Health Law Blog - Healthcare Legal Issues

Nursing Facility Compliance Program Deadline Is Here!

Nursing Facilities Must Have Effective Compliance Programs In Place by March 23, 2013

Nursing Home Compliance ProgramsThe statutory deadline requiring nursing facilities to have formal compliance programs in place is upon us.  The Patient Protection and Affordable Care Act (PPACA) requires all nursing facilities and skilled nursing facilities to have formally adopted effective compliance and ethics programs by March 23, 2013.  To date, the Centers for Medicare & Medicaid Services (CMS) has not released final regulations regarding the required elements of nursing facility compliance programs.  However, the failure of CMS to issue final regulations should not deter nursing facilities from adopting compliance programs.  Even though regulations have not been released, the statutory mandate is in place.  Additionally, there is an abundance of guidelines that define what should be included in the compliance progam of a nursing facility. 

It is unclear how the failure of CMS to issue regulations will impact enforcement in this area.  The statute requires effective compliance programs to be in place by March 23, 2013 regardless of whether regulations are released.  Compliance programs are now a “condition of participation” that can be cited in survey reports.  Directions to survery agencies on this issue is not clear, but it is possible that citations could be issued in this area.  Additionally, if a nursing facility is contemplating a transaction, it is likely that the failure to have a compliance program in place by March 23, 2013 will arise in the course of due diligance.

Remember that it is not enough to simply have the appropriate compliance documents in place.  The compliance program must be demonstrated (and certified) to be “effective.”  Documents alone cannot make a compliance program “effective.”  Compliance program effectiveness requires a specific anlysis of both the content and operation of the compliance program.  Compliance programs that do not have a track record of effective operation cannot be considered to be “effective.”  Organizations need to consider what backup they plan to create to meet the certification requirements under PPACA.  Nursing facilities that do not have compliance programs in place need to address this deficiency immediately.  Those that have compliance programs in place need to assess the effectiveness of their programs.  In either event, experienced compliance counsel should be consulted to determine hat is required in order to meet the statutory mandate.

Ruder Ware offers a full range of compliance attorney services.  Health care attorney John Fisher is certified in Health Care Compliance and Corporate Compliance and Ethics and is one of a handful of attorneys in private practice in the country to hold this dual compliance certification.  You can contact Mr. Fisher through the Ruder Ware web site or through the “Contact” section of this blog.

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John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

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