HI 00401.200 Providers of Services

A provider of services (or provider) is a hospital, skilled nursing facility (SNF), home health agency (HHA), detoxification facility (effective April 1, 1981), comprehensive outpatient rehabilitation facility (effective July 1, 1981), and, for the limited purpose of furnishing outpatient physical therapy or speech pathology services, a clinic, rehabilitation agency, or public health agency which meets the applicable eligibility requirements of title XVIII of the Social Security Act and regulations issued by the Administration.

To be a participating provider qualified to receive payment under Medicare, a provider must be in compliance with applicable provisions of title VI of the Civil Rights Act of 1964 and must enter into an agreement under section 1866 of the Social Security Act which provides that it (a) will not charge any individual or other person for items and services covered by the health insurance program other than deductibles and coinsurance amounts; and (b) will return any money incorrectly collected from the individual or other person on the individual's behalf or make certain other disposition according to instructions from the Administration.

A provider which has executed an agreement becomes qualified to participate after the agreement is accepted by CMS. When the agreement is made retroactive, the provider must comply with the terms of the agreement as of the retroactive effective date.

Payment will be made to the provider for covered items and services it furnishes on or after the effective date of the agreement.