CMS Pub. 100-04, ch. 1, § 40.4

or Cancellation of Provider Agreement

(Rev. 980, Issued: 06-14-06, Effective: 10-01-06, Implementation: 10-02-06)

The CMS RO will inform the FI upon termination, expiration or cancellation of a

provider agreement.

Effective with the date a provider agreement under §1866 of the Act (or swing bed

approval) terminates, expires, or is cancelled, no payment is made to the provider under

such agreement for:

A Termination of Hospital Agreement

Inpatient hospital services (including inpatient psychiatric hospital services) and swing

bed extended care services furnished on or after the effective date of the hospital’s

termination, except that payment can continue to be made for up to 30 days of inpatient

hospital services and/or swing bed extended care services (total of no more than 30 days)

furnished on or after the termination date to beneficiaries who were admitted (at either

the acute or extended care level) prior to the termination date.

B Termination of Swing Bed Approval

Swing bed extended care services furnished on or after the effective date of the

termination of the hospital’s swing bed approval, except that payment can continue for up

to 30 days of extended care services furnished on or after the termination date to

beneficiaries who were admitted (at either the acute or extended care level) prior to the

termination date.

C Skilled Nursing Facility Termination

Posthospital extended care services furnished on or after the effective date of termination

of the agreement, where such agreement has been voluntarily terminated by the provider

(§40.1) or involuntarily terminated by the Secretary for cause (§40.2). However, payment

can continue to be made for up to 30 days of posthospital extended care services

furnished on and after the termination date to beneficiaries who were admitted prior to

the termination date.

D Expiration SNF

Posthospital extended care services furnished on or after the date which follows the last

day of the specified term of the agreement, where such agreement has expired at the close

of the last day of its specified term (§40.3), except that where the agreement has not been

renewed, payment can be made for up to 30 days of posthospital extended care services

furnished on and after the date which follows the last day of the specified term of such

agreement to beneficiaries who were admitted on or before such last day.

E HHA and Hospice

Home health and hospice services furnished under a plan which is established on or after

the termination date, except that if the plan was established before the termination date,

payment is made for services for up to 30 days following the effective date of

termination.

F Other

Other items and services, including outpatient physical therapy or speech-language

pathology and diagnostic services, furnished on or after the effective date of termination

or, in the case of an expiration or cancellation of an SNF agreement, on or after the day

following the close of such agreement.