CMS Pub. 100-04, ch. 1, § 40.2

A3-3008.2, RHC-331

The Secretary may terminate an agreement with a provider if it is determined that the

provider:

• Is not complying fully (or substantially in the case of SNFs) with the provisions of

the agreement or with the applicable provisions of title XVIII of the Act and

regulations;

• No longer meets the appropriate conditions (requirements for SNFs) of

participation;

• Has failed to supply information which is necessary to determine whether

payments are due or were due and the amounts of such payments; or

• Refuses to permit examinations of fiscal and other records, including medical

records.

The cancellation of a SNF agreement is viewed as an involuntary termination of the

agreement by the Secretary for cause. Such actions involve a finding that the SNF has

not satisfactorily completed its written plan providing for the correction of deficiencies

with respect to one or more of the standards in the applicable requirements of

participation, or that the facility has not made substantial effort and progress in correcting

such deficiencies.

A provider which is dissatisfied with the Secretary’s determination terminating its

agreement is entitled to request a hearing thereon in accordance with the appeals

procedures contained in 42 CFR Part 498. There is no reconsideration step before the

opportunity for a hearing.

For the FI’s role in processing involuntary terminations, see §40.2.1.

NOTE: The involuntary termination of a hospital’s approval authorizing it to provide

extended care services, i.e., to be a swing bed facility, (see Chapter 3) does not

automatically result in the involuntary termination of the hospital’s agreement relating to

the provision of hospital services.