# 42 C.F.R. § 411.110 (2026): Basis for determination of nonconformance

> Federal · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_110

## Section

- **Citation:** 42 C.F.R. § 411.110 (2026)
- **Heading:** Basis for determination of nonconformance
- **Jurisdiction:** Federal
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Title 42 CFR: Public Health / Chapter IV: CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES / Part 411: EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT / Subpart E: Limitations on Payment for Services Covered Under Group Health Plans: General Provisions / § 411.110: § 411.110   Basis for determination of nonconformance.

## Text

(a) A “determination of nonconformance” is a CMS determination that a GHP or LGHP is a nonconforming plan as provided in this section.
(b) CMS makes a determination of nonconformance for a GHP or LGHP that, at any time during a calendar year, fails to comply with any of the following statutory provisions:
(1) The prohibition against taking into account that a beneficiary who is covered or seeks to be covered under the plan is entitled to Medicare on the basis of ESRD, age, or disability, or eligible on the basis of ESRD.
(2) The nondifferentiation clause for individuals with ESRD.
(3) The equal benefits clause for the working aged.
(4) The obligation to refund conditional Medicare primary payments.
(c) CMS may make a determination of nonconformance for a GHP or LGHP that fails to respond to a request for information, or to provide correct information, either voluntarily or in response to a CMS request, on the plan's primary payment obligation with respect to a given beneficiary, if that failure contributes to either or both of the following:
(1) Medicare erroneously making a primary payment.
(2) A delay or foreclosure of CMS's ability to recover an erroneous primary payment.

## Nearby sections

- [42 C.F.R. § 411.100 (2026) § 411.100   Basis and scope.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_100.md)
- [42 C.F.R. § 411.101 (2026) § 411.101   Definitions.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_101.md)
- [42 C.F.R. § 411.102 (2026) § 411.102   Basic prohibitions and requirements.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_102.md)
- [42 C.F.R. § 411.103 (2026) § 411.103   Prohibition against financial and other incentives.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_103.md)
- [42 C.F.R. § 411.104 (2026) § 411.104   Current employment status.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_104.md)
- [42 C.F.R. § 411.106 (2026) § 411.106   Aggregation rules.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_106.md)
- [42 C.F.R. § 411.108 (2026) § 411.108   Taking into account entitlement to Medicare.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_108.md)
- [42 C.F.R. § 411.110 (2026) § 411.110   Basis for determination of nonconformance.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_110.md)
- [42 C.F.R. § 411.112 (2026) § 411.112   Documentation of conformance.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_112.md)
- [42 C.F.R. § 411.114 (2026) § 411.114   Determination of nonconformance.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_114.md)
- [42 C.F.R. § 411.115 (2026) § 411.115   Notice of determination of nonconformance.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_115.md)
- [42 C.F.R. § 411.120 (2026) § 411.120   Appeals.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_120.md)
- [42 C.F.R. § 411.121 (2026) § 411.121   Hearing procedures.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_121.md)
- [42 C.F.R. § 411.122 (2026) § 411.122   Hearing officer's decision.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_122.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/CFR_T42_P411_S411_110. Check the current official text before relying on it. Not legal advice.