HHS-OIG Issues Updated Compliance Guidance for Nursing Facilities
The Department of Health and Human Services Office of Inspector General (HHS-OIG) has released compliance program guidance for nursing facilities. The guidance document is the first release in a new set of industry segment-specific compliance program guidance (ICPG) documents that should be used in conjunction with the General Compliance Program Guidance (GCPG) that applies to all entities and individuals in healthcare. The purpose of the Nursing Facility ICPG is to help with risk identification and the implementation of an effective voluntary compliance program to improve the quality of care for using home residents and reduce risks to prevent fraud, waste, and abuse.
The GCPG covers the seven elements of a compliance program and includes adaptations for small and large entities and other compliance considerations, whereas the nursing facility ICPG is tailored to compliance risk areas for the nursing facility industry segment and explains specific compliance measures that nursing facilities can take to reduce risk. The nursing facility ICPG updates previous guidance issued by HHS-OIG in 2000 and the 2008 Supplemental CPG for Nursing Facilities. Those documents have been replaced with the GCPG and the new Nursing Facility ICPG.
The nursing facility ICPG describes the key areas that pose risks of noncompliance with Federal fraud and abuse authorities and healthcare program requirements for nursing facilities and includes HHS-OIG recommendations for ensuring compliance in each of the following key areas:
- Quality of Care and Quality of Life
- Including ensuring adequate staffing and staff competency, appropriate resident care plans and activities, person-centric care, proper medication management, and resident safety.
- Medicare & Medicaid Billing Requirements
- Including risks associated with the SNF Prospective Payment System (PPS), value-based payment models such as the SNF VBP Program, Medicare Advantage and Medicaid Managed Care, Medicare Part D, and Medicare health plan enrollment.
- Federal Anti-Kickback Statute
- Including risks associated with free or below fair market value goods and services, discounts, arrangements for services and supplies, long-term care pharmacy and consultant pharmacy agreements, hospital and hospice arrangements, care coordination and value-based care arrangements, and joint ventures.
- Other risk areas
- Including risks associated with third-party transactions, Stark law, anti-supplementation, civil rights, and the HIPAA Privacy, Security, and Breach Notification Rules.
The guidance documents do not create any new obligations, are non-binding, and do not cover all compliance and quality considerations and risks for nursing facilities; however, HHS-OIG believes the Nursing Facility ICPG will be useful for all nursing facility operators and will help them to reduce risks and meet their compliance obligations.
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