Medicaid Providers Must File Compliance Certifications in December

Medicaid providers who are subject to mandatory compliance program obligations set out in state law and regulation must complete an online form before Dec. 31, 2017 certifying that they have implemented a compliance program that meets the regulatory requirements. In addition, Medicaid providers who are covered by provisions in the federal Deficit Reduction Act of 2005 (DRA) are required to complete a second, separate online certification prior to the end of the year. Both certifications can be accessed on the Compliance page of the Office of the Medicaid Inspector General (OMIG) website. OMIG has posted slides and a YouTube presentation outlining both certification requirements, pointing to additional resources and information in their Compliance Library and providing tips for successful certification.

Compliance Program Certification Required by New York State Social Services Law & Regulations

Section 521 of Social Services Regulations (18 NYCRR 521) specifies that "upon applying for enrollment in the medical assistance program, and during the month of December each year thereafter, a required provider shall certify to the department, using a form provided by the Office of the Medicaid Inspector General on its Web site, that a compliance program meeting the requirements of this Part is in place." Required providers include 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 time period.

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, referred to as the “SSL Certification” on the OMIG website, can be accessed here. Last year, OMIG issued detailed Compliance Program Review Guidance, which LeadingAge NY counsel Hinman Straub analyzed and summarized. Both the summary and guidance are available here.

Compliance Program Certification Required by the Federal Deficit Reduction Act (DRA)

Medicaid providers subject to the DRA must certify that they are meeting the specific requirements of the DRA. OMIG’s online certification form (“DRA Certification”) sets out the specific points required in that certification. A Frequently Asked Questions (FAQ) document specifies who must file the DRA certification and describes compliance requirements. As a general rule, providers who received more than $5 million in Medicaid payments are required to 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 can be submitted by email to compliance@omig.ny.gov (please indicate “Certification Question” in the subject line) and are also fielded by the Bureau of Compliance at 518-408-0401.

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