---
kind: "section"
citation: "42 C.F.R. § 412.167"
title: "42"
number: "412.167"
heading: "Appeal under the Hospital Value-Based Purchasing (VBP) Program."
url: "https://uscodex.org/cfr/42/412.167"
---

# §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](/cfr/42/412.163.md) 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)](#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)](/cfr/42/1886.md?p=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)](/cfr/42/1886.md?p=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)](/cfr/42/1886.md?p=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.**

## Notes

### Amendments

[50 FR 12741, Mar. 29, 1985, as amended at 78 FR 75196, Dec. 10, 2013; 86 FR 45520, Aug. 13, 2021]

### Source

Source: 77 FR 53674, Aug. 31, 2012, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 50 FR 12741, Mar. 29, 1985, unless otherwise noted.

### Amendments

[50 FR 12741, Mar. 29, 1985, as amended at 78 FR 75196, Dec. 10, 2013; 86 FR 45520, Aug. 13, 2021]