Title 42-Public Health

Subpart F-Standards for Intermediate Care Facilities Other Than Facilities for the Mentally Retarded

Sec.

442.300 Basis, purpose, and scope.

ADMINISTRATION

442.2

Terms.

442.306 Written policies and procedures: Admission.

442.307 Written policies and procedures: Transfer and discharge.

442.308 Written policies and procedures: Chemical and physical restraints.

442.309 Written policies and procedures: Resident complaints and recommendations.

442.310 Written policies and procedures: Resident records.

442.311 Written policies and procedures: Resident's bill of rights.

442.312 Written policies and procedures: Delegation of rights and responsibilities. 442.313 Emergencies.

442.314 Staff training programs.

442.315 Health and safety laws.

442.316

Transfer agreements.

442.317 Arrangements with

442.111 Certification period: Facilities with

442.105 Certification

with deficiencies:

General provisions.

442.110 Certification period: General provisions.

sources.

deficiencies.

442.323 Fire protection: Waivers.

dosage.

to control medication

Title 42-Public Health

AUTHORITY: Sec. 1102 of the Social Security Act (42 U.S.C. 1302).

SOURCE: 43 FR 45233, Sept. 29, 1978, unless otherwise noted.

Subpart A-General Provisions

§ 442.1 Basis and purpose.

(a) This part states requirements for provider agreements, facility certification, and facility standards relating to the provision of skilled nursing facility and intermediate care facility services to Medicaid recipients. The requirements apply to State Medicaid agencies and survey agencies and to the facilities. This part is based on the following sections of the Act:

(1) Section 1902(a)(4), administrative methods for proper and efficient operation of the State plan;

(2) Section 1902(a)(27), provider agreements;

(3) Section 1902(a)(28), skilled nursing facility standards;

(4) Section 1902(a)(33)(B), survey agency functions;

State

(5) Section 1905 (c) and (d), definition of intermediate care facility services;

(6) Section 1905 (f) and (i), definition of skilled nursing facility services; and

(7) Section 1910, participation of Medicare-certified skilled nursing facilities in Medicaid.

(b) Section 431.610 of this subchapter contains requirements for designating the State licensing agency to survey these facilities and for certain survey agency responsibilities.

Subpart B-Provider Agreements

§ 442.10 State plan requirement.

A State plan must provide that requirements of this subpart are met.

§ 442.12 Provider agreement: General requirements.

(a) Certification and recertification. Except as provided in paragraph (b) of this section, a Medicaid agency may not execute a provider agreement with a facility for SNF or ICF services nor make Medicaid payments to a facility for those services unless the Secretary or the State survey agency has certified the facility under this part to provide those services. (See § 442.101 for certification by the Secretary or by the State survey agency.

(b) Exception. The certification requirement of paragraph (a) of this section does not apply with respect to Christian Science sanitoria operated, or listed and certified, by the First Church of Christ Scientist, Boston, Mass.

(c) Conformance with certification condition. An agreement must be in accordance with the certification provisions set by the Secretary or the survey agency under Subpart C of this part.

(d) Denial for good cause. (1) If the Medicaid agency has adequate documentation showing good cause, it may refuse to execute an agreement, or may cancel an agreement, with a certified facility.

(2) A provider agreement is not a Valid agreement for purposes of this part even though certified by the State survey agency, if the facility fails to meet the civil rights requirements set forth in 45 CFR Parts 80, 84, and 90.

[45 FR 22936, Apr. 4, 1980]

§ 442.13 Effective date of agreement.

(a) Basic requirements. If the Medicaid agency enters into a provider agreement, the effective date must be in accordance with this section.

(b) All Federal requirements are met on the date of the survey. The agreement must be effective on the date the onsite survey is completed (or on the day following the expiration of a cur

rent agreement) if, on the date of the survey, the provider meets:

(1) All Federal health and safety standards; and

(2) Any other requirements imposed by the Medicaid agency.

(c) All Federal requirements are not met on the date of the survey. If the provider fails to meet any of the requirements specified in paragraph (b) of this section, the agreement must be effective on the earlier of the following dates:

(1) The date on which the provider meets all requirements.

(2) The date on which the provider submits a correction plan acceptable to the State survey agency or an approvable waiver request, or both.

[45 FR 22936, Apr. 4, 1980]

§ 442.14 Effect of change of ownership.

(a) Assignment of agreement. When there is a change of ownership, the Medicaid agency must automatically assign the agreement to the new

owner.

(b) Conditions that apply to assigned agreements. An assigned agreement is subject to all applicable statutes and regulations and to the terms and conditions under which it was originally issued, including, but not limited to, the following:

(1) Any existing plan of correction. (2) Any expiration date. (3) Compliance with applicable health and safety standards.

(4) Compliance with the ownership and financial interest disclosure requirements of §§ 455.104 and 455.105 of this chapter.

(5) Compliance with civil rights requirements set forth in 45 CFR Parts 80, 84, and 90.

(6) Compliance with any additional requirements imposed by the Medicaid agency.

[45 FR 22936, Apr. 4, 1980]

§ 442.15 Duration of agreement.

(a) Except as specified under § 442.16, the duration of an agreement may not exceed 12 months.

(b) The agreement must be for the same duration as the certification period set by the survey agency. However, if the Medicaid agency has ade

60-131 O-81--39

quate documentation showing good cause, it may make an agreement for less than this period.

(c) FFP is available for services provided by a facility for up to 30 days after its agreement expires or terminates under the conditions specified in § 441.11 of this subchapter.

§ 442.16 Extension of agreement.

A Medicaid agency may extend a provider agreement for up to 2 months beyond its original expiration date if it receives written notice from the survey agency, before the expiration date of the agreement, that extension will not jeopardize the patients' health and safety, and—

(a) Is needed to prevent irreparable harm to the facility or hardship to the recipients in the facility; or

(b) Is needed because it is impracticable to determine, before the expiration date, whether the facility meets certification standards.

§ 442.20 Additional

requirements for

agreements with SNF's participating in Medicare.

(a) The Medicaid agency's agreement with a SNF participating in Medicare must

(1) Provide for the same terms and conditions as Medicare certification; and

(2) Be for the same duration as the Medicare certification.

(b) If the Secretary notifies the Medicaid agency that he has denied, terminated, or refused to renew a Medicare agreement with a SNF, the agency must deny, terminate, or refuse to renew its Medicaid agreement with that SNF. The denial, termination, or refusal to renew the Medicaid agreement must be effective on the same date as the denial, termination, or refusal to renew the Medicare agreement.

(c) If the Medicaid agency has terminated an agreement under paragraph (b) of this section, it may not make another agreement with that SNF until

(1) The conditions causing the termination are removed; and

(2) The SNF provides reasonable assurance to the survey agency that the conditions will not recur.

[43 FR 45233, Sept. 29, 1978, as amended at 44 FR 9753, Feb. 15, 1979]

§ 442.30 Agreement as evidence of certification.

(a) Under §§ 440.40(a) and 440.150 of this subchapter, FFP is available in expenditures for SNF and ICF service only if the facility has been certified as meeting the requirements for Medicaid participation, as evidenced by a provider agreement executed under this part. An agreement is not valid evidence that a facility has met those requirements if the Administrator determines that

(1) The survey agency failed to apply the applicable certification standards required under Subpart D, E, F, or G of this part;

(2) The survey agency failed to follow the rules and procedures for certification set forth in Subpart C of this part and § 431.610 of this subchapter;

(3) The survey agency failed to perform any of the functions specified in § 431.610(g) of this subchapter relating to evaluating and acting on information about the facility and inspecting the facility;

(4) The survey agency failed to use the Federal standards and the forms, methods, and procedures required under § 431.610(f)(1) for determining qualifications of providers; or

(5) The agreement's terms and conditions do not meet the requirements of this subpart.

(b) The Administrator will make the determination under paragraph (a) of this section through onsite surveys, other Federal reviews, State certification records, or reports he may require from the Medicaid or survey agency.

(c) If the Administrator disallows a State's claim for FFP because of a determination under paragraph (a) of this section, the State is entitled upon request to reconsideration of the disallowance under 45 CFR Part 16.

Subpart C-Certification of SNF's and ICF's

§ 442.100 State plan requirements.

A State plan must provide that the requirements of this subpart are met.

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