C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 442—STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES › Subpart B—Provider Agreements

42 C.F.R. § 442.12

Provider agreement: General requirements

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(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 § 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 § 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/IID or subpart E of part 488 of this chapter for NFs.

(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]
Notes of Decisions
Cited in 27 cases, 1982–2012 · leading case: Woodruff v. Indiana Family & Social Services Administration
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Woodruff v. Indiana Family & Social Services Administration (2012) ind · cites it 2× “§ 1396a(9) (2006); 42 C.F.R. § 442.12 (2011). Indiana’s survey agency is the State Department of Health.”
Legacy Healthcare, Inc. v. Barnes & Thornburg (2005) indctapp · cites it 3× “(citing 42 C.F.R. § 442.12 ). However, the OMPP is under no obligation to enter into a provider agreement simply because the ISDH has found the facility in question to be certified.”
Manor v. Department of Public Welfare (2002) pacommwct “” 42 C.F.R. § 442.12 (d) (emphasis added). In the case before us, Millcreek challenged the SOP on the grounds that the SOP is illegal and inconsistent with the above provisions of federal law.”
Department of Public Welfare v. Presbyterian Medical Center (2005) pa · cites it 2× “§ 1396a(a)(27); 42 C.F.R. §§ 442.12 , 431.107, and was styled as a contract action in order to invoke the Board of Claims' exclusive jurisdiction "to hear and determine all claims against the Commonwealth arising from contracts hereafter entered into with the Commonwealth.”
Texas Department of Health v. Texas Health Enterprises, Inc. (1993) texapp · cites it 2× “See 42 C.F.R. §§ 442.12 (1991). A careful reading of the federal statutes governing Medicaid does not support the contention that federal regulations prohibit Human Services from continuing to make vendor payments prior to the outcome of an administrative appeal challenging a…”
Blinzinger v. Americana Healthcare Corp. (1984) indctapp · cites it 2× “11(b) as follows: 42 CFR 442.12: "(a) ... a Medicaid agency may not .”
Lukes v. Department of Public Welfare (2009) pacommwct “…showing good cause, it may refuse to execute an agreement, or may cancel an agreement, with a certified facility.” 42 C.F.R. § 442.12 (d).”
37 soc.sec.rep.ser. 362, Medicare & Medicaid Guide P 40,322 Eric Lett v. Suzanne Magnant (1992) ca7 “42 C.F.R. § 442.12 (a) (DPW cannot enter into a provider agreement with an ICF/MR unless “the State survey agency [SBH] has certified the facility .”
Indiana State Department of Health v. Legacy Healthcare, Inc. (2001) indctapp · cites it 2× “See 42 C.F.R. § 442.12 (a). The OMPP is not obligated to enter a provider agreement with a facility merely be *192 cause it is certified as eligible by the ISDH.”
Department of Public Welfare v. Presbyterian Medical Center (2003) pacommwct · cites it 2× “Federal regulations require a provider to have a contract with DPW in order to be able to receive payment for providing services to Medical Assistance clients.”
Children's Healthcare is a Legal Duty, Inc. v. Vladeck (1996) mnd · cites it 2× “170 (c), 9 *1471 and 42 C.F.R. § 442.12 (b). 10 In addition, Plaintiffs attack regulations which exclude Christian Science sanitoria from definitions of “skilled nursing facilities” ( 42 C.”
Woodruff v. Wilson (2007) insd · cites it 2× “Once an ICF/MR is certified and ISDH has notified the Medicaid agency, the Medicaid agency executes a provider agreement under 42 CFR § 442.12 . See 42 CFR § 442.101 (stating the requirements for obtaining certification before a Medicaid agency may execute a provider agreement).”
Show all 27 citing cases →
— 42 C.F.R. § 442.12(a) — 1 case
Blinzinger v. Americana Healthcare Corp. (1984) indctapp “11(b) as follows: 42 CFR 442.12: "(a) ... a Medicaid agency may not .”
— 42 C.F.R. § 442.12(d) — 2 cases
Legacy Healthcare, Inc. v. Barnes & Thornburg (2005) indctapp “(citing 42 C.F.R. § 442.12 ). However, the OMPP is under no obligation to enter into a provider agreement simply because the ISDH has found the facility in question to be certified.”
Indiana State Department of Health v. Legacy Healthcare, Inc. (2001) indctapp “See 42 C.F.R. § 442.12 (a). The OMPP is not obligated to enter a provider agreement with a facility merely be *192 cause it is certified as eligible by the ISDH.”
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