§437.11. Provider agreements
A. The department shall make payments from medical assistance programs funds for goods, services, or supplies rendered to recipients to any person who has a provider agreement in effect with the department, who is complying with all federal and state laws and rules pertaining to the medical assistance programs, and who agrees that no person shall be subjected to discrimination under the medical assistance programs because of race, creed, ethnic origin, sex, age, or physical condition.
B. Each provider agreement shall require the health care provider to comply fully with all federal and state laws and rules pertaining to the medical assistance programs, to licensure, if required, and the practice of medicine, osteopathy, surgery, and midwifery. The provider agreement shall require the health care provider to provide goods, services, or supplies only if medically necessary and that are within the scope and quality of standard care.
C. Each provider agreement shall be a voluntary contract between the department and the health care provider in which the health care provider agrees to comply with federal and state laws and rules pertaining to the medical assistance programs when furnishing goods, services, or supplies to a recipient and the department agrees to pay a sum, determined by fee schedule, payment methodology, or other method, for the goods, services, or supplies provided to the recipient. However, a provider agreement shall not be construed to be a contract for the purposes of R.S. 42:1113(D).
D.(1) Unless the provider agreement is terminated by the secretary for cause as provided in Paragraph (2) of this Subsection, a health care provider agreement shall be effective for a stipulated period of time, shall be terminable by either party thirty days after receipt of written notice, and shall be renewable by mutual agreement.
(2) The secretary may terminate a provider agreement immediately and without written notice if a health care provider is the subject of a sanction or of a criminal, civil, or departmental proceeding.
E. Each health care provider who has a provider agreement with the department shall receive at least one provider number but may receive more than one provider number.
Acts 1997, No. 1142, §2.
Notes of Decisions
Planned Parenthood of Gulf Coast, Inc. v. Gee, 862 F.3d 445 (5th Cir. 2017).
· cites it 4× “R.S. § 46:437.11 the provider agreements are voluntary contracts subject to termination “by either party 30 days after receipt of written notice.”
Bozeman v. State, 879 So. 2d 692 (La. 2004).
“In addition to the requirements specified in R.S. 46:437.11, the provider agreement developed by the department shall require the health care provider to comply with the following: (10)(a) Accept payment from the medical assistance programs as payment in full, and prohibit the…”
New Orleans Home for Incurables, Inc. v. Greenstein, 911 F. Supp. 2d 386 (E.D. La. 2012).
· cites it 6× “R.S. 46:437.11, the Medical Assistance Programs Integrity Law (“MAPIL”), is an invalid exercise of power, because the basis is the license revocation, instead of the grounds as set forth in MAPIL.”
Planned Parenthood of Gulf Coast, Inc. v. Gee, 837 F.3d 477 (5th Cir. 2016).
· cites it 2× “R.S. § 46:437.11. That same day, then-Governor Jindal published a press release: “Governor Jindal and DHH decided to give the required 30-day' notice to terminate the Planned Parenthood Médicaid provider *484 contract because Planned Parenthood does not represent the values of…”
Benoit v. Turner Indus. Grp., LLC, 85 So. 3d 629 (La. 2012).
“R.S. 46:437.11(B). Under state law, providers are specifically required to accept Medicaid payment as payment in full, and are prohibited from the billing or collecting additional amounts from the recipient or the recipient’s responsible party.”
Akula v. Phillips, No. 2:22-cv-01070 (E.D. La. Dec. 23, 2022).
· cites it 13× “R.S. 46:437.11(D)(2).9 That statute allows the Secretary of the Louisiana Department of Health to “terminate a provider agreement immediately and without written notice if a health care provider is the subject of a sanction or of a criminal, civil, or departmental proceeding.”
Bozeman v. State, Dep't of Transp. & Dev., 839 So. 2d 960 (La. Ct. App. 2003).
“R.S. 46:437.11(B). Under state law, providers are specifically required to accept Medicaid payment as payment in full and are prohibited from the billing or collecting additional amounts from the recipient or the recipient’s responsible party.”
La. Rev. Stat. § 46:437.11(B): 2 cases
Benoit v. Turner Indus. Grp., LLC, 85 So. 3d 629 (La. 2012).
“R.S. 46:437.11(B). Under state law, providers are specifically required to accept Medicaid payment as payment in full, and are prohibited from the billing or collecting additional amounts from the recipient or the recipient’s responsible party.”
Bozeman v. State, Dep't of Transp. & Dev., 839 So. 2d 960 (La. Ct. App. 2003).
“R.S. 46:437.11(B). Under state law, providers are specifically required to accept Medicaid payment as payment in full and are prohibited from the billing or collecting additional amounts from the recipient or the recipient’s responsible party.”
La. Rev. Stat. § 46:437.11(D): 1 case
La. Rev. Stat. § 46:437.11(D)(1): 2 cases
New Orleans Home for Incurables, Inc. v. Greenstein, 911 F. Supp. 2d 386 (E.D. La. 2012).
“R.S. 46:437.11, the Medical Assistance Programs Integrity Law (“MAPIL”), is an invalid exercise of power, because the basis is the license revocation, instead of the grounds as set forth in MAPIL.”
La. Rev. Stat. § 46:437.11(D)(2): 5 cases
New Orleans Home for Incurables, Inc. v. Greenstein, 911 F. Supp. 2d 386 (E.D. La. 2012).
“R.S. 46:437.11, the Medical Assistance Programs Integrity Law (“MAPIL”), is an invalid exercise of power, because the basis is the license revocation, instead of the grounds as set forth in MAPIL.”
Planned Parenthood of Gulf Coast, Inc. v. Gee, 837 F.3d 477 (5th Cir. 2016).
“R.S. § 46:437.11. That same day, then-Governor Jindal published a press release: “Governor Jindal and DHH decided to give the required 30-day' notice to terminate the Planned Parenthood Médicaid provider *484 contract because Planned Parenthood does not represent the values of…”
Akula v. Phillips, No. 2:22-cv-01070 (E.D. La. Dec. 23, 2022).
“R.S. 46:437.11(D)(2).9 That statute allows the Secretary of the Louisiana Department of Health to “terminate a provider agreement immediately and without written notice if a health care provider is the subject of a sanction or of a criminal, civil, or departmental proceeding.”
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