OMIG Final Provider Compliance Regulations Take Effect on July 1, 2009

The New York State Office of the Medicaid Inspector General recently announced the passage of final provider compliance regulations.  The regulations go into effect on July 1, after which providers will have 90 days (by Oct. 1, 2009) to comply.

These compliance regulations apply to all Article 28, 36, 31 and 16 providers as well as providers who receive over $500,000 in Medicaid funds (this is the clarification to "providers who receive a substantial portion of their funds from Medicaid").

So what does this mean?

In order to participate in Medicaid, a provider will need to have the components listed below in place as they relate, at a minimum, to billings, payments, medical necessity and quality of care, governance, mandatory reporting, credentialing and other risk areas identified by the provider. These include:

• Written policies and procedures that describe compliance expectations   
• Designation of an employee with responsibility for the day-to-day operation of the compliance program   
• Training  and education of all affected employees and persons associated with the  provider  
• Communication lines to the responsible compliance position  
• Disciplinary policies to encourage good faith participation in the compliance program by all affected individuals   
• A system for routine identification of compliance risk areas specific to the provider  type  
• A system for responding to compliance issues as they are raised   
• A policy of non-intimidation and non-retaliation for good faith participation in the  compliance program

In addition, providers will also be required to submit a certification every year in December stating that they have these programs in place. OMIG will also be developing model compliance guidance for various sectors, starting with hospitals, though the date this guidance will be available has not been released.