C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 488—SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES › Subpart A—General Provisions

42 C.F.R. § 488.12

Effect of survey agency certification

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Certifications by the State survey agency represent recommendations to CMS.

(a) On the basis of these recommendations, CMS will determine whether:

(1) A provider or supplier is eligible to participate in or be covered under the Medicare program; or

(2) A provider or supplier accredited under a CMS-approved accreditation program remains deemed to meet the Medicare conditions or requirements, or will be placed under the jurisdiction of the SA and subject to further enforcement actions in accordance with the provisions at § 488.9.

(b) Notice of CMS's determination will be sent to the provider or supplier.

[53 FR 22859, June 17, 1988, as amended at 80 FR 29839, May 22, 2015]
Notes of Decisions
Cited in 7 cases (2 in the last 5 years), 1997–2024 · leading case: Avon Nursing & Rehab. v. Becerra, 995 F.3d 305 (2d Cir. 2021).
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Avon Nursing & Rehab. v. Becerra, 995 F.3d 305 (2d Cir. 2021). “For dually participating facilities, “[c]ertifications by the State survey agency represent recommendations,” 42 C.F.R. § 488.12 , and are “subject to the approval” of the Secretary, id.”
Alexis Hutchison & Martha Farber, & Trilogy Health Servs., LLC, d/b/a Springhurst Health Campus, 2 N.E.3d 802 (Ind. Ct. App. 2014). “" See also 42 C.F.R. § 488.12 (d)(2) (same). These provisions plainly prohibit facilities from conditioning admission upon a third party's guarantee of private pay costs.”
Evelyn v. v. Kings Cnty. Hosp. Ctr., 956 F. Supp. 288 (E.D.N.Y. 1997). “See 42 C.F.R. § 488.12 (survey reports constitute “recommendations” to the Health Care Financing Administration of HHS; based on these recommendations HHS will take appropriate action).”
Knight v. John Knox Manor, Inc., 92 So. 3d 111 (Ala. Civ. App. 2012). “§ 1396r(c)(5)(A)(ii), 42 C.F.R. § 488.12 (d)(2), and Alabama Administrative Code (Alabama Medicaid Agency), Rule 560-X-10-.”
Tower Health v. CHS Cmty. Health Sys. Inc, No. 23-2532 (3d Cir. Aug. 20, 2024). · cites it 2× “See 42 C.F.R. §§ 488.12 , 488.26(c)(1). PA DOH also issues state licenses after conducting surveys to verify that “the facility is in compliance with the state licensure regulations.”
Avon Nursing & Rehab. v. Azar, 410 F. Supp. 3d 648 (S.D.N.Y. 2019). “42 C.F.R. § 488.12 ; 488.330(b). Alternative remedies include, among other things, the imposition of a civil money penalty, the denial of payment for new admissions, and the appointment of temporary management.”
Blanchard v. Britthaven, Inc., No. 12-1366 (N.C. Ct. App. Feb. 18, 2014). “42 C.F.R. § 488.12 (2013). In this case, NC DHHS conducted surveys at Britthaven's Chapel Hill nursing home on 19 October 2007 and 29 November 2007.”
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