(a) Basis for withholding. CMS withholds payments to the State, in whole or in part, only if, after giving the agency reasonable notice and opportunity for a hearing in accordance with subpart D of this part, the Administrator finds—
(1) That the plan no longer complies with the provisions of section 1902 of the Act; or
(2) That in the administration of the plan there is failure to comply substantially with any of those provisions.
(Hearings under subpart D are generally not called until a reasonable effort has been made to resolve the issues through conferences and discussions. These may be continued even if a date and place have been set for the hearing.)
(b) Noncompliance of the plan. A question of noncompliance of a State plan may arise from an unapprovable change in the approved State plan or the failure of the State to change its approved plan to conform to a new Federal requirement for approval of State plans.
(c) Noncompliance in practice. A question of noncompliance in practice may arise from the State's failure to actually comply with a Federal requirement, regardless of whether the plan itself complies with that requirement.
(d) Notice and implementation of withholding. If the Administrator makes a finding of noncompliance under paragraph (a) of this section, the following rules apply:
(1) The Administrator notifies the State:
(i) That no further payments will be made to the State (or that payments will be made only for those portions or aspects of the program that are not affected by the noncompliance); and
(ii) That the total or partial withholding will continue until the Administrator is satisfied that the State's plan and practice are, and will continue to be, in compliance with Federal requirements.
(2) CMS withholds payments, in whole or in part, until the Administrator is satisfied regarding the State's compliance.
Notes of Decisions
Wilder v. Virginia Hosp. Assn., 496 U.S. 498 (1990).
· cites it 2× “Moreover, provision of federal funds is expressly conditioned on compliance with the amendment and the Secretary is authorized to withhold funds for noncompliance with this provision. 42 U. S. C.”
State of Tenn. v. United States Dep't of State, 931 F.3d 499 (6th Cir. 2019).
· cites it 2× “§ 1396c ; 42 C.F.R. § 430.35 (a). A hearing is "generally not called until a reasonable effort has been made to resolve the issues through conferences and discussions.”
Long Term Care Pharmacy All. v. Ferguson, 362 F.3d 50 (1st Cir. 2004).
“§ 1396c (2000); 42 C.F.R. § 430.35 (2002). By contrast, nothing in subsection (30)(A) expressly provides that those who furnish Medicaid services have any enforcement rights or, indeed, have any specific rights to procedural (e.”
Stewart v. Azar, 313 F. Supp. 3d 237 (D.C. Cir. 2018).
“; see also 42 C.F.R. § 430.35 . While Section 1115 allows the Secretary to relax those minimum requirements in some circumstances, the Court "doubt[s] that Congress would enact such comprehensive regulations, frame them in mandatory language, require the Secretary to enforce…”
Harris v. James, 127 F.3d 993 (11th Cir. 1997).
· cites it 3× “11 (citing 42 C.F.R. §§ 430.35 , 447.253(a),(b) (1989)).”
Indiana State Bd. of Pub. Welfare v. Tioga Pines Living Ctr., Inc., 637 N.E.2d 1306 (Ind. Ct. App. 1994).
· cites it 2× “42 C.F.R. § 430.35 (a). A question of noncompliance in practice may arise from the State’s failure to actually comply with a Federal requirement, regardless of whether the plan itself complies with that requirement.”
Fulkerson v. Comm'r, Maine Dep't of Human Servs., 802 F. Supp. 529 (D. Me. 1992).
· cites it 2× “§§ 1396a(a)(13)(A), 1396c; 42 C.F.R. § 430.35 ). The equal access provision at issue in this case is enforceable for the same reasons relied upon by the Wilder Court.”
Sobky v. Smoley, 855 F. Supp. 1123 (E.D. Cal. 1994).
“These regulations, set forth at 42 C.F.R. § 430.35 , apply to all plan requirements in § 1396a.”
Evergreen Presbyterian Ministries Inc. v. Hood, 235 F.3d 908 (5th Cir. 2001).
· cites it 2× “§ 1396c and 42 C.F.R. § 430.35 ). Finally, the Court found that even though “the Boren Amendment [gave] a State flexibility” in adopting rates, “the obligation imposed by the amendment [was not] too ‘vague and amorphous’ to be judicially enforceable.”
— 42 C.F.R. § 430.35(c) — 1 case
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.