§ 412.167 Appeal under the Hospital Value-Based Purchasing (VBP) Program. ( a ) A hospital may appeal the following issues: ( 1 ) CMS' decision to deny a hospital's correction request that the hospital submitted under the review and corrections process;
( 2 ) Whether the achievement/improvement points were calculated correctly;
( 3 ) Whether CMS properly used the higher of the achievement/improvement points in calculating the hospital's measure/dimension score;
( 4 ) Whether CMS correctly calculated the domain scores, including the normalization calculation;
( 5 ) Whether CMS used the proper lowest dimension score in calculating the hospital's HCAHPS consistency points;
( 6 ) Whether CMS calculated the HCAHPS consistency points correctly;
( 7 ) Whether the correct domain scores were used to calculate the Total Performance Score;
( 8 ) Whether each domain was weighted properly;
( 9 ) Whether the weighted domain scores were properly summed to arrive at the Total Performance Score; and,
( 10 ) Whether the hospital's open/closed status (including mergers and acquisitions) is properly specified in CMS' systems.
( b ) Appeals must be submitted within 30 days of CMS' decision to deny a corrections request under § 412.163 or within 30 days of the conclusion of the review and corrections period, as applicable, and must contain the following information: ( 1 ) Hospital's CMS Certification Number (CCN).
( 2 ) Hospital name.
( 3 ) Hospital's basis for requesting an appeal. This must identify the hospital's specific reason(s) for appealing the hospital's Total Performance Score or performance assessment with respect to the performance standards.
( 4 ) CEO contact information, including name, email address, telephone number, and mailing address (must include the physical address, not just the post office box).
( 5 ) QualityNet security official contact information, including name, email address, telephone number, and mailing address (must include the physical address, not just the post office box).
( c ) If a hospital is dissatisfied with CMS' decision on an appeal request submitted under paragraph (b) of this section, the hospital may request an independent CMS review of that decision.
( d ) *Limitations on review.* There is no administrative or judicial review of the following: ( 1 ) The methodology used to determine the amount of the value-based incentive payment under section 1886(o)(6) of the Act and the determination of such amount.
( 2 ) The determination of the amount of funding available for value-based incentive payments under section 1886(o)(7)(A) of the Act and the payment reduction under section 1886(o)(7)(B)(i) of the Act.
( 3 ) The establishment of the performance standards under section 1886(o)(3) of the Act and the performance period under section 1886(o)(4) of the Act.
( 4 ) The measures specified under section 1886(b)(3)(B)(viii) of the Act and the measures selected under section 1886(o)(2) of the Act.
( 5 ) The methodology developed under section 1886(o)(5) of the Act that is used to calculate hospital performance scores and the calculation of such scores.
( 6 ) The validation methodology that is specified under section 1886(b)(3)(B)(viii)(XI) of the Act.
[50 FR 12741, Mar. 29, 1985, as amended at 78 FR 75196, Dec. 10, 2013; 86 FR 45520, Aug. 13, 2021]