§ 155.1650 Failure to comply.
(a)General principle. For purposes of improper payment measurement under this subpart, HHS will classify APTC payments as improper when a State Exchange fails to provide adequate documentation demonstrating that such payments were made in accordance with applicable Federal requirements. (b)Determination of substantial noncompliance. HHS will determine that a State Exchange has failed to substantially comply with this subpart if the State Exchange: (1)Fails to submit required data or documentation within the timelines specified in the Annual Program Schedule.
(2)Submits data or documentation that is incomplete, inaccurate, or in a format that would reasonably prevent effective review.
(3)Fails to implement the CAP process as set out in § 155.1635(d). Free access — add to your briefcase to read the full text and ask questions with AI
§ 155.1650 Failure to comply.
(a) General principle. For purposes of improper payment measurement under this subpart, HHS will classify APTC payments as improper when a State Exchange fails to provide adequate documentation demonstrating that such payments were made in accordance with applicable Federal requirements.
(b) Determination of substantial noncompliance. HHS will determine that a State Exchange has failed to substantially comply with this subpart if the State Exchange:
(1) Fails to submit required data or documentation within the timelines specified in the Annual Program Schedule.
(2) Submits data or documentation that is incomplete, inaccurate, or in a format that would reasonably prevent effective review.
(3) Fails to implement the CAP process as set out in § 155.1635(d).
(4) Demonstrates a pattern of more than five instances during a SEIPM cycle in which the State Exchange fails to respond within 30 calendar days, or provides a non-responsive answer, to HHS requests for clarification or additional information.
(c) Notice and opportunity to cure. Before implementing measures under paragraph (d) of this section, HHS will:
(1) Provide written notice to the State Exchange specifying the nature of the noncompliance and the potential consequences.
(2) Allow the State Exchange a reasonable opportunity, not less than 30 days, to cure the noncompliance or demonstrate that compliance has been achieved.
(d) Remedial measures. If a State Exchange fails to substantially comply with the data collection requirements, the CAP provisions contained in this subpart, or HHS requests for clarification or additional information, and HHS finds that such failures undermine or prohibit HHS's efficient administration of Exchange improper payment measurement activities, HHS may implement measures or procedures for:
(1) Enhanced monitoring and reporting.
(2) Mandatory implementation of specific operational procedures or controls.
(3) On-site visits to State Exchange facilities to assess operational procedures, data systems, and compliance with program requirements.
(e) Escalation procedures. If a State Exchange continues to fail to comply after implementation of initial remedial measures under paragraph (d) of this section, HHS may initiate proceedings to revoke the State Exchange's authority to operate in accordance with applicable law.