42 CFR 411.114
§ 411.114 Determination of nonconformance.
United States · 42 CFR — Public Health · Status: effective
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- Citation
- 42 CFR 411.114, § 411.114 Determination of nonconformance, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/203441
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Full text
(a) Starting dates for determination of nonconformance. CMS's authority to determine nonconformance of GHPs begins on the following dates:
(1) On January 1, 1987 for MSP provisions that affect the disabled.
(2) On December 20, 1989 for MSP provisions that affect ESRD beneficiaries and the working aged.
(3) On August 10, 1993 for failure to refund mistaken Medicare primary payments.
(b) Special rule for failure to repay. A GHP that fails to comply with § 411.110 (a)(1), (a)(2), or (a)(3) in a particular year is nonconforming for that year. If, in a subsequent year, that plan fails to repay the resulting mistaken primary payments (in accordance with § 411.110(a)(4)), the plan is also nonconforming for the subsequent year. For example, if a plan paid secondary for the working aged in 1991, that plan was nonconforming for 1991. If in 1994 CMS identifies mistaken primary payments attributable to the 1991 violation, and the plan refuses to repay, it is also nonconforming for 1994.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.