---
kind: "section"
citation: "42 C.F.R. § 488.320"
title: "42"
number: "488.320"
heading: "Sanctions for inadequate survey performance."
url: "https://uscodex.org/cfr/42/488.320"
---

# §488.320. Sanctions for inadequate survey performance.

- (a) **Annual assessment of survey performance.** CMS assesses the performance of the State's survey and certification program annually.
- (b) **Sanctions for inadequate survey performance.** When a State demonstrates inadequate survey performance, as specified in [§ 488.318](/cfr/42/488.318.md), CMS notifies the survey agency of the inadequacy and takes action in accordance with paragraphs [(c)](#c) and [(d)](#d) of this section.
- (c) **Medicaid facilities.**
  - (1) **For a pattern of failure to identify deficiencies in Medicaid facilities, CMS—**
    - (i) Reduces FFP, as specified in [paragraph (e)](#e) of this section, and if appropriate;
    - (ii) **Provides for training of survey teams.**
  - (2) **For other survey inadequacies in Medicaid facilities, CMS provides for training of survey teams.**
- (d) **Medicare facilities.** For all survey inadequacies in Medicare facilities, CMS—
  - (1) Requires that the State survey agency submit a plan of correction;
  - (2) Provides for training of survey teams;
  - (3) Provides technical assistance on scheduling and procedural policies;
  - (4) Provides CMS-directed scheduling; or
  - (5) Initiates action to terminate the agreement between the Secretary and the State under section 1864 of the Act, either in whole or in part.
- (e) **Reduction of FFP.** In reducing FFP for inadequate survey performance, CMS uses the formula specified in section 1919(g)(3)(C) of the Act, that is 33 percent multiplied by a fraction—
  - (1) The numerator of which is equal to the total number of residents in the NFs that CMS found to be noncompliant during validation surveys for that quarter; and
  - (2) The denominator of which is equal to the total number of residents in the NFs in which CMS conducted validation surveys during that quarter.
- (f) **Appeal of FFP reduction.** When a State is dissatisfied with CMS's determination to reduce FFP, the State may appeal the determination to the Departmental Appeals Board, using the procedures specified in [45 CFR part 16](/cfr/45/part16.md).

## Notes

### Source

Source: 59 FR 56238, Nov. 10, 1994, unless otherwise noted.

### Authority

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

### Source

Source: 53 FR 22859, June 17, 1988, unless otherwise noted.