Link to an amendment published at 91 FR 33469, June 3, 2026.The agency may send a notice not later than the date of action if—
(a) The agency has factual information confirming the death of a beneficiary;
(b) The agency receives a clear written statement signed by a beneficiary that—
(1) He no longer wishes services; or
(2) Gives information that requires termination or reduction of services and indicates that he understands that this must be the result of supplying that information;
(c) The beneficiary has been admitted to an institution where he is ineligible under the plan for further services;
(d) The beneficiary's whereabouts are unknown, and the post office returns mail directed to him indicating no forwarding address (see § 435.919(f)(4) of this chapter for procedures if the beneficiary's whereabouts become known);
(e) The agency establishes the fact that the beneficiary has been accepted for Medicaid services by another local jurisdiction, State, territory, or commonwealth;
(f) A change in the level of medical care is prescribed by the beneficiary's physician;
(g) The notice involves an adverse determination made with regard to the preadmission screening requirements of section 1919(e)(7) of the Act; or
(h) The date of action will occur in less than 10 days, in accordance with § 483.15(b)(4)(ii) and (b)(8), which provides exceptions to the 30 days notice requirements of § 483.15(b)(4)(i) of this chapter.
[44 FR 17932, Mar. 29, 1979, as amended at 57 FR 56505, Nov. 30, 1992; 58 FR 25784, Apr. 28, 1993; 78 FR 42301, July 15, 2013; 81 FR 68847, Oct. 4, 2016; 89 FR 22866, Apr. 2, 2024]
Notes of Decisions
Cited in
4
cases, 1994–2015 · leading case:
Granato v. Bane, 74 F.3d 406 (2d Cir. 1996).
Granato v. Bane, 74 F.3d 406 (2d Cir. 1996).
· cites it 4× “” 42 C.F.R. § 431.213 (c) (1994). Where the agency acts under an exception to the 10-day advance notice requirement, the agency must “mail a notice not later than the date of action.”
Granato v. Bane, 841 F. Supp. 64 (N.D.N.Y. 1994).
· cites it 2× “And, 42 C.F.R. § 431.213 provides in pertinent part: The agency may mail a notice not later than the date of action if— ‡ ‡ ‡ ‡ ‡ (c) The recipient has been admitted to an institution where he is ineligible under the plan for further services; * * * * * * (f) A change in the…”
Perry v. Chen, 985 F. Supp. 1197 (D. Ariz. 1996).
“” 42 C.F.R. § 431.213 (f). The agency must grant an opportunity to a recipient who requests it because he or she believes the agency has taken an action erroneously.”
Charles Drake Cazier v. Dept of H & W (Idaho Ct. App. 2015).
“When the state agency is required to provide notice regarding an action, it must provide the notice at least ten days before the date of the action, unless advance notice is not required, 42 C.F.R. § 431.213 (2012) (exceptions from advance notice), or advance notice is only…”
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