(a) (1) Beginning in 2027, and except as provided in paragraph (a)(2) of this section, if the Board determines that a hospital's actual annual cost growth has exceeded the spending benchmark, the Board shall send the hospital notice of that finding and may require the hospital to submit a benchmark compliance plan within 45 days. (2) A hospital that the Board determines is participating in a Meaningful Cost Containment Arrangement, and for which the hospital's chief executive officer has provided a written attestation in compliance with § 9953(d)(7)c.1. of this title, is not subject to this section for the applicable benchmark compliance plan year. (b) The Board shall promulgate additional regulations and written guidance about the benchmark compliance plan process, including discretionary factors that the Board may consider in deciding whether a benchmark compliance plan is required, taking into account a hospital's financial condition, any ongoing strategies or investments that the health-care entity is implementing to improve patient access and quality, future long-term efficiency, population growth in the hospital service area, and such other factors as the Board may determine to be relevant. (c) A benchmark compliance plan submitted by a hospital must identify the causes of the hospital's cost growth and must include specific strategies, adjustments, and action steps the hospital proposes to implement to improve cost performance. The benchmark compliance plan must include specific identifiable and measurable expected outcomes and a timetable for implementation. The timetable for a benchmark compliance plan may not exceed 12 months. (d) If the Board determines that the benchmark compliance plan is incomplete, the Board shall provide written guidance explaining the criteria that have not been met and may provide an additional time period, up to 30 days, for resubmission. The hospital shall address each deficiency noted by the Board in the Board's written guidance, and resubmit the hospital's benchmark compliance plan to the Board, no later than 30 days from the date of the hospital's receipt of the Board's written guidance. (e)-(g) [Repealed.]
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