Prairieview Lutheran Home, ALJ Ruling 2026-24 (HHS-CRD June 1, 2026)

ORDER OF DISMISSAL

Petitioner, Prairieview Lutheran Home, filed a request for hearing before an administrative law judge (ALJ), seeking to challenge a December 31, 2025 informal dispute resolution letter from the Illinois Department of Public Health concerning deficiencies found during a November 2025 survey cycle. 

For the reasons set forth below, I dismiss as untimely the request for hearing filed by Petitioner. 

Background

Petitioner is a skilled nursing facility located in Danforth, Illinois that participates in the Medicare program.  The Illinois Department of Public Health (state agency) completed a survey of the facility on November 5, 2025.  Based on the survey findings, the Centers for Medicare & Medicaid Services (CMS) determined that the facility was not in substantial compliance with multiple Medicare program requirements, including 42 C.F.R. § 483.25 (Tag F684 – Quality of Care), cited at scope and severity level J (immediate jeopardy).  Electronic File (E-File) Document (Doc.) Nos. 5, 5a. 

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On November 12, 2025, the state agency issued an initial notice to Petitioner that the facility was not in substantial compliance and that its deficiency posed immediate jeopardy to resident health and safety and constitutes substandard quality of care.  E-File Doc. No. 5b.  The state agency therefore imposed a Discretionary Denial of Payment for New Admissions (DDPNA), effective November 27, 2025.  Id. at 2.  The initial notice informed Petitioner of the informal dispute resolution (IDR) process.  Id. at 3-4.  The notice also provided the following notice about formal appeal rights: 

If you disagree with this action imposed on your facility, you or your legal representative may request a hearing before an administrative law judge of the Department of Health and Human Services, Departmental Appeals Board (DAB).  Procedures governing this process are set out in 42 C.F.R. § 498.40, et seq . . . .  A request for a hearing should identify the specific issues, findings of fact and conclusions of law with which you disagree.  It should also specify the basis for contending that the findings and conclusions are incorrect . . . . A request for a hearing must be filed no later than sixty (60) days from the date of receipt of this notice. 

Id. at 4.  The initial notice also included detailed information on how to file the request for hearing, both through E-File and the mail.  Id. 

On November 21, 2025, Petitioner requested IDR.  E-File Doc. No. 5c.  The state agency completed the IDR process on December 31, 2025, recommending no changes to the statement of deficiencies, and stating that all deficiencies, and any imposed and/or recommended remedies as specified in the initial notice would remain in effect.  E-File Doc. No. 5b at 10-11.  On January 19, 2026, Petitioner filed a request for hearing that consisted of its IDR request form and attachments, and a copy of the December 31, 2025 IDR letter.  E-File Doc. Nos. 1, 1a. 

On January 22, 2026, I issued an Acknowledgment and Pre-hearing Order.  E-File Doc. No. 2a.  On March 20, 2026, CMS filed a motion to dismiss for untimeliness.1  E-File Doc. No. 5.  On March 25, 2026, I issued an order staying deadlines and allowed Petitioner until April 9, 2026, to file a response.  E-File Doc. No. 7.  On April 8, 2026, Petitioner filed a reply, stating it did not oppose CMS’s motion to dismiss.  E-File Doc. No. 8. 

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Discussion

Section 1866(h) of the Social Security Act authorizes administrative review of determinations that a provider has failed to substantially comply with Medicare program requirements “to the same extent as is provided in section 205(b) [of the Act].”  Under section 205(b), the Secretary must provide reasonable notice and opportunity for a hearing “upon request by [the affected party] who makes a showing in writing that his or her rights may be prejudiced” by the Secretary’s decision.  The request for hearing “must be filed within sixty days” after receipt of the notice of CMS’s determination.  Act § 205(b) (emphasis added).  Thus, the 60-day time limit is a statutory requirement.  See Cary Health and Rehab Ctr., DAB No. 1771 at 8-9 (2001). 

Similarly, the regulations mandate that the affected party “file the request in writing within 60 days from receipt of the notice . . . unless that period is extended . . . .”  42 C.F.R. § 498.40(a)(2).  If the request is not filed within 60 days, the party may file a written request for extension, which the ALJ may grant “for good cause shown.”  On motion of a party, or on his/her own motion, the ALJ may dismiss a request for hearing where that request was not timely filed and the time for filing was not extended.  42 C.F.R. § 498.70(c). 

Petitioner’s request for hearing was not filed within 60 days of the notice letter.2  Applying the regulatory presumption that Petitioner received the initial notice five days after November 12, 2025, Petitioner received the notice on November 17, 2025.  42 C.F.R. §§ 498.40(a)(2), 498.22(b)(3).  The deadline for Petitioner to file the request for hearing was January 16, 2026.  However, Petitioner did not file its request for hearing until January 19, 2026. 

Petitioner does not oppose the motion to dismiss and does not request an extension nor offer any good cause explanation for its late filing of the request for hearing.  E-File Doc. No. 8.  Because Petitioner’s request for hearing was untimely, and because no good cause justifies my extending the time for filing, I dismiss this appeal pursuant to 42 C.F.R. § 498.70(c). 

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III.  Conclusion

For the reasons set forth above, I dismiss Petitioner’s request for hearing pursuant to 42 C.F.R. § 498.70(c). 

Served by DAB E-File.