Bria of Cahokia, ALJ Ruling 2026-10 (HHS CRD February 17, 2026)

DISMISSAL

For the reasons set forth below, I conclude that Petitioner, Bria of Cahokia, is not entitled to Administrative Law Judge (ALJ) review of determinations made by the Centers for Medicare & Medicaid Services (CMS) following surveys completed on August 20, 2025, and September 10, 2025.  I therefore dismiss its hearing request pursuant to 42 C.F.R. § 498.70(b).

1. Petitioner has no right to a hearing because CMS did not impose a remedy.1

Petitioner is a skilled nursing facility, located in Cahokia, Illinois, that participates in the Medicare program as a provider of services.  On August 20, 2025, the Illinois Department of Public Health (state agency) completed a complaint investigation survey and found that the facility was not in substantial compliance with Medicare program requirements.

In a letter, dated August 28, 2025, the state agency advised the facility that, based on the survey findings, it recommended that CMS impose remedies:  a discretionary denial of

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payment for new admissions (DPNA), effective September 12, 2025; a civil money penalty; and termination of the facility’s provider agreement, effective February 20, 2026.  Originating Case Decision (E-file #1a).

Petitioner requested an ALJ hearing.

State surveyors returned to the facility on September 10, 2025, to investigate additional complaint allegations.  The state agency identified more deficiencies and recommended that CMS impose additional remedies.  CMS Ex. 1.

On November 6, 2025, state surveyors returned to the facility and determined that it had corrected its deficiencies and returned to substantial compliance, effective September 11, 2025.  Neither the DPNA nor termination went into effect, and CMS imposed no other remedies.  Id.

CMS now moves to dismiss Petitioner’s hearing request.  With its motion and brief, CMS files one exhibit (CMS Ex. 1).  Petitioner did not respond to CMS’s motion.

The hearing rights of a long-term care facility are established by federal regulations at 42 C.F.R. Part 498.  A provider dissatisfied with an initial determination is entitled to further review, but it has no right to appeal an administrative action that is not an initial determination.  42 C.F.R. § 498.3(a), (d).  The regulations specify which actions are “initial determinations” and set forth examples of actions that are not.  A finding of noncompliance that results in the imposition of a remedy specified in 42 C.F.R. § 488.408 (except the state monitoring remedy) is an initial determination for which a facility may request an ALJ hearing.  42 C.F.R. § 498.3(b)(13).  But a facility has no right to a hearing unless CMS imposes one of the specified remedies.  Heritage Convalescent Ctr., DAB No. 3073 at 6-7 (2022); Columbus Park Nursing & Rehab. Ctr., DAB No. 2316 at 6 (2010), appeal dismissed, 940 F.Supp.2d 805 (N.D. Ill. 2013); The Lutheran Home – Caledonia, DAB No. 1753 (2000); Schowalter Villa, DAB No. 1688 (1999); Arcadia Acres, Inc., DAB No. 1607 (1997).  The remedy, not the citation of a deficiency, triggers the right to a hearing.  Schowalter Villa; Arcadia Acres, Inc.  Where CMS withdraws the remedies or otherwise declines to impose one, Petitioner has no right to a hearing.  See, Fountain Lake Health & Rehabilitation, Inc., DAB No. 1985 (2005).

Because CMS has imposed no remedies, Petitioner has no right to an ALJ hearing, and this matter must be dismissed.  42 C.F.R. § 498.70(b).  I therefore grant CMS’s motion.