OMIG Final Provider Compliance Regulations Take Effect on July 1
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.
CHCANYS Co-Sponsors Oral Health Advocacy Efforts at State Capital
Oral health advocates from around the state will gather in Albany on Monday, May 11th to educate legislators on the importance of good oral health. For more information, click: here
CHCANYS Responds to State Budget
Community health and primary care fared well in the 2009-10 New York State Budget. Click here to read CHCANYS’ press release.
CHCANYS Urges Governor and Legislature to Increase D&TC Indigent Care Pool this Year
Significant funds available through recently enacted Federal stimulus legislation presents New York with the opportunity to provide adequate support this year to the D&TC Indigent Care Pool. CHCANYS is urging the Governor and the Legislature to demonstrate their commitment to health care for vulnerable individuals by adding support for the D&TC Indigent Care Pool in the amount of $111 million. Click here for background and Policy Request Detail.
CHCANYS Releases Its 2009-10 Legislative Agenda
Restoring Electronic Health Record Transition Funding and strengthening the Diagnostic & Treatment Centers Indigent Care Pool are at the top of the CHCANYS’ Legislative Agenda for 2009-10. Click here to download.Community, Migrant and Homeless Health Center Handbook
Community, Migrant and Homeless Health Center Handbook
CHCANYS teamed up with The Empire Justice Center, the statewide legal services organization, to develop a handbook detailing health care coverage for immigrants. Funding for the project came from the New York State Health Foundation and a number of health centers across New York provided invaluable assistance in putting the handbook together. To download a copy, click here.
CHCANYS’ Sponsors NYS Department of Health APG Webinar
CHCANYS, in conjunction with the New York State Department of Health, held a webinar on Wednesday, September 10 regarding New York State’s recent efforts to reform ambulatory care payment in the Medicaid program, including an orientation to the Ambulatory Patient Group (APG) payment methodology with a specific focus on FQHCs. Greg Allen, Director of the Division of Financial Planning and Policy at the Department of Health’s Office of Health Insurance Programs presented. The webinar provided an overview of the recently enacted changes to ambulatory care reimbursement in New York State that are scheduled to take effect for D&TCs in March 2009. Click here to download a copy of the presentation.
Commercial Reimbursement
Inadequate reimbursement rates from private insurers threaten the future of many of New York State’s community health centers (CHCs) and their ability to continue serving all patients, concludes a new study, Improving Commercial Reimbursement for Health Centers: Case Studies and Recommendations for New York, released recently by the Community Health Care Association of New York State (CHCANYS), and funded by CHCANYS and the RCHN Community Health Foundation. In addition, the Primary Care Development Corporation just released its own report, New York’s Primary Care Reimbursement System, which analyzes the reimbursement system for the primary care sector and includes principles and recommendations for reforming the system.
