---
kind: "range"
citation: "45 C.F.R. §§ 150.209–150.219"
title: "45"
from: "150.209"
to: "150.219"
count: 6
url: "https://uscodex.org/cfr/45/150.209..150.219"
---

# §150.209. Verification of exhaustion of remedies and contact with State officials.


If CMS receives a complaint or other information indicating that a State is failing to enforce PHS Act requirements, CMS assesses whether the affected individual or entity has made reasonable efforts to exhaust available State remedies. As part of its assessment, CMS may contact State officials regarding the questions raised.


# §150.211. Notice to the State.


If CMS is satisfied that there is a reasonable question whether there has been a failure to substantially enforce PHS Act requirements, CMS sends, in writing, the notice described in [§ 150.213](/cfr/45/150.213.md) of this part, to the following State officials:

- (a) **The governor or chief executive officer of the State.**
- (b) **The insurance commissioner or chief insurance regulatory official.**
- (c) If the alleged failure involves HMOs, the official responsible for regulating HMOs if different from the official listed in [paragraph (b)](#b) of this section.

# §150.213. Form and content of notice.


The notice provided to the State is in writing and does the following:

- (a) Identifies the PHS Act requirement or requirements that have allegedly not been substantially enforced.
- (b) Describes the factual basis for the allegation of a failure or failures to enforce PHS Act requirements.
- (c) Explains that the consequence of a State's failure to substantially enforce PHS Act requirements is that CMS enforces them.
- (d) Advises the State that it has 30 days from the date of the notice to respond, unless the time for response is extended as described in [§ 150.215](/cfr/45/150.215.md) of this subpart. The State's response should include any information that the State wishes CMS to consider in making the preliminary determination described in [§ 150.217](/cfr/45/150.217.md).

# §150.215. Extension for good cause.


CMS may extend, for good cause, the time the State has for responding to the notice described in [§ 150.213](/cfr/45/150.213.md) of this subpart. Examples of good cause include an agreement between CMS and the State that there should be a public hearing on the State's enforcement, or evidence that the State is undertaking expedited enforcement activities.


# §150.217. Preliminary determination.


If, at the end of the 30-day period (and any extension), the State has not established to CMS's satisfaction that it is substantially enforcing the PHS Act requirements described in the notice, CMS takes the following actions:

- (a) Consults with the appropriate State officials identified in [§ 150.211](/cfr/45/150.211.md) (or their designees).
- (b) Notifies the State of CMS's preliminary determination that the State has failed to substantially enforce the requirements and that the failure is continuing.
- (c) **Permits the State a reasonable opportunity to show evidence of substantial enforcement.**

# §150.219. Final determination.


If, after providing notice and a reasonable opportunity for the State to show that it has corrected any failure to substantially enforce, CMS finds that the failure to substantially enforce has not been corrected, it will send the State a written notice of its final determination. The notice includes the following:

- (a) **Identification of the PHS Act requirements that CMS is enforcing.**
- (b) **The effective date of CMS's enforcement.**