When a CMP is Due and Payable

10005.21 - When a CMP is Due and Payable (Rev. 221; Issued: 05-10-24; Effective: 05-10-24; Implemetation:05-10-24) In accordance with HHA (42 CFR 488.845(f)) and hospice program (42 CFR 488.1245(f)) regulations, payments are due for all CMPs within 15 days from any of the following: • After a final administrative decision when the HHA or hospice program achieves substantial compliance before the final decision or the effective date of termination before final decision, o A final administrative decision includes an ALJ decision and review by the Departmental Appeals Board, if the HHA or hospice program requests a review of the ALJ decision. • After the time to appeal has expired and the HHA or hospice program does not appeal or fails to timely appeal the initial determination, • After CMS receives a written request from the HHA or hospice program requesting to waive its right to appeal the determinations that led to the imposition of a CMP, • After substantial compliance is achieved, or • After the effective date of termination. Note: The regulations at §488.845 for HHA and §488.1245 for hospice programs do not include a provision for extended payment plans for HHA or hospice program CMPs. An HHA or hospice program has two options for action following the imposition of a CMP: • The HHA or hospice program could pay the amount due for all CMPs imposed prior to the date a CMP is due and payable; or • The HHA or hospice program could request a hearing based on the determination of noncompliance with Medicare CoPs. When an HHA or hospice program provides timely notice waiving its right to a hearing, CMS reduces the final CMP amount by 35%. This reduction is reflected once the CMP stops accruing, that is, when the HHA or hospice program achieves substantial compliance before CMS receives its request to waive a hearing, or the effective date of the termination occurs before CMS received the waiver request. Impact of Hearing Requests: Within 60 days of receipt of the notice of imposition of a penalty, the HHA or hospice program may file a request directly to the Departmental Appeals Board in the Office of the Secretary, Department of Health and Human Services with a copy to the State and CMS. In accordance with §498.40(b), the HHA’s or hospice program’s appeal request would identify the specific issues of contention, the findings of fact and conclusions of the law with which the HHA or hospice program disagreed, and the specific basis for contending that the survey findings and determinations were invalid. A hearing would be completed before any penalty was collected. However, sanctions/remedies would continue regardless of the timing of any appeals proceedings if the HHA or hospice program had not met the CoPs. Requesting an appeal would not delay or end the imposition of a sanction/remedy but can only affect the collection of any final CMP amounts due. A CMP would begin to accrue on the last day of the survey which identified the noncompliance. These include penalties imposed on a per day basis, as well as penalties imposed per instance of noncompliance.