Section 150.217 - Preliminary determinationIf, 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 (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.64 FR 45795, Aug. 20, 1999, as amended at 78 FR 13440 , Feb. 27, 2013