Section 6102 of the Patient Protection and Affordable Care Act of 2010, as amended by the Healthcare Reconciliation Act 2010 (the Healthcare Reform Law), created a mandatory requirement for skilled nursing facilities to establish a compliance and ethics program as a condition of participation in the Medicare, Medicaid and CHIP programs by the end of 2012. Although other providers may be required to enact similar compliance plans in the future, as allowed by Section 6401 of the Healthcare Reform Law, skilled nursing facilities are the first of all providers required to participate in the mandatory compliance program.
Here's What's Required
According to the language in section 6102, the skilled nursing facility's compliance program must be "reasonably designed, implemented, and enforced so that it will be generally effective in preventing and detecting criminal, civil and administrative violations under this Act and in promoting quality of care." Section 6102 lists eight required components of the compliance program:
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Compliance standards and procedures must be adopted and followed by employees and other agents in a position to reduce criminal, civil and administrative violations under the PPACA
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Specific individuals with authority and sufficient resources must be assigned the responsibility to oversee compliance with the standards and procedures
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The organization must exercise due care to ensure that the above authority is not delegated to an individual with a propensity to engage in criminal, civil and administrative violations of the PPACA
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The organization must take steps to educate its employees and agents of the compliance program
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The organization must take reasonable steps to achieve compliance with its standards
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The standards and procedures must be consistently enforced
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In the event that an offense is detected, the organization must take all reasonable steps to respond appropriately and to prevent similar offenses
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The organization must periodically reassess the compliance programs and make changes necessary to reflect changes within the organization
More Guidance is On the Way
By March 23, 2012, the secretary of HHS, working jointly with OIG, must promulgate regulations for "an effective compliance program" for nursing facility operating organizations. Thereafter, all skilled nursing facility must submit their compliance plan to HHS within one year, or by December 31, 2012. They must also have "in operation" a compliance and ethics program that meets the laws criteria.
Although the healthcare reform law suggests that the nursing facility requirement program regulations due to be published at the end of this year may contain a model compliance program, there is no guarantee such a plan will be published. Since the implementation of the voluntary compliance program guidance over the last 12 years, OIG has never published a model compliance program. Given this history, it is unlikely a compliance plan will be made available.
For More Information
As our providers embark on this new mandatory requirement, Polsinelli Shughart is prepared to work in partnership with its clients to ensure they are ready to meet the challenges of drafting a compliance program that meets their needs and maintains compliance.
If you have questions about today's announcement or would like more information, please contact:
