On April 8, 2022, CMS released the updates to the standard Civil Money Penalty (CMP) amounts that will be used for the next three years beginning with plan year 2022. The ‘Per Enrollee’ penalty amount increased by 9.4% or $20 which could amount to a significant increase depending on the number of enrollees impacted by the deficiency. The aggravated factors also increased by 9.4% or $10 which, compounded with the standard penalty amount, could result in an additional $30 per enrollee in penalties being assessed. The ‘Per determination’ penalty amount also increased by 9.4% or $1,933, which would apply to any invalid data submission or any violations that apply at the contract level. Each contract would be assessed their own penalty causing the potential for multiplied penalties to be assessed for plans with multiple contracts where the issues persisted across contracts.
In addition to the increase in CMP amounts, plans have an elevated risk to have a deficiency identified for audits this year. For CMS program audits, the universes and processes have significantly changed causing a greater risk for an invalid data submission being identified along with new possible conditions. CMS has also increased their audit presence in recent years causing a great exposure of a plan having a reoccurrence of a prior deficiency being identified would be assessed a compounded aggravated factor. Considering the increase in CMP amounts, the process changes, and the increase in exposure, plans should take action today to mitigate their risk of receiving any deficiencies on future audits.
Per Enrollee CMP Aggravating Factors and Untimely or Inaccurate Material Penalty Adjustments
| Adjustment Year | Applied Standard Penalty | Aggravating Factor (AF) | Untimely of Inaccurate Materials Penalty | Untimely or Inaccurate Materials AF |
| 2020/2021 | $212 | $106 | $27 | $16 |
| 2022 | $232 | $116 | $30 | $18 |
| $ Change | $20 | $10 | $3 | $2 |
| %Change | 9.4% | 9.4% | 11.1% | 12.5% |
