Involuntary Termination, Including SNF Agreement

10.6.2 - Involuntary Termination, Including SNF Agreement Cancellations (Rev. 1, 09-11-02) The Secretary may terminate an agreement (and in the case of a SNF, he/she may terminate its agreement prior to the close of the specified term of the agreement) with a provider if it is determined that the provider: • Is not complying substantially with the provisions of the agreement or with the applicable provisions of title XVIII of the Act and regulations; • No longer meets the appropriate requirements for 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 at the close of the predetermined date stated in the cancellation clause contained in such agreement (see §10.6.2 of this chapter) 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 for 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. NOTE: The involuntary termination of a hospital's approval authorizing it to provide extended care services, i.e., to be a swing bed facility, does not automatically result in the involuntary termination of the hospital's agreement relating to the provision of hospital services.