Hi everyone – After we were so involved in shaping the OMIG protocols for residential services and then provided many trainings to make your agencies audit proof, we thought we were done. NOT SO FAST as Doug and I found out at our first meeting with our new contact at OMIG last week. So, on top of everything else that you are doing during these days of extraordinary change, OMIG intends to start seriously monitoring compliance plans.
As you know, you’ve been required to have Compliance Plans for years, however OMIG will now do compliance reviews with the expectation that you will be 100% in compliance with 8 statutory elements and your own compliance plan.
There is a lot on the OMIG website related to this topic – the following is just a sample. I urge all of you, if you have not already, to go to the website to use their materials to ensure that you are in compliance. https://omig.ny.gov/compliance – go to the right side of the page and explore the compliance library.
We will have OMIG at the conference in November to go over this in some detail, so please consider sending your compliance staff.
If you are not sufficiently in compliance you could be subjected to a Corporate Integrity Agreement, which can be onerous. You can find an actual agreement here. https://www.omig.ny.gov/images/stories/cia/20160401_Glen_Island_CIA_Fully_Executed%20CIA_Redacted.pdf.
When you file your annual certification that you are in compliance, you really need to actually be in compliance, i.e. that you have a plan that is adopted, operational and maintained. If they find that the certification is untrue, you have filed a false instrument, which could be a misdemeanor or a felony depending on circumstances.
New York State Social Services Law §363-d recognizes that there is a wide variety of provider types enrolled in the Medicaid program and that compliance programs should reflect a provider’s size, complexity, resources, and culture. However, the statute requires that all compliance programs satisfy the eight elements set out in §363-d subd. 2 and 18 NYCRR 521.3(c). The following link will bring you to a list of items that the OMIG deems to be insufficient as they relate to the 8 areas of compliance. https://www.omig.ny.gov/images/stories/compliance/20150310_insufficiency_list.pdf. Some of these items are related to, for example, receivables and payables; how your finance department is organized; if your compliance officer has no conflicts, etc. Some of the items might be a surprise – some are required by GAAP so you do it already. It is very comprehensive and OMIG does not consider an agency to be in compliance unless that agency is 100% in compliance.
Informational webinars on the requirements, forms, the 8 elements and more can be found at https://omig.ny.gov/compliance-related-webinars. I suggest that you watch them in the order that they appear, with number 35 first.
The following link is to a PPT of risk areas specifically for residential programs. There is nothing new here. Just a review of the items that you must have in the record. https://www.omig.ny.gov/images/stories/compliance_alerts/20141007_compliance_guidance-2014-06_revised.pdf
Finally, the OMIG 2016-2017 Work plan can be found here. http://hca-nys.org/general-news/omig-2016-17-work-plan-now-available Although our OMH residential programs are not included in the work plan, compliance reviews are. (This doesn’t mean that no residential providers will be audited.) All of our providers that have been audited over the last 5 years or so have almost all gotten a clean audit. This probably has something to do with us being dropped from the next work plan. Thanks to all of you have done such a great job!