[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

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

[CITE: 42CFR442.118]



[Page 291]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 442_STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE 

CARE FACILITIES FOR THE MENTALLY RETARDED--Table of Contents

 

                   Subpart C_Certification of ICFs/MR

 

Sec. 442.118  Denial of payments for new admissions to an ICF/MR.



    (a) Basis for denial of payments. The Medicaid agency may deny 

payment for new admissions to an ICF/MR that no longer meets the 

applicable conditions of participation specified under subpart I of part 

483 of this chapter.

    (b) Agency procedures. Before denying payments for new admissions, 

the Medicaid agency must comply with the following requirements:

    (1) Provide the facility up to 60 days to correct the cited 

deficiencies and comply with conditions of participation for ICFs/MR.

    (2) If at the end of the specified period the facility has not 

achieved compliance, give the facility notice of intent to deny payment 

for new admissions, and opportunity for an informal hearing.

    (3) If the facility requests a hearing, provide an informal hearing 

that includes--

    (i) The opportunity for the facility to present, before a State 

Medicaid official who was not involved in making the initial 

determination, evidence or documentation, in writing or in person, to 

refute the decision that the facility is out of compliance with the 

conditions of participation for ICFs/MR.

    (ii) A written decision setting forth the factual and legal bases 

pertinent to a resolution of the dispute.

    (4) If the decision of the informal hearing is to deny payments for 

new admissions, provide the facility and the public, at least 15 days 

before the effective date of the sanction, with a notice that includes 

the effective date and the reasons for the denial of payments.



[51 FR 24491, July 3, 1986, as amended at 59 FR 56236, Nov. 10, 1994]