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Code of Federal Regulations Title 42. Public Health § 42.416.35 Termination of agreement

Current as of January 02, 2025 | Updated by Findlaw Staff

(a) Termination by the ASC—

(1) Notice to CMS. An ASC that wishes to terminate its agreement must send CMS written notice of its intent.

(2) Date of termination. The notice may state the intended date of termination which must be the first day of a calendar month.

(i) If the notice does not specify a date, or the date is not acceptable to CMS, CMS may set a date that will not be more than 6 months from the date on the ASC's notice of intent.

(ii) CMS may accept a termination date that is less than 6 months after the date on the ASC's notice if it determines that to do so would not unduly disrupt services to the community or otherwise interfere with the effective and efficient administration of the Medicare program.

(3) Voluntary termination. If an ASC ceases to furnish services to the community, that shall be deemed to be a voluntary termination of the agreement by the ASC, effective on the last day of business with Medicare beneficiaries.

(b) Termination by CMS—

(1) Cause for termination. CMS may terminate an agreement if it determines that the ASC—

(i) No longer meets the conditions for coverage as specified under § 416.26;  or

(ii) Is not in substantial compliance with the provisions of the agreement, the requirements of this subpart, and other applicable regulations of subchapter B of this chapter, or any applicable provisions of title XVIII of the Act.

(2) Notice of termination. CMS sends notice of termination to the ASC at least 15 days before the effective date stated in the notice.

(3) Appeal by the ASC. An ASC may appeal the termination of its agreement in accordance with the provisions set forth in part 498 of this chapter.

(c) Effect of termination. Payment is not available for ASC services furnished on or after the effective date of termination.

(d) Notice to the public. Prompt notice of the date and effect of termination is given to the public by—

(1) The ASC, after CMS has approved or set a termination date;  or

(2) CMS, when it has terminated the agreement.

(e) Conditions for reinstatement after termination of agreement by CMS. When an agreement with an ASC is terminated by CMS, the ASC may not file another agreement to participate in the Medicare program unless CMS—

(1) Finds that the reason for the termination of the prior agreement has been removed;  and

(2) Is assured that the reason for the termination will not recur.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.416.35 Termination of agreement - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-416-35/

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