Provider Agreements

10.1 - Provider Agreements (Rev. 12425, Issued: 12-21-23, Effective: 01-01-24, Implementation: 01-02-24) The following provider types must have provider agreements under Medicare: • Hospitals, • Skilled nursing facilities (SNFs), • Home health agencies (HHAs), • Clinics, rehabilitation agencies, and public health agencies, • Comprehensive outpatient rehabilitation facilities (CORFs), • Hospices, • Critical access hospitals (CAHs), and • Community mental health centers (CMHCs). Clinics, rehabilitation agencies, and public health agencies may enter into provider agreements only for furnishing outpatient therapy services as defined in section 10 above. CMHCs may enter into provider agreements only to furnish partial hospitalization or intensive outpatient services. The term "provider agreement" is defined in 42 CFR 489.3 as an agreement between CMS and one of these providers specified in this section to provide services and to comply with the requirements of section 1866 of the Act. A provider which has executed an agreement becomes qualified to participate after the agreement is accepted. When the agreement is made retroactive, the provider must comply with the terms of the agreement and the provisions of title XVIII and regulations issued thereunder as of the retroactive date. For payment to be made to the provider for covered items and services it furnishes on or after the effective date of the agreement, the provider must have a record keeping capability sufficient to determine the costs of services furnished to Medicare beneficiaries. Provider agreements require the providers to comply with regulations. Therefore, new provider agreements are not made when regulations change. Providers as defined in this section may also function as suppliers and bill the program for other services provided as suppliers if they meet the applicable requirements for supplying the specific service.