The Deadline Is Fast Approaching for Meeting the Legal Mandate for an Effective Nursing Home Compliance Program

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).
5. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf.

About the Author

Thomas Herrmann advises health care clients on compliance and regulatory matters, with a focus on development and management of effective health care compliance programs. Mr. Herrmann is a recognized expert on issues related to the federal Anti-Kickback Statute, Stark Law and the False Claims Act.