42 CFR § 489.11 - Acceptance of a provider as a participant.
(a) Action by CMS. If CMS determines that the provider meets the requirements, it will send the provider—
(1) Written notice of that determination; and
(2) Two copies of the provider agreement.
(b) Action by provider. If the provider wishes to participate, it must return both copies of the agreement, duly signed by an authorized official, to CMS, together with a written statement indicating whether it has been adjudged insolvent or bankrupt in any State or Federal court, or whether any insolvency or bankruptcy actions are pending.
(c) Notice of acceptance. If CMS accepts the agreement, it will return one copy to the provider with a written notice that—
(1) Indicates the dates on which it was signed by the provider's representative and accepted by CMS; and
(2) Specifies the effective date of the agreement.