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. § 488.3

Conditions of participation, conditions for coverage, conditions for certification and long term care requirements

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(a) Basic rules. To be approved for participation in, or coverage under, the Medicare program, a prospective provider or supplier must meet the following:

(1) Meet the applicable statutory definitions in section 1138(b), 1819, 1820, 1832(a)(2)(C), 1832(a)(2)(F), 1832(a)(2)(J), 1834(e), 1861, 1881, 1883, 1891, 1913 or 1919 of the Act.

(2) Be in compliance with the applicable conditions, certification requirements, or long term care requirements prescribed in part 405 subparts U or X, part 410 subpart E, part 416, part 418 subpart C, parts 482 through 486, part 491 subpart A, or part 494 of this chapter.

(b) Special conditions. The Secretary shall consult with state agencies and national AOs, as applicable, to develop CoP, CfC, conditions for certification and long term care requirements.

(1) The Secretary may, at a state's request, approve health and safety requirements for providers or suppliers in the state that exceed Medicare program requirements.

(2) If a state or political subdivision imposes requirements on institutions (that exceed the Medicare program requirements) as a condition for the purchase of health services under a state Medicaid plan approved under title XIX of the Act, (or if Guam, Puerto Rico, or the Virgin Islands does so under a state plan for Old Age Assistance under title I of the Act, or for Aid to the Aged, Blind, and Disabled under the original title XVI of the Act), the Secretary imposes similar requirements as a condition for payment under Medicare in that state or political subdivision.

[80 FR 29835, May 22, 2015]
Notes of Decisions
Cited in 8 cases (1 in the last 5 years), 2003–2025 · leading case: United States Ex Rel. Ortega v. Columbia Healthcare, Inc., 240 F. Supp. 2d 8 (D.D.C. 2003).
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United States Ex Rel. Ortega v. Columbia Healthcare, Inc., 240 F. Supp. 2d 8 (D.D.C. 2003). “42 C.F.R. 488.3(a). However, the federal government does not monitor compliance with the conditions.”
Blue Valley Hosp., Inc. v. Azar, 919 F.3d 1278 (10th Cir. 2019). “42 C.F.R. § 488.3 (a)(1). To ensure healthcare providers comply with the statutory and regulatory Conditions of Participation in the programs, CMS conducts surveys through state survey agencies.”
Odhuno v. Reed's Cove Health & Rehab., LLC, 355 F. Supp. 3d 1026 (D. Kan. 2018). “IT IS THEREFORE ORDERED that KDADS Defendants Motion for Summary Judgment (Doc.”
Woodruff v. Wilson, 484 F. Supp. 2d 876 (S.D. Ind. 2007). “42 CFR § 488.3 (a). In addition, the provisions of part 483 subpart B contain the requirements that an institution must meet in order to qualify to participate as a SNF in the Medicare program and as an NF in the Medicaid program.”
Kearney Reg'l Med. Ctr., LLC v. U.S. Dep't of Health & Human Servs., 934 F.3d 812 (8th Cir. 2019). “" The Medicare Act defines a "hospital" as an institution that, among other things, "is primarily engaged in providing" certain services "to inpatients." 42 U.S.C.”
Trust Under the Will of James Wills v. Burwell, 306 F. Supp. 3d 684 (E.D. Pa. 2018). · cites it 2× “See 42 C.F.R. § 488.3 (a)(1). The Medicare Act defines "hospital," in relevant part, as an institution that "is primarily engaged in providing, by or under the supervision of physicians, to inpatients (A) diagnostic services and therapeutic services for medical diagnosis,…”
Golden Living Ctr. v. HHS (6th Cir. 2020). “See 42 C.F.R. § 488.3 (as effective 2014). As a skilled nursing facility, it is required to comply with 42 U.”
In re: Prospect Med. Holdings, Inc., et al. v. Robert F. Kennedy, Jr., in his Off. capacity as Sec'y, United States Dep't of Health & Human Servs.; & Mehmet Oz, in his Off. capacity as Adm'r, Ctr. for Medicare & Medicaid Servs. (Bankr. N.D. Tex. 2025). “61 If a provider receives an initial determination from CMS—such as happened with CMS’s termination of CCMC’s Medicare provider agreement—and is dissatisfied 51 42 C.”
— 42 C.F.R. § 488.3(a) — 1 case
United States Ex Rel. Ortega v. Columbia Healthcare, Inc., 240 F. Supp. 2d 8 (D.D.C. 2003). “42 C.F.R. 488.3(a). However, the federal government does not monitor compliance with the conditions.”
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