[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR488.320]



[Page 922]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 488_SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES--Table of 

 

     Subpart E_Survey and Certification of Long-Term Care Facilities

 

Sec.  488.320  Sanctions for inadequate survey performance.



    (a) Annual assessment of survey performance. CMS assesses the 

performance of the State's survey and certification program annually.

    (b) Sanctions for inadequate survey performance. When a State 

demonstrates inadequate survey performance, as specified in Sec.  

488.318, CMS notifies the survey agency of the inadequacy and takes 

action in accordance with paragraphs (c) and (d) of this section.

    (c) Medicaid facilities. (1) For a pattern of failure to identify 

deficiencies in Medicaid facilities, CMS--

    (i) Reduces FFP, as specified in paragraph (e) of this section, and 

if appropriate;

    (ii) Provides for training of survey teams.

    (2) For other survey inadequacies in Medicaid facilities, CMS 

provides for training of survey teams.

    (d) Medicare facilities. For all survey inadequacies in Medicare 

facilities, CMS--

    (1) Requires that the State survey agency submit a plan of 

correction;

    (2) Provides for training of survey teams;

    (3) Provides technical assistance on scheduling and procedural 

policies;

    (4) Provides CMS-directed scheduling; or

    (5) Initiates action to terminate the agreement between the 

Secretary and the State under section 1864 of the Act, either in whole 

or in part.

    (e) Reduction of FFP. In reducing FFP for inadequate survey 

performance, CMS uses the formula specified in section 1919(g)(3)(C) of 

the Act, that is 33 percent multiplied by a fraction--

    (1) The numerator of which is equal to the total number of residents 

in the NFs that CMS found to be noncompliant during validation surveys 

for that quarter; and

    (2) The denominator of which is equal to the total number of 

residents in the NFs in which CMS conducted validation surveys during 

that quarter.

    (f) Appeal of FFP reduction. When a State is dissatisfied with CMS's 

determination to reduce FFP, the State may appeal the determination to 

the Departmental Appeals Board, using the procedures specified in 45 CFR 

part 16.