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Since 2007, New York has required Medicaid providers to implement and operate an effective compliance program as a condition of participation in the Medicaid program and as a condition of payment. Medicaid’s mandatory compliance program obligations were updated with 2020 amendments to New York’s Social Services Law § 363-d and with the NYS Office of the Medicaid Inspector General’s (“OMIG”) new updated regulations published on December 28, 2022 and effective on April 1, 2023.
This 90-minute briefing will focus on each of the 7 elements required for an effective compliance program and identify what has been updated so attorneys can assist Medicaid providers conduct a gap analysis of their historic compliance programs when compared to the 2020 and 2022 updated requirements.
Faculty will specifically address:
- Quick reference guide to statutory and regulatory authorities, OMIG’s guidance, and some new compliance terms of art (10 minutes)
- Compliance program elements as identified in the OMIG regulations:
-Element #1 – Written policies procedures and standards of conduct required for
compliance programs (20 minutes)
-Element #2 – Compliance officer and compliance committee (10 minutes)
-Element #3 – Training and education on the compliance program (5 minutes)
-Element #4 – Lines of communication for the compliance program (5 minutes)
-Element #5 – Disciplinary standards supporting the compliance program (10 minutes)
-Element #6 – Auditing and monitoring under the compliance program (15 minutes)
-Element #7 – Responding to compliance issues (10 minutes)
- Key takeaways (5 minutes)
Who Should Attend: In-house and law firm lawyers who advise hospitals, nursing homes, healthcare institutions or agencies and healthcare professionals who participate in New York State’s Medicaid program.
Program Level: Update
Prerequisites: There are no prerequisites for this program, but a basic understanding of New York’s historic compliance program obligation would be helpful, but is not required.
Advanced Preparation: None
Matthew D. Babcock, FACHE(R)
Harris Beach PLLC