How will compliance be audited and enforced by CMS?
The Centers for Medicare and Medicaid Services (CMS) will create a process for auditing hospital compliance with the regulations adopted in the final rule. This will include evaluation of complaints made by individuals or entities to CMS, evaluation of hospital’s publication media such as website, hospital infrastructure and IT provider’s publication media.
The following steps will take place in every case in which CMS determines a hospital is not compliant with the requirements:
- Provide a warning notice to the hospital
- Request a Corrective Action Plan (CLAP) from the hospital
- Determine and impose a Civil Monetary Penalty (CMP) on the hospital and publicize the non-compliant status and penalty on a CMS website.
CMS will determine a hospital as non-compliant by reviewing the new requirements changes such as: accessibility of price information without barriers such as blocking codes (captcha), agreements to terms and conditions, or submission of consumer’s personal information. Estimator tools without the file’s formats and without mandatory information to be disclosed will not meet rule compliance.
CMS may also impose a CMP on a hospital that it identifies as noncompliant. CMS Increased penalties for noncompliance up to $5,500 per day or $2,007,500 for full calendar year, depending on the hospital size and beds quantity.
Hospitals and others healthcare providers that are subject to comply may appeal a CMP within 3p calendar days by requesting a hearing to defend or justify any reasons for noncompliance.
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