New York State Office of the Medicaid Inspector General. Frequently Asked Questions. Medicaid Integrity Program; Medicaid Integrity Contractors; MICs. Regulations found in 1. N. Y. C. R. R. Part 5. July 1, 2. 00. 9. Medicaid. In addition, a compliance program is required for other persons, providers or affiliates who provide care, services or supplies under the Medicaid program, or who submit claims for care, services or supplies for or on behalf of another person for which Medicaid is, or should be reasonably expected by the provider to be a substantial portion of their business operations . The first group of providers (those subject to the specified articles in the PHL or the MHL) must have a compliance program under New York Social Services Law . Affiliated providers may operate under the umbrella compliance program of its parent organization, as long as the compliance program addresses the core requirements as provided by the regulation and is specific enough to address the structure, operations and risk areas of each affiliate. For example, there may be an enterprise- wide compliance program for a multiple provider health system, but the compliance program may have specific terms that seek to address individual provider types within the system. Given the nature of the referral and billing relationship between/with counties, districts and these types of providers, to avoid unnecessary duplication of effort and costs to contracted providers of services, the OMIG supports an approach where the county/district incorporates (covers) early intervention, pre- school, and school- age special education providers under the county's or district's compliance program (including, for example, the sharing of resources – such as a toll- free hot line). In such cases, the OMIG would expect an appropriate written agreement detailing the respective responsibilities of the parties. Such agreements may include, be incorporated in, or be ancillary to, the contract for the provision of such services executed by the county/district and provider which includes provision for Medicaid payments and reimbursement including statements of reassignment, record maintenance, quality assurance review and liability of providers for failure to support the county/district relative to special services and programs paid by or reimbursed through Medicaid. Notwithstanding the other compliance- related functions performed by the county and/or district, the OMIG assumes that early intervention, preschool and school age special education providers will ensure an internal compliance presence by designating an employee who has an understanding of the culture and operations of the provider, to address issues raised by provider staff and to coordinate those compliance initiatives handled by the provider in satisfaction of Part 5. The law contains a set of minimum core requirements that are applicable to all providers, regardless of size. However, the OMIG recognizes that there is no . The OMIG does not anticipate issuing model compliance plans or templates. Our mission is to enhance the integrity of the New York State Medicaid program by. OMIG will protect the health and welfare of the people of the State of New York by promoting Medicaid program integrity at all levels of.OMIG suggests that Medicaid providers review Medicaid Updates and Compliance Alerts among other OMIG publications and outreach methods for information on how providers can meet New York's mandatory compliance requirements. There is a library on the OMIG Web site which guides providers in developing and implementing an effective compliance program. Program Management; Program Integrity; Medicaid ACO; Health Homes; Services. Reduce cycle times throughout the program integrity process while improving hit rates. NEW YORK STATE DEPARTMENT OF HEALTH. Eligibility Verification and Program Integrity Services. HHS Office of Inspector General Medicaid Integrity Program Report. HHS Office of Inspector General Medicaid Integrity Program Report. The New York State Medicaid Inspector General (OMIG) fights fraud, improves program integrity and saves taxpayer dollars. WILL THE OMIG PROVIDE ASSISTANCE TO PROVIDERS UPON REQUEST? The OMIG's assistance to Medicaid providers is limited. HOW WILL THE MANDATORY COMPLIANCE LAW IMPACT PROVIDERS? If a Medicaid provider is required to have a compliance program meeting the requirements of Social Services Law . WHAT ARE THE POSSIBLE CONSEQUENCES FOR FAILING TO ADOPT AND IMPLEMENT AN EFFECTIVE COMPLIANCE PROGRAM? IS THERE AN EXCEPTION TO THE MANDATORY COMPLIANCE LAW? TThe Mandatory Compliance Law provides that . A compliance program may be a part of more comprehensive compliance activities so long as the minimum requirements of the law and implementing regulations are met. WHAT IS THE PROCESS FOR CERTIFICATION UNDER THE MANDATORY COMPLIANCE LAW? Newly enrolling Medicaid providers: Social Services Law . CAN PROVIDERS SUBMIT PAPER CERTIFICATIONS? No. Only on- line certifications will be accepted. WILL PROVIDERS RECEIVE A CONFIRMATION OF RECEIPT? An electronic confirmation will be generated upon submission of the certification and sent to the provider by email. This electronic confirmation will be in the form of a printable page with a confirmation number on it. The provider should print this confirmation page for their records and retain it as proof of certification along with the email from the Bureau of Compliance. WHO SHOULD COMPLETE THE CERTIFICATION (OR WHO SHOULD BE THE CERTIFYING OFFICIAL)? The OMIG strongly encourages that someone from senior management (other than the compliance officer) or a member of the governing authority complete the certification (or be listed as the certifying official) as an indication that the provider's compliance efforts and responsibilities extend beyond the compliance officer. DOES A PROVIDER HAVE TO SUBMIT A SEPARATE CERTIFICATION FOR EACH LOCATION OR PROVIDER NUMBER? Do not use an FEIN that has not been registered with the Medicaid program such as a parent FEIN. The DRA applies to providers who bill or receive over $5 million annually from the Medicaid program. WHAT IS THE CONSEQUENCE OF A PROVIDER'S FAILURE TO CERTIFY? OMIG is authorized to impose administrative sanctions, up to and including exclusion from the program, against providers who fail to certify to the existence of an effective compliance program. If required providers do not certify annually, they will be deemed to be failing to meet their statutory and regulatory obligations as providers under the Medicaid program. SHOULD PROVIDERS SUBMIT A COPY OF THEIR COMPLIANCE PLAN OR SELF ASSESSMENTS ALONG WITH THE CERTIFICATION? OMIG will specifically request a copy of a provider's compliance program and request that the provider complete a self assessment when the OMIG is interested in evaluating a particular provider's compliance with the Mandatory Compliance Law. WHAT ARE THE INSTRUCTIONS FOR COMPLETING THE SSL CERTIFICATION FORM? When completing the Social Services Law . The SSL certification form must be completed during December of each year in which a Medicaid provider is required to implement an effective compliance program that meets New York State's Mandatory Compliance law. The Social Services Law form should be completed by enrolled/servicing providers and enrolling providers. WHAT ARE THE INSTRUCTIONS FOR COMPLETING THE DEFICIT REDUCTION ACT OF 2. DRA) CERTIFICATION FORM? FAQs specific to the DRA certification and form can be accessed.
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