[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR489.13]



[Page 944-945]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 489_PROVIDER AGREEMENTS AND SUPPLIER APPROVAL--Table of Contents

 

                      Subpart A_General Provisions

 

Sec.  489.13  Effective date of agreement or approval.



    (a) Applicability--(1) General rule. Except as provided in paragraph 

(a)(2) of this section, this section applies to Medicare provider 

agreements with, and supplier approval of, entities that, as a basis for 

participation in Medicare--

    (i) Are subject to survey and certification by CMS or the State 

survey agency; or

    (ii) Are deemed to meet Federal requirements on the basis of 

accreditation by an accrediting organization whose program has CMS 

approval at the time of accreditation survey and accreditation decision.

    (2) Exceptions. (i) For an agreement with a community mental health 

center (CMHC) or a Federally qualified health center (FQHC), the 

effective date is the date on which CMS accepts a signed agreement which 

assures that the CMHC or FQHC meets all Federal requirements.

    (ii) A Medicare supplier approval of a laboratory is effective only 

while the laboratory has in effect a valid CLIA certificate issued under 

part 493 of this chapter, and only for the specialty and subspecialty 

tests it is authorized to perform.

    (b) All Federal requirements are met on the date of survey. The 

agreement or approval is effective on the date the survey (including the 

Life Safety Code survey, if applicable) is completed, if on that date 

the provider or supplier meets all applicable Federal requirements as 

set forth in this chapter. (If the agreement or approval is time-

limited, the new agreement or approval is effective on the day following 

expiration of the current agreement or approval.)

    (c) All Federal requirements are not met on the date of survey. If 

on the date the survey is completed the provider or supplier fails to 

meet any of the requirements specified in paragraph (b) of this section, 

the following rules apply:

    (1) For an agreement with an SNF, the effective date is the date on 

which--



[[Page 945]]



    (i) The SNF is in substantial compliance (as defined in Sec.  

488.301 of this chapter) with the requirements for participation; and

    (ii) CMS or the State survey agency receives from the SNF, if 

applicable, an approvable waiver request.

    (2) For an agreement with, or an approval of, any other provider or 

supplier, (except those specified in paragraph (a)(2) of this section), 

the effective date is the earlier of the following:

    (i) The date on which the provider or supplier meets all 

requirements.

    (ii) The date on which a provider or supplier is found to meet all 

conditions of participation or coverage, but has lower level 

deficiencies, and CMS or the State survey agency receives an acceptable 

plan of correction for the lower level deficiencies, or an approvable 

waiver request, or both. (The date of receipt is the effective date 

regardless of when CMS approves the plan of correction or the waiver 

request, or both.)

    (d) Accredited provider or supplier requests participation in the 

Medicare program--(1) General rule. If the provider or supplier is 

currently accredited by a national accrediting organization whose 

program had CMS approval at the time of accreditation survey and 

accreditation decision, and on the basis of accreditation, CMS has 

deemed the provider or supplier to meet Federal requirements, the 

effective date depends on whether the provider or supplier is subject to 

requirements in addition to those included in the accrediting 

organization's approved program.

    (i) Provider or supplier subject to additional requirements. If the 

provider or supplier is subject to additional requirements, the 

effective date of the agreement or approval is the date on which the 

provider or supplier meets all requirements, including the additional 

requirements.

    (ii) Provider or supplier not subject to additional requirements. 

For a provider or supplier that is not subject to additional 

requirements, the effective date is the date of the provider's or 

supplier's initial request for participation if on that date the 

provider or supplier met all Federal requirements.

    (2) Special rule: Retroactive effective date. If a provider or 

supplier meets the requirements of paragraphs (d)(1) and (d)(1)(i) or 

(d)(1)(ii) of this section, the effective date may be retroactive for up 

to one year to encompass dates on which the provider or supplier 

furnished, to a Medicare beneficiary, covered services for which it has 

not been paid.



[62 FR 43936, Aug. 18, 1997]