CMS Pub. 100-04, ch. 1, § 40.3.1

A2-2804.1

Since one of the key issues is whether the facility has furnished “reasonable assurance”

that the reasons for termination will not recur, the provider agreement cannot be effective

before the date on which “reasonable assurance” is deemed to have been provided.

Generally, a facility will be required to operate for a period of 60 days without recurrence

of the deficiencies that were the basis for the termination. The provider agreement will be

effective with the end of the 60-day period. If corrections were made before filing the

new request for participation, the period of compliance before filing the new request will

be counted as part of the 60-day period; however, in no case can the effective date of the

provider agreement be earlier than the date of the new request for participation.

Exceptions to the 60-day period of compliance will be made where:

• Structural changes have eliminated the reasons for termination. “Reasonable

assurance” will be considered established as of the date such structural changes

were completed. The effective date will be that date or the date of filing the new

request to participate, whichever is later.

• "Reasonable assurance” is not established even after 60 days of compliance,

because of the facility’s history of misrepresentation or of making temporary

corrections and then relapsing into the old deficiencies that were the basis for

termination. The effective date in such cases would be the earliest date after 60

days at which “reasonable assurance” is deemed to have been established, or the

filing date of the new request to participate, whichever is later.