Denial of Payment for New Admissions
What this clause says
The Secretary may deny payment under the State plan or under this title with respect to any individual admitted to the facility after the effective date of the notice of noncompliance.
What this actually means
Denial of payment for new admissions is an intermediate enforcement remedy. The building stays open and keeps caring for existing residents, but the program stops paying for anyone admitted after the effective date.
What it means for an operator
It is a revenue event rather than a physical one, and that is exactly why most insurance programs do not respond to it. Business income coverage on a property policy is typically triggered by physical damage, so a regulatory sanction that empties a building over several months falls outside it entirely. Loss of license coverage is the product designed for this, and the questions to ask are whether it is triggered by a suspension or a payment sanction rather than only by an outright revocation, what the indemnity period is, and whether the limit is sized against the actual monthly contribution of the affected census. Operators consistently discover this coverage gap during the sanction rather than before it.
Why the Policy Checker does not score this
This term is worth understanding and cannot be checked from a declarations page. There is no single field that would answer it, and scoring it from an assumption would produce a confident wrong finding, which is the one thing a tool like this must never do. It is defined here and left out of the check.
See this in your policy
Check this term against your own program.
Run the Policy CheckerRelated clauses
Common questions about this clause
- What is loss of license coverage and when does it actually pay?
- Does business interruption cover census loss after a fire?
- How does a named storm deductible work for a senior living facility?
- What insurance does a new assisted living facility need?
- Does our insurance change when we start taking Medicaid residents?