• Obamacare Imposes New Compliance Program Requirements for Nursing Facilities
  • January 28, 2013 | Author: Michael R. Bertoncini
  • Law Firm: Jackson Lewis LLP - Boston Office
  • Under the Patient Protection and Affordable Care Act of 2010 (PPACA), also known as Obamacare, all nursing facilities and skilled nursing facilities must have a compliance and ethics program that contains certain statutorily-required elements by March 23, 2013. The program must be effective in preventing and detecting criminal, civil, and administrative violations under PPACA and in promoting quality of care.

    The PPACA requires the following eight program elements or components:

    • Compliance standards and procedures to be followed by employees and agents;
    • “High-level personnel” designated to oversee compliance with “sufficient resources and authority” to assure compliance;
    • Discretionary authority not given to individuals the organization knows or should know have a “propensity to engage in criminal, civil, and administrative violations”;
    • Effective communication of the standards and procedures to all employees and agents;
    • Adoption of monitoring, auditing and reporting systems that include anti-retaliation protections for employees who report offenses;
    • Consistent enforcement of standards through disciplinary action;
    • Reasonable responses to reported offenses and steps to prevent further similar offenses, if an offense is detected; and
    • Periodic reviews of the program to identify necessary changes or modifications.

    Department of Health and Human Services (DHHS) Office of the Inspector General has made designing, implementing, and maintaining an effective compliance program a best practice for nursing facilities since 2000. PPACA has made such compliance programs mandatory.

    While the PPACA calls for DHHS to publish regulations providing additional guidance on compliance programs, DHHS has not yet done so. The absence of such regulatory guidance, however, does not relieve nursing facilities and skilled nursing facilities of their statutory obligation.

    All nursing facilities and skilled nursing facilities should consider reviewing their existing compliance and ethics programs to ensure that they include the required statutory elements.