General Provisions

10003.2 - General Provisions (Rev. 221; Issued: 05-10-24; Effective: 05-10-24; Implemetation:05-10-24) Under section 1891(e)(1) of the Act for HHAs and section 1822(c)(5) of the Act for hospice programs, if CMS or a SA determines that condition-level deficiencies immediately jeopardize the health or safety of its patients, then CMS must take immediate action to notify the provider of the jeopardy situation and the provider must correct the deficiencies. If the IJ is not removed because the provider is unable or unwilling to correct the deficiencies, CMS will terminate the provider’s provider agreement. In addition, CMS may impose one or more specified alternative sanctions or enforcement remedies, respectively, including but not limited to CMPs and suspension of all Medicare payments before the effective date of termination. If CMS finds that the provider is not in compliance with the Medicare CoPs and the deficiencies involved do not immediately jeopardize the health and safety of the individuals to whom the HHA or hospice program furnishes items and services, CMS may terminate the provider agreement and should consider the imposition of an alternative sanction(s)/enforcement remedy(ies) The decision to impose one or more alternative sanctions for HHAs or enforcement remedies for hospice programs would be based on condition-level deficiencies or repeat deficiencies found in the provider during a survey. While SAs are not required to recommend the types of sanction/remedies to be imposed, they are encouraged to do so since States may be more familiar with a facility’s history and the specific circumstances in the case at hand. To ensure effective communication and exchange of information, CMS encourages that all documentation is included in iQIES or any subsequent system. The CMS Location will consider these recommendations but ultimately makes the enforcement determination. Not all situations require the same sanctions/remedies. The CMS Location should use the enforcement sanction/remedy most appropriate in considering the level/degree of harm, the context behind the facility noncompliance, and the type of enforcement that has the best chance of the facility achieving future compliance. While a range of sanctions/remedies are available, suspension of payment for all new admissions is likely to be the most effective at rapidly returning the provider to compliance.