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Compliance Reminders

As the year draws to a close, Medicaid providers should be certain to file required compliance certifications with the Office of the Medicaid Inspector General (OMIG) by Dec. 31st, while Medicare providers should ensure that they have a current Memorandum of Agreement (MOA) with the designated Medicare Review organization. Details of these requirements are provided below.

Compliance Certifications. Medicaid providers subject to mandatory compliance program obligations must complete an online form before Dec. 31, 2019 certifying that they have implemented a compliance program that meets the regulatory requirements. In addition, those Medicaid providers subject to Deficit Reduction Act of 2005 (DRA) provisions must complete a second, separate online certification by the end of the year. Both certifications can be accessed on the Compliance Certification page of the OMIG website.

1. SSL Certification: Section 521 of Social Services Regulations (18 NYCRR 521) specifies that a required provider shall certify annually to the Department of Health (DOH), using a form provided by OMIG, that a compliance program meeting the regulatory requirements is in place. Nursing homes, home care agencies, and other organizations that can reasonably expect to claim or order $500,000 in Medicaid services or supplies, or receive at least $500,000 in Medicaid payments, in a 12-month period are covered by the requirements.

Detailed information on providers required to certify and on the elements that must be included in a compliance program is available here. The online certification form (i.e., the “SSL Certification”) can be accessed here. In 2016, OMIG issued detailed Compliance Program Review Guidance, which LeadingAge NY counsel Hinman Straub analyzed and summarized. Both the summary and guidance are available here. The SSL Certification is due by the end of the year.

2. DRA Certification: In addition to the SSL Certification, Medicaid providers subject to the DRA must also certify that they are meeting its requirements. OMIG’s online certification form (“DRA Certification”) lists the specific points required in that certification. A Frequently Asked Questions (FAQ) document specifies who must file the DRA Certification and describes compliance requirements. Generally, providers that receive more than $5 million in Medicaid payments in a year must complete the DRA Certification.

OMIG points out that while the mandatory compliance requirements contained in state law and regulation address similar areas as the DRA requirements, there are significant differences in which providers are covered and the scope of provider responsibilities. Please note that when each certification is submitted, the system generates a confirmation page that should be printed and kept on file as documentation of timely submission. Questions may be directed to OMIG’s Bureau of Compliance at compliance@omig.ny.gov or 518-408-0401.

MOA with Medicare Review Contractor. As a requirement of participation in the Medicare program, hospice, home care, and nursing home providers are required to have in place an MOA with the designated Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO). BFCC-QIOs manage Medicare beneficiary complaints and quality of care reviews to ensure consistency in the review process while taking into consideration local factors important to beneficiaries and their families. They also handle cases in which beneficiaries want to appeal a health care provider’s decision to discharge them from the hospital or discontinue other types of services. Livanta is the BFCC-QIO covering New York State.

Earlier this year, Livanta notified covered providers (i.e., nursing homes, home care agencies, and hospices) that they are required to sign a new MOA. Old versions of the MOA are not acceptable. Covered providers that have not executed the new MOA with Livanta should do so as soon as possible to remain in compliance. Information with links to the form is available here. Please note that a separate MOA is required for each Centers for Medicare and Medicaid Services Certification Number (CCN) under which an organization operates.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841