[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR498.1]



[Page 1096-1097]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 498_APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT 

 

                      Subpart A_General Provisions

 

Sec.  498.1  Statutory basis.





    (a) Section 1866(h) of the Act provides for a hearing and for 

judicial review of the hearing for any institution or agency 

dissatisfied with a determination that it is not a provider, or with any 

determination described in section 1866(b)(2) of the Act.

    (b) Section 1866(b)(2) of the Act lists determinations that serve as 

a basis for termination of a provider agreement.

    (c) Sections 1128 (a) and (b) of the Act provide for exclusion of 

certain individuals or entities because of conviction of crimes related 

to their participation in Medicare and section 1128(f) provides for 

hearing and judicial review for exclusions.

    (d) Section 1156 of the Act establishes certain obligations for 

practitioners and providers of health care services, and provides 

sanctions and penalties for those that fail to meet those obligations.

    (e)-(f) [Reserved]



[[Page 1097]]



    (g) Although Sec.  1866(h) of the Act is silent regarding appeal 

rights for suppliers and practitioners, the rules in this part include 

procedures for review of determinations that affect those two groups.

    (h) Section 1128A(c)(2) of the Act provides that the Secretary may 

not collect a civil money penalty until the affected entity has had 

notice and opportunity for a hearing.

    (i) Section 1819(h) of the Act--

    (1) Provides that, for SNFs found to be out of compliance with the 

requirements for participation, specified remedies may be imposed 

instead of, or in addition to, termination of the facility's Medicare 

provider agreement; and

    (2) Makes certain provisions of section 1128A of the Act applicable 

to civil money penalties imposed on SNFs.

    (j) Section 1891(e) of the Act provides that, for home health 

agencies (HHAs) found to be out of compliance with the conditions of 

participation, specified remedies may be imposed instead of, or in 

addition to, termination of the HHA's Medicare provider agreement.

    (k) Section 1891(f) of the Act--

    (1) Requires the Secretary to develop a range of such remedies; and

    (2) Makes certain provisions of section 1128A of the Act applicable 

to civil money penalties imposed on HHAs.



[52 FR 22446, June 12, 1987, as amended at 59 FR 56251, Nov. 10, 1994; 

61 FR 32349, June 24, 1996]