C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 447—PAYMENTS FOR SERVICES › Subpart C—Payment for Inpatient Hospital and Long-Term Care Facility Services

42 C.F.R. § 447.256

Procedures for CMS action on assurances and State plan amendments

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(a) Criteria for approval. (1) CMS approval action on State plans and State plan amendments, is taken in accordance with subpart B of part 430 of this chapter and sections 1116, 1902(b) and 1915(f) of the Act.

(2) In the case of State plan and plan amendment changes in payment methods and standards, CMS bases its approval on the acceptability of the Medicaid agency's assurances that the requirements of § 447.253 have been met, and the State's compliance with the other requirements of this subpart.

(b) Time limit. CMS will send a notice to the agency of its determination as to whether the assurances regarding a State plan amendment are acceptable within 90 days of the date CMS receives the assurances described in § 447.253, and the related information described in § 447.255 of this subpart. If CMS does not send a notice to the agency of its determination within this time limit and the provisions in paragraph (a) of this section are met, the assurances and/or the State plan amendment will be deemed accepted and approved.

(c) Effective date. A State plan amendment that is approved will become effective not earlier than the first day of the calendar quarter in which an approvable amendment is submitted in accordance with §§ 430.20 of this chapter and 447.253.

[48 FR 56058, Dec. 19, 1983, as amended at 52 FR 28147, July 28, 1987]
Notes of Decisions
Cited in 38 cases, 1983–2019 · leading case: Wilder v. Virginia Hosp. Assn., 496 U.S. 498 (1990).
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Wilder v. Virginia Hosp. Assn., 496 U.S. 498 (1990). · cites it 2× “*508 See 42 CFR § 447.256 (2) (1989). The Secretary's review focuses "on the assurances which attest to the fact that States' findings do indeed indicate that the payment rates are reasonable" and judges "whether the assurances are satisfactory.”
New England Mem'l Hosp. v. Rate Setting Comm'n, 475 N.E.2d 740 (Mass. 1985). · cites it 3× “42 C.F.R. § 447.256 (a) (1981). A proposed change is effective on the date specified by the State agency in its assurances submitted to the Secretary, but in no event earlier than the first day of the calendar quarter in which the assurances are submitted.”
Exeter Mem'l Hosp. Ass'n v. Belshe, 943 F. Supp. 1239 (E.D. Cal. 1996). · cites it 5× “16 (a)(2) 3 ; 42 C.F.R. § 447.256 (b). The 90-day period begins anew when the State submits the requested information.”
Multicare Med. Ctr. v. State of Wash., 768 F. Supp. 1349 (W.D. Wash. 1991). · cites it 2× “42 C.F.R. § 447.256 (c). 10. The Division of Medical Assistance is the division within DSHS which is directly responsible for administering the state’s Medical Assistance programs, including the Medicaid program and the state-only funded Medically Indigent and General…”
Child.'s Hosp. & Health Ctr., a Washington Corp. v. S. Kimberly Belshe, Dir., California Dep't of Health Servs., 188 F.3d 1090 (9th Cir. 1999). “By enacting the Boren Amendment, Congress intended to require only “the minimum level [of oversight] necessary to assure proper accountability, and not to burden States and facilities with unnecessary paperwork requirements.”
Kansas Health Care Ass'n v. Kansas Dep't of Soc. & Rehab. Servs., 31 F.3d 1536 (10th Cir. 1994). “42 C.F.R. § 447.256 (b). If it fails to act within the 90 days, the plan is deemed approved.”
Child.'s Hosp. v. Sec'y of Dep't of Pub. Welfare, 568 F. Supp. 1001 (E.D. Pa. 1983). · cites it 2× “Effective Date of the Regulations The crux of this issue is whether the submission of assurances on September 28, 1982, was sufficient to trigger the effective date provision of 42 C.F.R. § 447.256 (b). 3 If so, DPW’s regulations were properly made effective July 1, 1982,…”
LifeCare Med. Transports, Inc. v. Virginia Dep't of Med. Assistance Servs., 759 S.E.2d 35 (Va. Ct. App. 2014). “42 C.F.R. § 447.256 (a)(2) states “[i]n the case of State plan and plan amendment changes in payment methods and standards, CMS bases its approval on the acceptability of the Medicaid agency’s assurances that the requirements of § 447.”
Wisconsin Hosp. Ass'n v. Reivitz, 630 F. Supp. 1015 (E.D. Wis. 1986). · cites it 2× “Consequently, the State’s failure to follow these procedures, plaintiffs contend, voids the freeze legislation and 42 C.F.R. § 447.256 (b) precludes its resurrection by submitting belated assurances since the freeze was for a finite period of time.”
Indiana State Bd. of Pub. Welfare v. Tioga Pines Living Ctr., Inc., 637 N.E.2d 1306 (Ind. Ct. App. 1994). “” 42 C.F.R. § 447.256 (c). Therefore, if the State intended its regulations to become effective on April 1, 1991, it needed to make its finding on 4.”
Avon Nursing Home v. Axelrod, 195 A.D.2d 1046 (N.Y. App. Div. 1993). “253”' (42 CFR 447.256 [c]; emphasis added), the State has failed to demonstrate that plan amendment 87-7 is approvable.”
St. James Nursing Home v. DeBuono, 12 A.D.3d 921 (N.Y. App. Div. 2004). · cites it 2× “However, since the 1997 findings constituted supplemental materials that were submitted to HCFA before it ruled on the sufficiency of SPA 95-24 and SPA 96-24, we agree with Supreme Court’s conclusion that those SPAs were “approvable” within the meaning of 42 CFR 447.”
Show all 38 citing cases →
— 42 C.F.R. § 447.256(c) — 5 cases
In re Gorney Est., 314 Mich. App. 281 (Mich. Ct. App. 2016).
State of New York v. Shalala, 119 F.3d 175 (2d Cir. 1997).
New York v. Shalala, 119 F.3d 175 (2d Cir. 1997).
Tulare Local Health Care Dist. v. Cal. Dep't of Health Care Servs., 328 F. Supp. 3d 988 (2018).
in Re Rasmer Est. (Mich. Ct. App. 2016).
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