C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION › Subpart D—Appeals Process for NFs and ICFs/IID

42 C.F.R. § 431.151

Scope and applicability

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(a) General rules. This subpart sets forth the appeals procedures that a State must make available as follows:

(1) To a nursing facility (NF) that is dissatisfied with a State's finding of noncompliance that has resulted in one of the following adverse actions:

(i) Denial or termination of its provider agreement.

(ii) Imposition of a civil money penalty or other alternative remedy.

(2) To an intermediate care facility for Individuals with Intellectual Disabilities (ICF/IID) that is dissatisfied with a State's finding of noncompliance that has resulted in the denial, termination, or nonrenewal of its provider agreement.

(3) To an NF or ICF/IID that is dissatisfied with a determination as to the effective date of its provider agreement.

(b) Special rules. This subpart also sets forth the special rules that apply in particular circumstances, the limitations on the grounds for appeal, and the scope of review during a hearing.

[61 FR 32348, June 24, 1996, as amended at 62 FR 43935, Aug. 18, 1997]
Notes of Decisions
Cited in 15 cases (1 in the last 5 years), 1979–2023 · leading case: Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1 (2000).
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Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1 (2000). · cites it 2× “§§ 1395cc(b)(2)(A), (h); 42 CFR § 431.151 et seq. (1998); § 488.408(g); 42 CFR pt.”
Bryn Mawr Care, Inc. v. Kathleen Sebelius, 749 F.3d 592 (7th Cir. 2014). · cites it 4× “See 42 C.F.R. § 431.151 (requiring a hearing when a state imposes “a civil money penalty”).”
Bryn Mawr Care v. Sebelius, 898 F. Supp. 2d 1009 (N.D. Ill. 2012). · cites it 8× “Kohrman also argues that pursuant 42 C.F.R. § 431.151 the IDPH was not authorized nor required to provide Plaintiff with a hearing.”
Annie Green, Dba Christian Home for the Aged v. John R. Cashman, Dir., Ohio Dep't of Health, 605 F.2d 945 (6th Cir. 1979). “9749, 9753 (1970) (to be codified in 42 CFR § 431.151 to 431.154). These regulations, which became effective during the pendency of this appeal, áre apparently based upon the minimal standards of Mathews v.”
Legacy Healthcare, Inc. v. Feldman, 11 F. App'x 589 (7th Cir. 2001). · cites it 3× “According to the state court, 42 C.F.R. § 431.151 (a)(2) required the OMPP to make a “full evidentiary hearing” available to New Horizon when the OMPP terminated the facility’s provider agreement.”
Texas Health Enter., Inc. v. Texas Dep't of Health, 954 S.W.2d 168 (Tex. App. 1997). “See 42 C.F.R. § 431.151 (b) (1991). Finally, in Terrace’s fifth point of error, prejudgment interest is sought in the amount of Medicaid vendor payments not made to Terrace following the termination of Terrace’s Medicaid Provider Contract.”
Texas Health Enter., Inc. v. Texas Dep't of Health, 925 S.W.2d 750 (Tex. App. 1996). “’ See 42 C.F.R. § 431.151 (c) (1995). We interpret the definitional provision cited by the Center as requiring that the agency issue a written decision, but we do not believe that the written decision is subject to the same time limitation as the hearing.”
Hillburn v. Maher, 795 F.2d 252 (2d Cir. 1986). “See 42 C. F.R. § 431.151 — §' 431.154.” Judgment at 13.”
River Nile Invalid Coach & Ambulance, Inc. v. Velez, 601 F. Supp. 2d 609 (D.N.J. 2009). “42 C.F.R. § 431.151 (a)(l)-(3) (defining the scope and applicability of the subpart).”
Perry Cnty. Nursing Ctr. v. United States Dep't of Health & Human Servs., 603 F. App'x 265 (5th Cir. 2015). “See 42 C.F.R. §§ 431.151 (a)(1), 498.5(k). 5 .”
Lomond View Nursing Homes, Inc. v. Califano, 639 F.2d 674 (10th Cir. 1981). “The issues to be so considered have become somewhat narrowed, but we do not disagree with that portion of the trial court’s order, but only as a statutory or regulatory provision provided in these circumstances.”
River Nile Invalid Coach & Ambulance v. Velez, 601 F. Supp. 2d 609 (D.N.J. 2009). “42 C.F.R. § 431.151 (a)(1)-(3) (defining the scope and applicability of the subpart).”
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— 42 C.F.R. § 431.151(a)(1)(H) — 1 case
Bryn Mawr Care v. Sebelius, 898 F. Supp. 2d 1009 (N.D. Ill. 2012). “Kohrman also argues that pursuant 42 C.F.R. § 431.151 the IDPH was not authorized nor required to provide Plaintiff with a hearing.”
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