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Nursing Home Facilities Need to Take Action If They Haven’t Already

The Patient Protection and Affordable Care Act (ACA), enacted in March 2010, included a number of provisions aimed at enhancing and ensuring the integrity of the Medicare and Medicaid programs. Section 6102 of the ACA mandated that skilled nursing facilities and nursing facilities, as a condition of enrollment in Medicare and Medicaid, adopt and implement a “compliance and ethics program that is effective in prevent­ing and detecting criminal, civil, and administrative viola­tions…and in promoting quality of care….1 Although the Congressional target date for effectuation of this provision was 36 months after the date of enactment,2 implementing regulations for an effective compliance and ethics program for operating organizations were not issued until October 2016.3

As part of a major revision of the conditions that long-term care (LTC) facilities must meet to participate in the Medicare and Medicaid programs, the regulation issued by the Centers for Medicare & Medicaid Services (CMS) on October 4, 2016, gives facilities until November 28, 2019, to establish and implement the mandated compli­ance and ethics program.4 As of that date, state survey agencies will begin assessing facility implementation of an effective compliance and ethics program.5

1. 42 USC § 1320a-7j(b)(1).
2. 42 USC § 1320a-7j(b)(2).
3. 81 Fed. Reg. 68688 (October 4, 2016).
4. 42 CFR § 483.85(b).

Editor's Note: This article was originally published in the September - October 2018 Edition of the Journal of Health Care Compliance. Published here with permission.

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