[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR411.115]



[Page 401-402]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 411_EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT

--Table of Contents

 

Subpart E_Limitations on Payment for Services Covered Under Group Health 

                        Plans: General Provisions

 

Sec. 411.115  Notice of determination of nonconformance.



    (a) Notice to the GHP or LGHP. (1) If CMS determines that a GHP or 

an LGHP is nonconforming with respect to a particular calendar year, CMS 

mails to the plan written notice of the following:

    (i) The determination.

    (ii) The basis for the determination.

    (iii) The right of the parties to request a hearing.

    (iv) An explanation of the procedure for requesting a hearing.



[[Page 402]]



    (v) The tax that may be assessed by the IRS in accordance with 

section 5000 of the IRC.

    (vi) The fact that if none of the parties requests a hearing within 

65 days from the date of its notice, the determination is binding on all 

parties unless it is reopened in accordance with Sec. 411.126.

    (2) The notice also states that the plan must, within 30 days from 

the date on its notice, submit to CMS the names and addresses of all 

employers and employee organizations that contributed to the plan during 

the calendar year for which CMS has determined nonconformance.

    (b) Notice to contributing employers and employee organizations. CMS 

mails written notice of the determination, including all the information 

specified in paragraph (a)(1) of this section, to all contributing 

employers and employee organizations already known to CMS or identified 

by the plan in accordance with paragraph (a)(2) of this section. 

Employers and employee organizations have 65 days from the date of their 

notice to request a hearing.