Breaking Compliance News Blog

Phase III: Do SNFs need a Compliance Officer?

Posted by Margaret Scavotto, JD, CHC on 2/25/20 8:15 AM

 

Absolutely.

In July 2019, CMS published a proposed rule that would modify the Compliance and Ethics program aspects of the Phase III Long-Term Care Facilities Requirements for Participation (the “Proposed Rule”).

Some of these proposed modifications removed requirements to assign compliance roles to nursing home personnel. For example, CMS proposes eliminating the following requirements:

  • All nursing homes must designate “an appropriate compliance and ethics program contact to which individuals may report suspected violations.”
  • Chains of five or more nursing homes must designate a compliance officer for whom the compliance program “is a major responsibility.”
  • Chains of five or more nursing homes must designate compliance liaisons at each facility.

 

If made final, the changes will go into effect one year after the rule goes into effect.

CMS’ proposed removal of the compliance officer, compliance liaison, and compliance reports contact requirements might have some nursing homes jumping for joy. After all, fewer regulatory requirements likely means fewer F-tags on your state survey. While we can likely all agree that fewer F-tags are a good thing, nursing homes would be wise to designate someone as compliance officer.

Keep in mind that the Proposed Rule has not yet been made final, and, as of November 28, 2019, SNFs are expected to comply with the original Phase 3 compliance requirements at 42 CFR 483.85. But, what if the Proposed Rule becomes final?

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Topics: compliance, compliance officer, Phase 3

Have you measured your compliance culture?

Posted by Margaret Scavotto, JD, CHC on 2/19/20 11:00 AM

 

Many healthcare providers are accustomed to assessing their compliance programs on a regular basis. The OIG recommends this practice annually - and, as of November 28, 2019, nursing homes are required to conduct an annual review. It is common for providers to evaluate compliance policies, training, auditing programs, and other aspects of the seven elements of an effective compliance program. It is less common - and yet crucial - for organizations to evaluate their compliance culture.

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Topics: Culture of Compliance, annual review, compliance, Phase 3, surveys

Download MPA's Guide to Compliance Program Review/Annual Review

Posted by Margaret Scavotto, JD, CHC on 2/12/20 9:15 AM

Compliance program review is essential to maintaining an effective program.

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Topics: annual review, compliance, Phase 3

Top 5 reasons you need a compliance program review

Posted by Margaret Scavotto, JD, CHC on 2/11/20 10:15 AM

 

1. Without a review, you don’t know what you don’t know.

Were policies distributed? Were staff, board members, contractors, and volunteers properly trained? Were all risk areas audited? Were audit findings mitigated? Were compliance reports properly investigated and met with discipline and corrective action? Without conducting a review, you don’t know. Who would you rather identify your compliance flaws: your own organization, via a compliance review – or the government, via an audit or investigation?

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Topics: Compliance Basics, annual review, compliance, vendor screening, Phase 3

Phase III: Do SNFs need to conduct a compliance program annual review?

Posted by Margaret Scavotto, JD, CHC on 1/21/20 8:00 AM

In a word: yes.

In July 2019, CMS published a proposed rule that would modify the Compliance and Ethics program aspects of the Phase III Long-Term Care Facilities Requirements for Participation.

One of the proposed modifications brought a sigh of relief from the nursing home industry: CMS wants to drop the requirement that nursing homes conduct an annual review of their compliance programs.

Instead, CMS proposes the following: “The operating organization for each facility must periodically review and revise its compliance program to identify necessary changes within the organization and its facilities.”

While CMS did not define “periodically” in the proposed rule, CMS refers to a “biennial” review in the proposed rule comments. Hopefully this will be clarified in the final rule.

Keep in mind that the Proposed Rule has not yet been made final, and, as of November 28, 2019, SNFs are expected to comply with the original Phase 3 compliance requirements at 42 CFR 483.85. But, what if the Proposed Rule becomes final?

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Topics: annual review, compliance, Phase 3

Quiz: Is your nursing home ready for Phase 3 compliance?

Posted by Margaret Scavotto, JD, CHC on 1/7/20 8:15 AM

As of November 28, 2019, nursing homes are expected to be in compliance with the Phase 3 compliance regulations.

On November 22, 2019, CMS issued a memorandum with an update on the Phase 3 Requirements of Participation. In this memo, CMS advised:

  • CMS will not release updated Interpretive Guidance and training addressing Phase 3 until the second quarter of 2020. CMS is somewhat limited in its ability to survey until then.
  • But... nursing homes are still expected to comply with Phase 3 by November 28, 2019.

What does this mean?

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Topics: compliance, Phase 3

Phase 3 Nursing Home Compliance Update!

Posted by Margaret Scavotto, JD, CHC on 12/4/19 10:58 AM

On November 22, 2019, CMS issued a memorandum with an update on the Phase 3 Requirements of Participation. In this memo, CMS advised:

  • CMS will not release updated Interpretive Guidance and training addressing Phase 3 until the second quarter of 2020. CMS is somewhat limited in its ability to survey until then.
  • But... nursing homes are still expected to comply with Phase 3 by November 28, 2019.

What does this mean??

It means that, right now, nursing homes are required by law to comply with Phase 3, including the Compliance and Ethics Program requirements - and CMS expects nursing homes to be in compliance.

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Topics: skilled nursing, guidance, compliance, Phase 3

DOJ cracking down on nursing homes

Posted by Margaret Scavotto, JD, CHC on 11/5/19 8:15 AM

The Department of Justice (DOJ) aims to use its Elder Justice Initiative to  pursue more criminal charges in nursing home investigations. Typically, the DOJ uses civil lawsuits to pursue False Claims Act violations against nursing homes. Toni Bacon, a DOJ associate deputy general, explains the shift: "We need to go after cases civilly because they [are] providing grossly substandard care and, in the appropriate case, refer it for a parallel criminal prosecution."

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Topics: Penalties and Enforcement, compliance

CMS' New Affiliate Screening Requirements Are Coming

Posted by Margaret Scavotto, JD, CHC on 10/23/19 7:58 AM

On November 4, CMS' Program Integrity Enhancements to the Provider Enrollment Process final rule goes into effect. 

The "Affiliates" provision of this rule requires Medicare, Medicaid and CHIP providers to disclose to CMS any affiliations with organizations that have had a "disclosable event." Providers who fail to make these disclosures can be denied enrollment - or have their enrollment revoked. The purpose of this new process is to stop fraud and help CMS find parties that have committed fraud.

What's an "affiliation"?

There are five ways a provider can have an "affiliation' with an organization:

  • a 5% or more direct or indirect ownership interest in another organization
  • a general or limited partnership interest (of any percentage) in another organization
  • an interest in which an individual or entity exercises "operational or managerial control over, or directly or indirectly conducts, the day-to-day operations of another organization," by contract of another arrangement. This includes sole proprietorships.
  • when an individual is acting as officer or director of a corporation
  • a reassignment or payment assignment relationship

 

What's a "disclosable event"?

Providers must disclose "affiliations" within the past five years to CMS if the affiliated organization has a "disclosable event:"

  • current uncollected debt owed to Medicare, Medicaid or CHIP
  • current or prior payment suspension
  • current or prior OIG exclusions
  • Medicare, Medicaid or CHIP enrollment denial, revocation or termination

When does this go into effect?

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Topics: Excluded Providers, compliance, vendor screening

Have you tested your compliance hotline lately?

Posted by Margaret Scavotto, JD, CHC on 10/2/19 7:28 AM

The Kansas Medicaid fraud and abuse complaint email inbox went unchecked for 17 months.

According to a report issued by the Kansas Office of the Medicaid Inspector General, 209 emails were unread. 95 of these emails "alleged fraud, waste, abuse, or illegal acts related to Medicaid, MediKan, or SCHIP, or were seeking information on how to report suspected fraud." 42 of these emails contained "partially or wholly substantiated allegations of Medicaid or SCHIP fraud, waste, abuse or illegal acts....

How did it happen?

The complaint inbox went unchecked from August 2, 2017 to January 9, 2019.

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Topics: Hotline, annual review, compliance

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