According to the Affordable Care Act (ACA) all skilled nursing facilities are required to implement Compliance Programs as a condition of enrollment to prevent criminal, civil and administrative violations. On October 4, 2016, The Centers for Medicare and Medicaid Services (CMS) published the requirements for long-term care facilities, including the ACA compliance program mandate as a condition of enrollment. This final rule means that to comply with CMS standards, skilled nursing facilities must have an effective compliance program implemented in their facility. The final rule cited industry specific guidance for the development of an effective program, which included reference to a memorandum issued by the Office of Inspector General (OIG).
In March of 2000, the Office of Inspector General (OIG) re-issued guidance regarding required elements for an effective compliance program for skilled nursing facilities. The OIG developed seven core elements of a compliance program which include:
1) Written policies and procedures;
2) Designated individual to oversee the program;
3) Training and Education;
4) Effective auditing and monitoring;
5) Reporting, which includes developing effective lines of communication;
6) Enforcement; and
7) Responding promptly to detected offenses and developing corrective actions.
The OIGs guidance directly corresponds with the long-term care final rule requirements in that all seven elements must be implemented within the facility to comply with CMS requirements. Additionally, the Department of Justice has hired compliance experts to evaluate the effectiveness of corporate compliance programs for facilities under a fraud investigation. These compliance experts will not only be looking to ensure that facilities have a compliance program, but evaluating effectiveness and quality when determining penalties and sentences. Facilities should begin to assess their internal policies and procedures now to prepare to get into compliance with the final rule requirements regarding compliance and ethics programs.
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