C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 455—PROGRAM INTEGRITY: MEDICAID › Subpart E—Provider Screening and Enrollment

42 C.F.R. § 455.410

Enrollment and screening of providers

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

(a) The State Medicaid agency must require all enrolled providers to be screened under to this subpart.

(b) The State Medicaid agency must require all ordering or referring physicians or other professionals providing services under the State plan or under a waiver of the plan to be enrolled as participating providers.

(c) The State Medicaid agency may rely on the results of the provider screening performed by any of the following:

(1) Medicare contractors.

(2) Medicaid agencies or Children's Health Insurance Programs of other States.

(d) The State Medicaid agency must allow enrollment of all Medicare-enrolled providers and suppliers for purposes of processing claims to determine Medicare cost-sharing (as defined in section 1905(p)(3) of the Act) if the providers or suppliers meet all Federal Medicaid enrollment requirements, including, but not limited to, all applicable provisions of 42 CFR part 455, subparts B and E. This paragraph (d) applies even if the Medicare-enrolled provider or supplier is of a type not recognized by the State Medicaid Agency.

[76 FR 5968, Feb. 2, 2011, as amended at 86 FR 45521, Aug. 13, 2021]
Notes of Decisions
Cited in 1 case (1 in the last 5 years), 2021–2021 · leading case: Select Specialty Hosp. - Denver, Inc. v. Sebelius (D.D.C. 2021).
Sort: Relevance Newest Treatment
Select Specialty Hosp. - Denver, Inc. v. Sebelius (D.D.C. 2021). “Most recently, on May 10, 2021, CMS published a notice of proposed rulemaking concerning LTCH payments that intends “[t]o clarify states’ obligations regarding claims for Medicare cost-sharing by adding a new paragraph (d) to 42 C.F.R. 455.410 to specify in regulation how states…”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.