US · guidance
CMS Pub. 100-06, ch. 3, § 30.3
Provider is No Longer Participating in Medicare But is Participating in
Medicaid: One or More Cost Reports Not Filed
(Rev. 29, 01-02-04)
Where a provider's agreement under title XVIII has terminated and one or more cost reports
have not been submitted the FI shall send the first demand letter. Requirements for this letter are
in Chapter 4, §20. Since this situation involves not only a terminated provider but a provider that
has failed to meet the basic obligation (submission of a cost report) for the period when it did
participate, the first demand letter provides notice that initiation of the procedure for withholding
the Federal share of Medicaid payments will begin in 15 days if the FI does not receive the cost
report.
The FI shall continue sending demand letters to the provider. (Chapter 4, §20 for the requirements for
the second and third demand letters) The demand letters must be sent at 30-day intervals where the
provider has not responded even though the procedures for withholding the Federal share of Medicaid
payments have been initiated.) This must be done so that if recoupment efforts and the withholding of
Medicaid payments are not effective, the case will be ready for referral to the Department of Treasury.
History
(Rev. 29, 01-02-04)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
98b2f2d2347aa423e3ddccb52da693dbf01227b7efb39f65443c6d6d6f449aeb
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