Form Cms-462l - Adverse Acti0n Extract For Snfs And Nfs (Page 6 of 6) in pdf

Form Cms-462l - Adverse Acti0n Extract For Snfs And Nfs Page 6

Item 46 Enter the status of the State’s determination of noncompliance as per the State court of

appeals decision (“R” for reversed, “S” for sustained, “M” for modified).

Item 47 Indicate the name of the State “Court of Last Resort” (e.g., Superior Court, Supreme Court,

etc.) to which the facility files an appeal.

Item 48

Enter the date on which the State “Court of Last Resort” renders its decision.

Item 49 Indicate the name of the State “Court of Last Resort” (e.g., Superior Court, Supreme Court,

etc.) to which the facility files an appeal. NOTE: This field should be completed if the State

to which the facility files an appeal has more than one “Court of Last Resort,” and this court

also renders a decision.

Item 50

Enter the date on which the State “Court of Last Resort” renders its decision.

Item 51 Enter the status of the State’s determination of noncompliance as per the State superior

court’s decision (“R” for reversed, “S” for sustained, “M” for modified). Use both boxes if

there were two State superior court decisions.

Page 4 of 4

INSTR. to FORM CMS-462L (7/95)

Form Cms-462l - Adverse Acti0n Extract For Snfs And Nfs Page 6