Kusserow on Compliance: Time running out for nursing and long term care providers’ development of mandated compliance programs

Tips to meet the challenge in a timely and cost effectively manner

The OIG issued voluntary Compliance Program Guidance for Nursing Facilities in March 2000, followed by Supplemental Compliance Program guidance in September 2008. However, the Patient Protection and Affordable Care Act (ACA) made compliance a mandate and it is a game changer for this sector. The new mandates note as a condition of enrollment in Medicare and Medicaid “a facility shall . . . have in operation a compliance and ethics program. . . .”   HHS was directed to issue regulations “for an effective compliance and ethics program for operating organizations” and CMS has issued those regulations with a deadline for organizations and facilities to meet these requirements by November 28, 2019. At that time, state survey agencies will begin assessing facility compliance for compliance.

Tom Herrmann, J.D., served over 20 years in the OIG Office of Counsel and for the past ten years has been a compliance consultant, specializing in nursing home compliance programs. He noted that many nursing facilities lagged behind in developing effective compliance programs because it was viewed as cost prohibitive. Those that implemented programs following the OIG guidance will have little difficulty in meeting the standards. For those who delayed program development, time is running out. State survey agencies will conduct compliance audits following the CMS State Operation Manual “Guidance to Surveyors for Long Term Care Facilities”.  Survey protocols and guides for State Survey Agencies have also been posted by CMS and can be reviewed by nursing homes in preparation for the reviews.  When building or improving the compliance program, CMS requires an annual review of its compliance and ethics program to assess the resources needed for an effective compliance program that includes mandatory training for all covered persons. For more information regarding advisory services in building effective compliance programs, Tom Herrmann can be reached at therrmann@strategicm.com or via phone at (703) 535-1410.

Kash Chopra, JD, provides compliance staffing for clients. She explained that many nursing homes may not require hiring a fulltime compliance office, however, designating someone on the staff to act as a compliance officer as a secondary duty is not a good idea and seldom works satisfactorily. Invariably, the primary duties drive out time for the compliance responsibilities.  One solution that should be considered is using an expert as a Designated Compliance Officer (DCO) to quickly, efficiently, and inexpensively build and manage the program. The OIG in its compliance program documents specifically advises: “For those companies that have limited resources, the compliance function could be outsourced to an expert in compliance.”  For more on staffing compliance officers, Kash Chopra can be reached at 703-236-1291 or at kchopra@strategicm.com

Daniel Peake of the Compliance Resource Center said that many nursing home clients have found an economical solution to the costs of building and managing their compliance program by outsourcing key elements, such as hotline services, sanction screening, compliance training, code and policy development. These services can take a big bite out of the work of building an effective compliance program at a very small price for most organizations providing nursing or long term care. For more information about the cost and benefits of outsourcing key compliance elements, Daniel Peake can be reached at (dpeake@compliancereource.com (703)-236-9854).

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2018 Strategic Management Services, LLC. Published with permission.