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CASE | DECISION |JUDGE | FOOTNOTE

Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Civil Remedies Division
IN THE CASE OF  


SUBJECT:

Health Care & Rehab of Corsicana,

Petitioner,

DATE: April 29, 2005
                                          
             - v -

 

Centers for Medicare & Medicaid Services.

 

Docket No.C-05-144
Decision No. CR1301
DECISION
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DECISION

This case presents the narrow question as to whether a long-term care facility has a right to a hearing when the Centers for Medicare & Medicaid Services (CMS) withdraws the enforcement remedies provided for in 42 C.F.R. � 488.406. I conclude that the facility is not entitled to a hearing and grant CMS's motion to dismiss.

Petitioner, Health Care & Rehab of Corsicana, is a skilled nursing facility located in Corsicana, Texas, certified to participate in the Medicare and Medicaid programs as a provider of services. On December 22, 2004, the Texas Department of Human Services completed an inspection of Petitioner's facility and found noncompliance. In a notice dated January 31, 2005, CMS advised Petitioner that, based on those survey findings, it would impose the following remedies: termination of its provider agreement, denial of payment for new admissions, and directed inservice training. CMS Exhibit (Ex.) 1. Petitioner timely requested a hearing. Subsequently, in a letter dated March 23, 2005, CMS notified Petitioner of its decision to rescind the remedies. CMS Ex. 2. CMS now moves to dismiss this case, arguing that Petitioner has no right to a hearing because the previously-imposed remedies have been rescinded. In support of its motion to dismiss, CMS attached the two aforementioned exhibits, CMS Exs. 1-2. Petitioner did not respond to the motion, and the time for response has since passed. In the absence of objection, I have admitted CMS Exs. 1-2 into the record.

1. Petitioner has no right to a hearing if CMS has not imposed a remedy. (1)

The hearing rights of a long-term care facility are established by federal regulations at 42 C.F.R. Part 498. A provider dissatisfied with CMS's initial determination is entitled to further review, but administrative actions that are not initial determinations are not subject to appeal. 42 C.F.R. � 498.3(d). The regulations specify which actions are "initial determinations" and set forth examples of actions that are not. A finding of noncompliance that results in the imposition of a remedy specified in 42 C.F.R. � 488.406 is an initial determination for which a facility may request an administrative law judge (ALJ) hearing. 42 C.F.R. � 498.3(b)(13). Unless the finding of noncompliance results in the imposition of a specified remedy, however, the finding is not an initial determination. 42 C.F.R. � 498.3(d)(10)(ii). Where, as here, CMS rescinds its remedy determination, Petitioner no longer has a hearing right because the determination that is subject to a hearing no longer exists. Schowalter Villa, DAB No. 1688 (1999).

CMS has rescinded its remedy determination and, consequently, Petitioner no longer has a right to an ALJ hearing. An ALJ may dismiss a hearing request where a party has no right to a hearing. 42 C.F.R. � 498.70(b). I therefore grant CMS's motion to dismiss and order this case dismissed.

JUDGE
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Carolyn Cozad Hughes

Administrative Law Judge

FOOTNOTE
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1. There being no dispute of fact in this case, I make this one conclusion of law.

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