Section 512.590 - [Effective 10/1/2024] Monitoring and compliance(a)Compliance with laws. The TEAM participant and each of its downstream participants must comply with all applicable laws and regulations.(b)CMS monitoring and compliance activities.(1) CMS staff, or its approved designee, may conduct monitoring activities to ensure compliance by the TEAM participant and each of its downstream participants with the terms of TEAM under this subpart to-(i) Understand TEAM participants' use of TEAM payments; and(ii) Promote the safety of beneficiaries and the integrity of TEAM.(2) Monitoring activities may include, without limitation, all of the following:(i) Documentation requests sent to the TEAM participant and its downstream participants, including surveys and questionnaires.(ii) Audits of claims data, quality measures, medical records, and other data from the TEAM participant and its downstream participants.(iii) Interviews with members of the staff and leadership of the TEAM participant and its downstream participants.(iv) Interviews with beneficiaries and their caregivers.(v) Site visits to the TEAM participant and its downstream participants, performed in a manner consistent with paragraph (c) of this section.(vi) Monitoring quality outcomes and clinical data, if applicable.(vii) Tracking patient complaints and appeals.(3) In conducting monitoring and oversight activities, CMS or its designees may use any relevant data or information including without limitation all Medicare claims submitted for items or services furnished to TEAM beneficiaries.(c)Site visits.(1) In a manner consistent with § 512.584, the TEAM participant and its downstream participants must cooperate in periodic site visits performed by CMS or its designees in order to facilitate the evaluation of TEAM and the monitoring of the TEAM participant's compliance with the terms of TEAM.(2) CMS or its designee provides, to the extent practicable, the TEAM participant or downstream participant with no less than 15 days advance notice of any site visit. CMS- (i) Attempts, to the extent practicable, to accommodate a request for particular dates in scheduling site visits; and(ii) Does not accept a date request from a TEAM participant or downstream participant that is more than 60 days after the date of the CMS initial site visit notice.(3) The TEAM participant and its downstream participants must ensure that personnel with the appropriate responsibilities and knowledge associated with the purpose of the site visit are available during all site visits.(4) CMS may perform unannounced site visits at the office of the TEAM participant and any of its downstream participants at any time to investigate concerns about the health or safety of beneficiaries or other patients or other program integrity issues.(5) Nothing in this part shall be construed to limit or otherwise prevent CMS from performing site visits permitted or required by applicable law.(d)Reopening of payment determinations.(1) CMS may reopen a TEAM payment determination on its own motion or at the request of a TEAM participant, within 4 years from the date of the determination, for good cause (as defined at § 405.986 of this chapter).(2) CMS may reopen a TEAM payment determination at any time if there exists reliable evidence (as defined in § 405.902 of this chapter) that the determination was procured by fraud or similar fault (as defined in § 405.902 of this chapter).(3) CMS's decision regarding whether to reopen a TEAM payment determination is binding and not subject to appeal.(e)OIG authority. Nothing contained in the terms of TEAM limits or restricts the authority of the HHS Office of Inspector General or any other Federal government authority, including its authority to audit, evaluate, investigate, or inspect the TEAM participant or its downstream participants for violations of any Federal statutes, rules, or regulations.