Note: This topic is of special interest to our SNF readers. General healthcare compliance and HIPAA topics will return next week!
The Affordable Care Act mandated compliance and ethics programs for all nursing facilities. Medicare and Medicaid will require implementation by November 28, 2019.
Are you ready?
Fortunately, the ACA requirements closely – but not entirely – track the ACA OIG compliance program guidance and the Federal Sentencing Guidelines principles for compliance programs, so providers who have built compliance programs on these documents should be in pretty good shape. Here is what the ACA requires nursing facilities to have by November 28, 2019:
- Written compliance and ethics policies and procedures that are communicated to staff, contractors and volunteers and:
- Reduce the risk of criminal, civil and administrative violations
- Promote quality of care
- Designate a compliance contact to receive reports
- Include an anonymous way to report non-compliance without retribution
- Include disciplinary standards
- Apply to contractors and volunteers
- Assigned high-level personnel oversight for the compliance program, and sufficient resources and authority for such high-level personnel
- Due care not to delegate substantial discretionary authority to individuals the SNF knew or should have known had a propensity to commit a crime
- Auditing and monitoring
- A reporting system
- Consistent enforcement via discipline
- Annual review.*
*It can take weeks or even months to review a compliance program, so if this is your first experience with annual review, it is a good idea to start early.
Organizations with five or more facilities must also have:
- A mandatory annual compliance training program, and
- A compliance officer who reports directly to the governing body, with designated compliance liaisons at each site
Note: while these items are only mandatory under the ACA for SNFs with five or more sites, it is a good idea for all SNFs to consider incorporating these items into their own compliance programs. While they are not mandatory for smaller organizations, they will strengthen your program and make it easier to run an effective compliance program.