---
kind: "section"
citation: "42 U.S.C. § 1395i–6"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1395i–6"
heading: "Hospice program survey and enforcement procedures"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1395i-6"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XVIII — Health Insurance for Aged and Disabled"
  - "Part A — Hospital Insurance Benefits for Aged and Disabled"
---

# §1395i–6. Hospice program survey and enforcement procedures

- (a) **Surveys—**
  - (1) **Frequency—** Any entity that is certified as a hospice program (as defined in [section 1395x(dd)(2) of this title](/usc/42/1395x.md?p=dd-2)) shall be subject to a [standard](/usc/42/1320d.md?p=7) survey by an appropriate [State](/usc/42/619.md?p=5) or local survey [agency](/usc/42/1397n–12.md?p=1), or an approved accreditation [agency](/usc/42/1397n–12.md?p=1), as determined by the [Secretary](/usc/42/1301.md?p=a-6), not less frequently than once every 36 months.
  - (2) **Public transparency of survey and certification information—**
    - (A) **Submission of information to the Secretary—**
      - (i) **In general—** Each [State](/usc/42/619.md?p=5) or local survey [agency](/usc/42/1397n–12.md?p=1), and each national accreditation body with respect to which the [Secretary](/usc/42/1301.md?p=a-6) has made a finding under [section 1395bb(a) of this title](/usc/42/1395bb.md?p=a) respecting the accreditation of a hospice program by such body, shall submit, in a form and manner, and at a time, specified by the [Secretary](/usc/42/1301.md?p=a-6) for purposes of this paragraph, information respecting any survey or certification made with respect to a hospice program by such survey [agency](/usc/42/1397n–12.md?p=1) or body, as applicable. Such information shall include any inspection report made by such survey [agency](/usc/42/1397n–12.md?p=1) or body with respect to such survey or certification, any enforcement actions taken as a result of such survey or certification, and any other information determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6).
      - (ii) **Required inclusion of specified form—** With respect to a survey under this subsection carried out by a national accreditation body described in [clause (i)](#a-2-A-i) on or after October 1, 2021, information described in such clause shall include Form CMS-2567 (or a successor form), along with such additional information determined appropriate by such body.
    - (B) **Public disclosure of information—** Beginning not later than October 1, 2022, the [Secretary](/usc/42/1301.md?p=a-6) shall publish the information submitted under [subparagraph (A)](#a-2-A) on the public website of the Centers for Medicare & Medicaid Services in a manner that is prominent, easily accessible, readily understandable, and searchable. The [Secretary](/usc/42/1301.md?p=a-6) shall provide for the timely update of such information so published.
  - (3) **Consistency of surveys—** Each [State](/usc/42/619.md?p=5) and the [Secretary](/usc/42/1301.md?p=a-6) shall implement programs to measure and reduce inconsistency in the application of survey results among surveyors.
  - (4) **Survey teams—**
    - (A) **In general—** In the case of a survey conducted under this subsection on or after October 1, 2021, by more than 1 individual, such survey shall be conducted by a multidisciplinary team of professionals ([including](/usc/42/1301.md?p=b) a registered professional nurse).
    - (B) **Prohibition of conflicts of interest—** Beginning October 1, 2021, a [State](/usc/42/619.md?p=5) may not use as a member of a survey team under this subsection an individual who is serving (or has served within the previous 2 years) as a member of the staff of, or as a consultant to, the program surveyed respecting compliance with the requirements of [section 1395x(dd) of this title](/usc/42/1395x.md?p=dd) or who has a personal or familial financial interest in the program being surveyed.
    - (C) **Training—** The [Secretary](/usc/42/1301.md?p=a-6) shall provide, not later than October 1, 2021, for the comprehensive training of [State](/usc/42/619.md?p=5) and Federal surveyors, and any surveyor employed by a national accreditation body described in [paragraph (2)(A)(i)](#a-2-A-i), in the conduct of surveys under this subsection, [including](/usc/42/1301.md?p=b) training with respect to the review of written plans for providing hospice care (as described in [section 1395f(a)(7)(B) of this title](/usc/42/1395f.md?p=a-7-B)). No individual shall serve as a member of a survey team with respect to a survey conducted on or after such date unless the individual has successfully completed a training and testing program in survey and certification techniques that has been approved by the [Secretary](/usc/42/1301.md?p=a-6).
  - (5) **Funding—** The [Secretary](/usc/42/1301.md?p=a-6) shall provide for the transfer, from the Federal [Hospital](/usc/42/300s–3.md?p=1) Insurance Trust Fund under [section 1395i of this title](/usc/42/1395i.md) to the Centers for Medicare & Medicaid Services Program Management Account, of $10,000,000 for each [fiscal year](/usc/42/619.md?p=3) (beginning with [fiscal year](/usc/42/619.md?p=3) 2022) for purposes of carrying out this subsection and [subsection (b)](#b). Sums so transferred shall remain available until expended. Any transfer pursuant to this paragraph shall be in addition to any transfer pursuant to section 3(a)(2) of the Improving Medicare Post-Acute Care Transformation Act of 2014.
- (b) **Special focus program—**
  - (1) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) shall conduct a special focus program for enforcement of requirements for hospice programs that the [Secretary](/usc/42/1301.md?p=a-6) has identified as having substantially failed to meet applicable requirements of this chapter.
  - (2) **Periodic surveys—** Under such special focus program, the [Secretary](/usc/42/1301.md?p=a-6) shall conduct surveys of each hospice program in the special focus program not less than once every 6 months.
- (c) **Enforcement—**
  - (1) **Situations involving immediate jeopardy—** If the [Secretary](/usc/42/1301.md?p=a-6) determines on the basis of a [standard](/usc/42/1320d.md?p=7) survey or otherwise that a hospice program that is certified for participation under this subchapter is no longer in compliance with the requirements specified in [section 1395x(dd) of this title](/usc/42/1395x.md?p=dd) and determines that the deficiencies involved immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services, the [Secretary](/usc/42/1301.md?p=a-6) shall take immediate action to ensure the removal of the jeopardy and correction of the deficiencies or terminate the certification of the program, and may provide, in addition, for 1 or more of the other remedies described in [paragraph (5)(B)](#c-5-B).
  - (2) **Situations not involving immediate jeopardy—** If the [Secretary](/usc/42/1301.md?p=a-6) determines on the basis of a [standard](/usc/42/1320d.md?p=7) survey or otherwise that a hospice program that is certified for participation under this subchapter is no longer in compliance with the requirements specified in [section 1395x(dd) of this title](/usc/42/1395x.md?p=dd) and determines that the deficiencies involved do not immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services, the [Secretary](/usc/42/1301.md?p=a-6) may (for a period not to exceed 6 months) impose remedies developed pursuant to [paragraph (5)(A)](#c-5-A), in lieu of terminating the certification of the program. If, after such a period of remedies, the program is still no longer in compliance with such requirements, the [Secretary](/usc/42/1301.md?p=a-6) shall terminate the certification of the program.
  - (3) **Penalty for previous noncompliance—** If the [Secretary](/usc/42/1301.md?p=a-6) determines that a hospice program that is certified for participation under this subchapter is in compliance with the requirements specified in [section 1395x(dd) of this title](/usc/42/1395x.md?p=dd) but, as of a previous period, did not meet such requirements, the [Secretary](/usc/42/1301.md?p=a-6) may provide for a civil money penalty under [paragraph (5)(B)(i)](#c-5-B-i) for the days in which the [Secretary](/usc/42/1301.md?p=a-6) finds that the program was not in compliance with such requirements.
  - (4) **Option to continue payments for noncompliant hospice programs—** The [Secretary](/usc/42/1301.md?p=a-6) may continue payments under this subchapter with respect to a hospice program not in compliance with the requirements specified in [section 1395x(dd) of this title](/usc/42/1395x.md?p=dd) over a period of not longer than 6 months, if—
    - (A) the [State](/usc/42/619.md?p=5) or local survey [agency](/usc/42/1397n–12.md?p=1) finds that it is more appropriate to take alternative action to assure compliance of the program with such requirements than to terminate the certification of the program;
    - (B) the program has submitted a plan and timetable for corrective action to the [Secretary](/usc/42/1301.md?p=a-6) for approval and the [Secretary](/usc/42/1301.md?p=a-6) approves the plan of corrective action; and
    - (C) the program agrees to repay to the Federal Government payments received under this subchapter during such period if the corrective action is not taken in accordance with the approved plan and timetable.

    The [Secretary](/usc/42/1301.md?p=a-6) shall establish guidelines for approval of corrective actions requested by hospice programs under this paragraph.

  - (5) **Remedies—**
    - (A) **Development—**
      - (i) **In general—** Not later than October 1, 2022, the [Secretary](/usc/42/1301.md?p=a-6) shall develop and implement—
        - (I) a range of remedies to apply to hospice programs under the conditions described in paragraphs [(1)](#c-1) through [(4)](#c-4); and
        - (II) appropriate procedures for appealing determinations relating to the imposition of such remedies.

      Remedies developed pursuant to the preceding sentence shall include the remedies specified in [subparagraph (B)](#c-5-B).

      - (ii) **Conditions of imposition of remedies—** Not later than October 1, 2022, the [Secretary](/usc/42/1301.md?p=a-6) shall develop and implement specific procedures with respect to the conditions under which each of the remedies developed under [clause (i)](#c-5-A-i) is to be applied, [including](/usc/42/1301.md?p=b) the amount of any fines and the severity of each of these remedies. Such procedures shall be designed so as to minimize the time between identification of deficiencies and imposition of these remedies and shall provide for the imposition of incrementally more severe fines for repeated or uncorrected deficiencies.
    - (B) **Specified remedies—** The remedies specified in this subparagraph are the following:
      - (i) Civil money penalties in an amount not to exceed $10,000 for each day of noncompliance by a hospice program with the requirements specified in [section 1395x(dd) of this title](/usc/42/1395x.md?p=dd).
      - (ii) Suspension of all or part of the payments to which a hospice program would otherwise be entitled under this subchapter with respect to items and services furnished by a hospice program on or after the date on which the [Secretary](/usc/42/1301.md?p=a-6) determines that remedies should be imposed pursuant to paragraphs [(1)](#c-1) and [(2)](#c-2).
      - (iii) The appointment of temporary management to oversee the operation of the hospice program and to protect and assure the health and safety of the individuals under the care of the program while improvements are made in order to bring the program into compliance with all such requirements.
    - (C) **Procedures—**
      - (i) **Civil money penalties—**
        - (I) **In general—** Subject to [subclause (II)](#c-5-C-i-II), the provisions of [section 1320a–7a of this title](/usc/42/1320a–7a.md) (other than subsections [(a)](#a) and [(b)](#b)) shall apply to a civil money penalty under this subsection in the same manner as such provisions apply to a penalty or proceeding under [section 1320a–7a(a) of this title](/usc/42/1320a–7a.md?p=a).
        - (II) **Retention of amounts for hospice program improvements—** The [Secretary](/usc/42/1301.md?p=a-6) may provide that any portion of civil money penalties collected under this subsection may be used to support activities that benefit individuals receiving hospice care, [including](/usc/42/1301.md?p=b) education and training programs to ensure hospice program compliance with the requirements of [section 1395x(dd) of this title](/usc/42/1395x.md?p=dd).
      - (ii) **Suspension of payment—** A finding to suspend payment under [subparagraph (B)(ii)](#c-5-B-ii) shall terminate when the [Secretary](/usc/42/1301.md?p=a-6) finds that the program is in substantial compliance with all requirements of [section 1395x(dd) of this title](/usc/42/1395x.md?p=dd).
      - (iii) **Temporary management—** The temporary management under [subparagraph (B)(iii)](#c-5-B-iii) shall not be terminated until the [Secretary](/usc/42/1301.md?p=a-6) has determined that the program has the management capability to ensure continued compliance with all the requirements referred to in such subparagraph.
    - (D) **Relationship to other remedies—** The remedies developed under [subparagraph (A)](#c-5-A) are in addition to sanctions otherwise available under [State](/usc/42/619.md?p=5) or Federal law and shall not be construed as limiting other remedies, [including](/usc/42/1301.md?p=b) any remedy available to an individual at common law.

## Source credit

(Aug. 14, 1935, ch. 531, title XVIII, § 1822, as added Pub. L. 116–260, div. CC, title IV, § 407(a)(1), Dec. 27, 2020, 134 Stat. 3003.)

## Notes

### Editorial Notes

### References in Text

Section 3(a)(2) of the Improving Medicare Post-Acute Care Transformation Act of 2014, referred to in subsec. (a)(5), means section 3(a)(2) of Pub. L. 113–185, Oct. 6, 2014, 128 Stat. 1968, which is not classified to the Code.