MAPIL STATUTORILY MANDATED REVISIONS TO ALL PROVIDER AGREEMENTS


The 1997 Regular Session of the Legislature passed and the Governor signed into law the Medical Assistance Program Integrity Law (MAPIL) cited as LSA-RS 46:437.1-46:440.3. This legislation has a significant impact on all Medicaid providers. All providers should take the time to become familiar with the provisions of this law.

MAPIL contains a number of provisions related to provider agreements. Those provisions which deal specifically with provider agreements and the enrollment process are contained in LSA-RS 46:437.11-46:437.14. The provider agreement provisions of MAPIL statutorily establish that the provider agreement is a contract between the Department and the provider and that the provider voluntarily entered into that contract. Among the terms and conditions imposed on the provider by this law are the following:

  • Comply with all federal and state laws and regulations;
  • Provide goods, services and supplies which are medically necessary in the scope and quality fitting the appropriate standard of care;
  • Have all necessary and required licenses or certificates;
  • Maintain and retain all records for a period of five (5) years;
  • Allow for inspection of all records by governmental authorities;
  • Safeguard against disclosure of information in patient medical records;
  • Bill other insurers and third parties prior to billing Medicaid;
  • Report and refund any and all overpayments;
  • Accept payment in full for Medicaid recipients providing allowances for co-payments authorized by Medicaid;
  • Agree to be subject to claims review;
  • The buyer and seller of a provider are liable for any administrative sanctions or civil judgments;
  • Notification prior to any change in ownership;
  • Inspection of facilities; and,
  • Posting of bond or letter of credit when required.

MAPIL's provider agreement provisions contain additional terms and conditions. The above is merely a brief outline of some of the terms and conditions and is not all-inclusive. The provider agreement provisions of MAPIL also provide the Secretary with the authority to deny enrollment or revoke enrollment under specific conditions.

The effective date of these provisions was August 15, 1997. All providers who were enrolled at that time or who enroll on or after that date are subject to these provisions. All provider agreements which were in effect before August 15, 1997 or became effective on or after August 15, 1997 are subject to the provisions of MAPIL and all provider agreements are deemed to be amended effective August 15, 1997 to contain the terms and conditions established in MAPIL.

Any provider who does not wish to be subjected to the terms, conditions and requirements of MAPIL must notify Provider Enrollment immediately that the provider is withdrawing from the Medicaid program. If no such written notice is received, the provider may continue as an enrolled provider subject to the provisions of MAPIL.