CMS Pub. 100-16, ch. 15, § 50

(Rev. 73, Issued: 09-30-05, Effective Date: 09-30-05)

If CMS determines that an MA organization has acted or failed to act, as specified above

under Federal Regulations at 42 CFR 422.752, CMS sends a written notice to the MA

organization stating the nature and basis of the proposed sanction, and also sends the

DHHS/OIG a copy of the notice. The MA organization has 15 days from receipt of the

notice to respond to the notice of intent to impose sanctions; otherwise the sanction(s)

goes into effect.

Upon receipt of the sanction notice, the MA organization has several other options:

• The MA organization may request an additional 15 days to respond, which is

granted at CMS's discretion. The request must provide a credible explanation of

why additional time is necessary and must be received by CMS before the 15-day

period expires. CMS does not grant an extension if it determines that the MA

organization's conduct poses a threat to an enrollee's health and safety.

• If the MA organization submits a response, as described above, a CMS official

not involved in the original determination conducts an informal

reconsideration. The reconsideration includes a review of the evidence and a

written decision that affirms or rescinds the original determination. If CMS's

original determination is rescinded by the reconsideration official, the

intermediate sanction process terminates.

• If the MA organization requests that CMS reconsider its original determination

and CMS affirms this determination in accordance with the informal

reconsideration process described above, the sanction is effective on the date

specified in the notice of CMS's reconsidered determination. However, if CMS

determines that the MA organization's conduct poses a serious threat to an

enrollee's health and safety, CMS may make the sanction effective on a date

before issuance of CMS's reconsidered determination.

If the MA organization does not seek to have CMS reconsider its decision, a sanction is

effective 15 days after the date that the organization is notified by CMS of its decision to

impose the sanction. The MA organization must submit a corrective action plan (CAP)

that includes a timetable for completion. The purpose of the CAP is to explain to CMS

how the sanctionable action will be corrected and avoided in the future. .The CMS-imposed intermediate sanctions remain in effect until CMS notifies the MA organization

that CMS is satisfied that the basis for imposing the sanction has been corrected and is

not likely to recur. CMS notifies the DHHS/OIG when CMS reverses or terminates a

sanction.