(a) Effect of termination. Termination of the provider agreement ends—
(1) Payment to the facility; and
(2) Any alternative remedy.
(b) Basis for termination. (1) CMS and the State may terminate a facility's provider agreement if a facility—
(i) Is not in substantial compliance with the requirements of participation, regardless of whether or not immediate jeopardy is present; or
(ii) Fails to submit an acceptable plan of correction within the timeframe specified by CMS or the State.
(2) CMS and the State terminate a facility's provider agreement if a facility—
(i) Fails to relinquish control to the temporary manager, if that remedy is imposed by CMS or the State; or
(ii) Does not meet the eligibility criteria for continuation of payment as set forth in § 488.412(a)(1).
(c) Notice of termination. Before terminating a provider agreement, CMS does and the State must notify the facility and the public—
(1) At least 2 calendar days before the effective date of termination for a facility with immediate jeopardy deficiencies; and
(2) At least 15 calendar days before the effective date of termination for a facility with non-immediate jeopardy deficiencies that constitute noncompliance.
(d) Procedures for termination. (1) CMS terminates the provider agreement in accordance with procedures set forth in § 489.53 of this chapter; and
(2) The State must terminate the provider agreement of a NF in accordance with procedures specified in parts 431 and 442 of this chapter.
Notes of Decisions
Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1 (2000).
· cites it 2× “See 42 CFR § 488.456 (b)(1) (1998). The Secretary's only response is that terminations are rarely imposed in fact, and certainly are not imposed where the provider has postponed correction of its deficiencies in order to preserve its appeal rights.”
Nat'l Ass'n of Psychiatric Health Sys. v. Shalala, 120 F. Supp. 2d 33 (D.D.C. 2000).
· cites it 2× “§ 1395cc(b)(2)(B); 42 C.F.R. §§ 488.456 , 489.53(a)(3). By notice in the Federal Register on December 19, 1997, HCFA announced a far-ranging proposed rule to revise many different COPs for hospitals participating in Medicare and Medicaid.”
Beverly Health & Rehab. Servs., Inc. v. Thompson, 223 F. Supp. 2d 73 (D.D.C. 2002).
“at 76-77) (citing 42 C.F.R. § 488.456 (b)(1).) Thus, there can be no question that the agency did not abuse its discretion by imposing termination, and it is not within this Court’s province to substitute its judgment for the agency’s decision that termination was appropriate…”
Bel Air Assocs. v. New Hampshire Dep't of Health & Human Servs., 910 A.2d 1232 (N.H. 2006).
“The petitioner, citing 42 C.F.R. 488.456 (2005) (termination of provider agreement ends payments to nursing facility), also argues that the existence of a contract may reasonably be inferred from its pleadings since a Medicaid provider contract is a prerequisite to reimbursement…”
Bryn Mawr Care, Inc. v. Kathleen Sebelius, 749 F.3d 592 (7th Cir. 2014).
“” 42 C.F.R. § 488.456 (b)(1), (b)(1)(h). Faced with this dilemma, Bryn Mawr chose to forego the risk of losing the “no deficiency” argument and submitted the plan of correction.”
Int'l Long Term Care, Inc. v. Shalala, 947 F. Supp. 15 (D.D.C. 1996).
“Of particular relevance to this litigation is 42 C.F.R. § 488.456 (b), which states that a health care provider agreement may be terminated “if a facility is not in substantial compliance with the requirements of participation.”
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