The various conditions which a provider (eg. hospital, skilled nursing facility) or supplier of services desiring to participate in the Medicare program is required to meet before participation is permitted. These conditions are specified in the statute and regulations and include compliance with tittle VI of the Civil Rights Act, signing an agreement to participate acceptable to the Secretary of HEW, meeting the definition of the particular institution or facility contained in the law (eg. in order to participate as a hospital an institution must be a hospital within the meaning of section 1861 (e) of the Social Security Act and must further meet standards for health and safety specified in regulations), conformity with State and local laws, having an acceptable utilization review plan, and meeting appropriate PSRO requirements. Investigations to determine whether or not health care facilities meet or continue to meet conditions of participation are made by the appropriate State health agency, which is responsible for certifying that the conditions have been met and that the provider or supplier is eligible to participate.