C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 489—PROVIDER AGREEMENTS AND SUPPLIER APPROVAL › Subpart A—General Provisions

42 C.F.R. § 489.10

Basic requirements

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(a) Any of the providers specified in § 489.2 may request participation in Medicare. In order to be accepted, it must meet the conditions of participation or requirements (for SNFs) set forth in this section and elsewhere in this chapter. The RNHCIs must meet the conditions for coverage, conditions for participation and the requirements set forth in this section and elsewhere in this chapter. The OTPs must meet the requirements set forth in this section and elsewhere in this chapter.

(b) In order to participate in the Medicare program, the provider must meet the applicable civil rights requirements of:

(1) Title VI of the Civil Rights Act of 1964, as implemented by 45 CFR part 80, which provides that no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subject to discrimination under, any program or activity receiving Federal financial assistance (section 601);

(2) Section 504 of the Rehabilitation Act of 1973, as implemented by 45 CFR part 84, which provides that no qualified handicapped person shall, on the basis of handicap, be excluded from participation in, be denied the benefits of, or otherwise be subject to discrimination under any program or activity receiving Federal financial assistance;

(3) The Age Discrimination Act of 1975, as implemented by 45 CFR part 90, which is designed to prohibit discrimination on the basis of age in programs or activities receiving Federal financial assistance. The Age Discrimination Act also permits federally assisted programs and activities, and beneficiaries of Federal funds, to continue to use certain age distinctions, and factors other than age, that meet the requirements of the Age Discrimination Act and 45 CFR part 90; and

(4) Other pertinent requirements of the Office of Civil Rights of HHS.

(c) In order for a hospital, SNF, HHA, hospice, or RNHCI to be accepted, it must also meet the advance directives requirements specified in subpart I of this part.

(d) The State survey agency will ascertain whether the provider meets the conditions of participation or requirements (for SNFs) and make its recommendations to CMS.

(e) In order for a home health agency to be accepted, it must also meet the surety bond requirements specified in subpart F of this part.

(f) In order for a home health agency to be accepted as a new provider, it must also meet the capitalization requirements specified in subpart B of this part.

[58 FR 61843, Nov. 23, 1993, as amended at 59 FR 6578, Feb. 11, 1994; 63 FR 312, Jan. 5, 1998; 68 FR 66720, Nov. 28, 2003; 84 FR 63204, Nov. 15, 2019]
Notes of Decisions
Cited in 7 cases (2 in the last 5 years), 1988–2024 · leading case: Catherine Johnson v. Xavier Becerra, 111 F.4th 1237 (D.C. Cir. 2024).
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Catherine Johnson v. Xavier Becerra, 111 F.4th 1237 (D.C. Cir. 2024). “§ 794 (a); 42 C.F.R. § 489.10 (b)(2). The Secretary administers the home health benefit and enforces the conditions of participation, including through regular audits of Medicare-enrolled HHAs.”
True Health Diagnostics, LLC v. Azar, 392 F. Supp. 3d 656 (E.D. Tex. 2019). “See 42 C.F.R. § 489.10 . The Secretary for the Department of Health and Human Services ("HHS") operates Medicare through CMS, which in turn hires contractors to perform administrative functions on CMS's behalf.”
True Health Diagnostics, LLC v. Azar, 392 F. Supp. 3d 666 (E.D. Tex. 2019). “See 42 C.F.R. § 489.10 . The Secretary for the Department of Health and Human Services ("HHS") operates Medicare through CMS, which in turn hires contractors to perform administrative functions on CMS's behalf.”
Eagle Healthcare, Inc. v. Sebelius, 969 F. Supp. 2d 38 (D.D.C. 2013). “42 C.F.R. § 489.10 . As discussed above, the Federal government, through Medicare, pays Medicare-certified healthcare facilities for services rendered to Medicare beneficiaries.”
Delta Health Grp., Inc. v. United States Dep't of Health & Human Servs., 459 F. Supp. 2d 1207 (N.D. Fla. 2006). “§§ 1395i-3(a) to (d), 1395cc(b)(2); see also 42 C.F.R. §§ 489.10 , 489.12 (setting forth the conditions for accepting and grounds for denying provider agreements); BP Care, Inc.”
Johnson v. Becerra (D.D.C. 2023). “See 42 C.F.R. § 489.10 . Under the Medicare statute, the Secretary has the “duty and responsibility” to “assure” that “the enforcement of such conditions and requirements are adequate to protect the health and safety of individuals under the care of a[n] [HHA] and to promote the…”
Oulton v. Bowen, 674 F. Supp. 429 (W.D.N.Y. 1988). “42 C.F.R. § 489.10 (1986) describes the “basic requirement” of a provider agreement and states in relevant part as follows: (a) Any of the providers specified in Sec.”
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