted Living, Inc. v. State, Dep't of Health & Soc. Servs., Div. of Health Care Servs., 222 P.3d 258 (Alaska 2009). “42 C.FR. § 431.107(b) (2008); see also 42 U.”

Stornanti v. Commonwealth, 451 N.E.2d 707 (Mass. 1983).

— 42 C.F.R. § 431.107(b)(2) — 1 case

Planned Parenthood of Indiana v. Carter, 854 N.E.2d 853 (Ind. Ct. App. 2006). “§ 1396b(q)(2), it appears that 42 CFR. § 431.107(b) expands the scope of 42 U.”

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