Breaking Compliance News Blog

CMS Changes SNF Compliance Program Requirements – Again

Posted by Margaret Scavotto & Scott Gima on 9/10/19 7:13 AM

Ladies and gentlemen, long-anticipated compliance program requirements are changing, one more time. Let’s take a look at what has changed – and what hasn’t.

The proposed rule

On July 16, 2019, CMS published a proposed rule that would modify multiple aspects of Phase III of the Long-Term Care Facilities Requirements for Participation (the “Proposed Rule”). The goal of the Proposed Rule is to reduce regulatory burdens and costs, allowing nursing homes to focus resources on providing quality resident care. Some of the most discussed proposed amendments are those to the Compliance and Ethics Program requirements (42 CFR 483.85), which, if finalized, will become effective one year later. With comments from the public due September 16, 2019, our best guess is that enforcement will begin October or November 2020.

Good news: fewer compliance-related F-tags ahead

Nursing homes: LeadingAge (and other associations) successfully lobbied on your behalf. 

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Topics: Affordable Care Act, OIG compliance resources, skilled nursing, compliance

Is your SNF ready for the November compliance program deadline??

Posted by Margaret Scavotto, JD, CHC on 5/29/19 10:24 AM

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:

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Topics: Compliance Basics, Affordable Care Act, skilled nursing

2019 Is the Year of the Compliance Program Annual Review

Posted by Margaret Scavotto, JD, CHC on 5/15/19 12:17 PM

All skilled nursing facilities will be required to have conducted an annual review of their compliance programs by November 28, 2019 (and it’s essential for other providers, too).  SNFs who have not conducted an annual review by November 28, 2019 will be in violation of the law.  

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Topics: Compliance Basics, Affordable Care Act, annual review, skilled nursing

Mandatory SNF Compliance Programs Will Be Here in November! Are You Ready?

Posted by Margaret Scavotto, JD, CHC on 5/2/19 8:41 AM

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.

 

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Topics: Compliance Basics, Affordable Care Act, skilled nursing

Compliance Boosts Census

Posted by Margaret Scavotto, JD, CHC on 1/20/15 7:00 AM

Compliance is mandatory. Ultimately, many long term care operators see compliance as a lot of work—and perhaps a burden. While all of these things are true, compliance also keeps health care providers out of hot water and away from the headlines. Did you know that your compliance program is a tremendous asset that boosts your bottom line?

The benefits of your compliance efforts go far beyond adhering to the government mandate. One of the benefits of investing in compliance is that your census may see a boost!

Compliance improves quality.

Quality Assurance & Performance Improvement (QAPI) plans are an essential component of each and every effective compliance program.  An effectively monitored quality assurance program should advance your quality of care by addressing issues immediately, before they become widespread. By actively managing your quality indicators with a data-driven, team approach, your SNF can improve the processes that translate into better quality, better care, and satisfied residents. Providing quality care is, after all, the reason we are in this business. And it comes with a perk: quality care is the best PR you can find. Invest in your QAPI effort, and see the favorable online reviews and word of mouth campaigns grow. This will increase your census.

Compliance reduces readmissions.

By using their compliance programs to reduce hospital readmissions, SNFs can increase admissions from hospitals—and boost census. The Affordable Care Act’s Hospital Readmissions Reduction Program reduces hospital inpatient prospective payments based on a hospital’s percent of preventable Medicare readmissions. The government instituted this program because it believes a high readmission rate indicates poor pre- or post-discharge care. In response, hospitals are increasing their efforts to reduce readmission rates to the extent possible.

As a result, hospitals’ readmission problem has become SNFs’ problem, too. Hospital discharge planners are more likely to direct patients to nursing homes with lower readmission rates. By actively monitoring, managing and ultimately reducing readmissions with their QA programs, nursing homes can increase admissions from hospitals and boost census.

Learn about the other ways that compliance can boost your bottom line by downloading MPA's free whitepaper: Compliance Saves Money.

What keeps you up  at night? Free Compliance  Risk Assessment

 

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Topics: Quality Assurance, Affordable Care Act

OIG: “It doesn’t matter” that ACA compliance regulations aren’t here.

Posted by Margaret Scavotto, JD, CHC on 7/2/14 4:20 PM

CMS recently hosted a Medicare Learning Network Webinar series called “How Effective Is Your Compliance Program”? The speakers included individuals from CMS, a provider, and the Office of Inspector General (OIG). CMS provided this webinar because the Affordable Care Act made compliance mandatory for all nursing facilities, and all Medicare and Medicaid providers. The Affordable Care Act also requires CMS to issue regulations that explain what these programs should look like—however the regulations are nowhere in sight, leaving many providers puzzled as to what to do next.

CMS stated at the beginning of the webinar that they don’t know when CMS will issue the regulations implementing the Affordable Care Act’s compliance mandate. MPA asked if the government could at least say whether these programs will be a condition of participation, or a condition of enrollment. Dr. Julie Taitsman, Chief Medical Officer for the OIG, responded that “It doesn’t matter.”  

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Topics: Compliance Basics, Penalties and Enforcement, Affordable Care Act

March 23 Came and Went: Now What?

Posted by Margaret Scavotto, JD, CHC on 6/28/13 11:51 AM

As all in the long term care industry are very aware, the Affordable Care Act mandates compliance programs in all nursing homes by March 23, 2013 -- a date that is now behind us.

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Topics: Penalties and Enforcement, Affordable Care Act

Supreme Court gives green light to mandatory compliance programs

Posted by Margaret Scavotto, JD, CHC on 7/13/12 4:13 PM

On June 28, 2012, the United States Supreme Court upheld the majority of the Patient Protection and Affordable Care Act. This means that the Act's requirement that all nursing homes have effective compliance programs by March 23, 2013 is here to stay--and quickly approaching.
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Topics: Compliance Basics, Affordable Care Act

Compliance: Why you should care, now

Posted by Margaret Scavotto, JD, CHC on 2/10/12 3:56 PM


Currently, SNFs are not required to have compliance programs. That's about to change. On March 23, 2013, the Patient Protection and Affordable Care Act (also known as the health reform law) takes the government's compliance recommendation and makes it mandatory. SNFs without compliance programs will soon be unable to participate in Medicare and Medicaid.
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Topics: Compliance Basics, Penalties and Enforcement, Affordable Care Act

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