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 F—Enforcement of Compliance for Long-Term Care Facilities with Deficiencies

42 C.F.R. § 488.402

General provisions

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(a) Purpose of remedies. The purpose of remedies is to ensure prompt compliance with program requirements.

(b) Basis for imposition and duration of remedies. When CMS or the State chooses to apply one or more remedies specified in § 488.406, the remedies are applied on the basis of noncompliance found during surveys conducted by CMS or by the survey agency.

(c) Number of remedies. CMS or the State may apply one or more remedies for each deficiency constituting noncompliance or for all deficiencies constituting noncompliance.

(d) Plan of correction requirement. (1) Except as specified in paragraph (d)(2) of this section, regardless of which remedy is applied, each facility that has deficiencies with respect to program requirements must submit a plan of correction for approval by CMS or the survey agency.

(2) Isolated deficiencies. A facility is not required to submit a plan of correction when it has deficiencies that are isolated and have a potential for minimal harm, but no actual harm has occurred.

(e) Disagreement regarding remedies. If the State and CMS disagree on the decision to impose a remedy, the disagreement is resolved in accordance with § 488.452.

(f) Notification requirements—(1) Except when the State is taking action against a non-State operated NF, CMS or the State (as authorized by CMS) gives the provider notice of the remedy, including the—

(i) Nature of the noncompliance;

(ii) Which remedy is imposed;

(iii) Effective date of the remedy; and

(iv) Right to appeal the determination leading to the remedy.

(2) When a State is taking action against a non-State operated NF, the State's notice must include the same information required by CMS in paragraph (f)(1) of this section.

(3) Immediate jeopardy—2 day notice. Except for civil money penalties and State monitoring imposed when there is immediate jeopardy, for all remedies specified in § 488.406 imposed when there is immediate jeopardy, the notice must be given at least 2 calendar days before the effective date of the enforcement action.

(4) No immediate jeopardy—15 day notice. Except for civil money penalties and State monitoring, notice must be given at least 15 calendar days before the effective date of the enforcement action in situations in which there is no immediate jeopardy.

(5) Date of enforcement action. The 2-and 15-day notice periods begin when the facility receives the notice.

(6) Civil money penalties. For civil money penalties, the notices must be given in accordance with the provisions of §§ 488.434 and 488.440.

(7) State monitoring. For State monitoring, no prior notice is required.

[59 FR 56243, Nov. 10, 1994; 60 FR 50118, Sept. 28, 1995, as amended at 64 FR 13360, Mar. 18, 1999]
Notes of Decisions
Cited in 12 cases (4 in the last 5 years), 2000–2025 · 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× “See 42 CFR §§ 488.402 (d), 488.456(b)(ii) (1998).”
Beverly Health & Rehab. Servs., Inc. v. Thompson, 223 F. Supp. 2d 73 (D.D.C. 2002). · cites it 3× “) *113 Contrary to plaintiffs’ argument regarding the failure to receive notice that termination was based on immediate and non-immediate jeopardy findings, the evidence supports the DAB’s finding that defendants provided notice as required by 42 C.F.R. § 488.402 (f), and that…”
Beechwood Restorative Care Ctr. v. Thompson, 494 F. Supp. 2d 181 (W.D.N.Y. 2007). · cites it 2× “” 42 C.F.R. § 488.402 (f)(4). Since the May 21 letter stated that a DPNA was being imposed as of the date of Beechwood’s receipt of the letter, Beechwood argues, the DPNA was invalid.”
Columbus Park Nursing & Rehab. Ctr. v. Sebelius, 940 F. Supp. 2d 805 (N.D. Ill. 2013). “See 42 CFR §§ 488.402 (d), 488.456(b)(ii) (1998).”
Delta Health Grp., Inc. v. United States Dep't of Health & Human Servs., 459 F. Supp. 2d 1207 (N.D. Fla. 2006). “42 C.F.R. § 488.402 (d). CMS is not, however, required to accept an unverified statement or claim as to when compliance is accomplished.”
Plott Nursing Home v. Sylvia Mathews Burwell, 779 F.3d 975 (9th Cir. 2015). · cites it 2× “30 42 C.F.R. § 488.402 (d)(2). 10 PLOTT NURSING HOME V.”
Perry Cnty. Nursing Ctr. v. United States Dep't of Health & Human Servs., 603 F. App'x 265 (5th Cir. 2015). “§ 1395i-3(h)(2)(B)(ii); 42 C.F.R. § 488.402 . 4 . See 42 C.F.R. §§ 431.”
Avon Nursing & Rehab. v. Azar (S.D.N.Y. 2023). “See 42 C.F.R. § 488.402 (b); § 488.10(a). Nursing facilities with poor survey results may be subjected to sanctions (known as “remedies”)—ranging from civil monetary penalties, to loss of Medicaid funding, to closure of the facility.”
Baxter Senior Living, LLC v. Zurich Am. Ins. Co. (Alaska 2024). “8 See 42 C.F.R. §§ 488.402 , 488.406, 488.408 (2023) (authorizing Centers for Medicare and Medicaid Services (CMS) and states to impose remedies under 42 C.”
Avon Nursing & Rehab. v. Becerra, 119 F.4th 286 (2d Cir. 2024). “Facilities that are subject to penalties for noncompliance have the right to appeal, see 42 C.F.R. § 488.402 (f)(1)(iv), and may request a hearing before an administrative law judge to contest the determination, see 42 C.”
Baxter Senior Living, LLC v. Zurich Am. Ins. Co. (D. Alaska 2025). “3d at 760-61 (citing 42 C.F.R. § 488.402 , 488.406, 488.408 (2023)).”
Outagamie Cnty. v. Wisconsin Dep't of Health Servs., 948 F. Supp. 2d 922 (E.D. Wis. 2013). “See 42 CFR §§ 488.402 (d), 488.456(b)(ii) (1998).”
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