Breaking Compliance News Blog

• Clarifications and technical corrections of Phase 2 guidance issued in 2017
• New guidance for Phase 3 requirements that went into effect November 28, 2019
• Arbitration requirements and guidance which went into effect September 16, 2019
• Changes to the Psychosocial Severity Guide

ENFORCEMENT

WHAT ABOUT THE PROPOSED RULE?

NURSING HOME COMPLIANCE REQUIREMENTS

IF YOU NEED HELP

Compliance is mandatory for SNFs! Is your compliance program survey-ready?

Sign up for MPA's Virtual Compliance Officer Training Course

*** Approved for 5 hours of NAB CEUs***

Compliance is mandatory for SNFs! Is your compliance program survey-ready?

Sign up for MPA's Virtual Compliance Officer Training Course

*** Approved for 5 hours of NAB CEUs***

Compliance is mandatory for SNFs! Is your compliance program survey-ready?

Sign up for MPA's Virtual Compliance Officer Training Course

*** Approved for 5 hours of NAB CEUs***

With CMS resuming routine nursing home surveys, it’s time to get your compliance and ethics program ready for future surveys.

Whether you are new to compliance or want to make sure you are ready to lead a Phase 3 Compliance and Ethics Program, MPA’s 4-part virtual how-to course can help. Sign up now and receive:

• Four 75-minute classes. We will keep the class going until all your questions are answered!
• One free compliance tool per class
• A 20% discount on MPA’s SNF Compliance Program (save $350)

Sign up for one course, or all four.

Price: $95 per course or $325 for all four. Sign up now.

Those enrolled in all four courses will receive a digital step-by-step compliance program implementation guide.

Can’t attend live? All attendees will receive access to the recorded classes for 6 months.

With CMS resuming routine nursing home surveys, it’s time to get your compliance and ethics program ready for future surveys.

Whether you are new to compliance or want to make sure you are ready to lead a Phase 3 Compliance and Ethics Program, MPA’s 4-part virtual how-to course can help. Sign up now and receive:

• Four 75-minute classes. We will keep the class going until all your questions are answered!
• One free compliance tool per class
• A 20% discount on MPA’s SNF Compliance Program (save $350)

Sign up for one course, or all four.

Price: $95 per course or $325 for all four. Sign up now.

Those enrolled in all four courses will receive a digital step-by-step compliance program implementation guide.

Can’t attend live? All attendees will receive access to the recorded classes for 6 months.

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. 

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:

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.  

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.