The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) released updated voluntary compliance program guidance titled Nursing Facility Industry Segment-Specific Compliance Program Guidance (ICPG) on November 20. This update marks the first revision since 2008.
The Nursing Facility ICPG, along with the OIG’s General Compliance Program Guidance (GCPG) that applies to all entities in the healthcare industry, serves as OIG’s updated, centralized resource for voluntary compliance program guidance specific to nursing facilities. Nursing facilities can use this ICPG to identify risks and implement effective compliance and quality programs to mitigate those risks.
Key elements of the Nursing Facility ICPG include:
- Identifying risk areas for nursing facilities
- Providing recommendations and practical considerations for mitigating these risks
- Offering other important information for nursing facilities to consider when implementing, evaluating, and updating their compliance and quality programs
OIG emphasizes the connection between compliance and quality programs, highlighting their interdependence. The guidance stresses that nursing facility compliance programs should integrate quality considerations into daily oversight. Specifically, the OIG advocates for collaboration between compliance and quality programs to monitor nursing facilities’ adherence to laws and regulations governing health and safety standards, resident care, and quality of life. These areas may extend beyond traditional compliance concerns and require specialized expertise in clinical or other domains.
Additionally, the Nursing Facility ICPG recommends that nursing facilities within a system or chain implement compliance and quality programs at the highest corporate level. This ensures a consistent approach to monitoring, assessment, and remediation across all facilities in the system or chain.
You can access the Nursing Facility ICPG here.
Compliance Perspective
Issue
Under the Centers for Medicare & Medicaid Services (CMS) requirements of participation for nursing facilities in the Medicare and Medicaid programs (Requirements of Participation or ROPs), operating organizations for nursing facilities are required to operate a compliance and ethics program that effectively prevents and detects criminal, civil, and administrative violations and promotes quality of care. The new OIG guidance serves as a tool to help facilities identify and mitigate risks, integrate compliance and quality programs, and align with CMS’s regulatory and quality standards. However, nursing facilities must now navigate how to align these updated recommendations with the existing CMS framework to maintain compliance and improve quality of care.
Discussion Points
- Review and update your policies and procedures for operating an effective compliance and ethics program to ensure they are effective and relevant. Policies should be reviewed at least annually, and revisions should be made promptly to reflect new information, regulatory changes, or emerging risks.
- Train all staff on compliance and ethics policies and procedures upon hire and at least annually thereafter. Emphasize that maintaining an effective compliance and ethics program is a shared responsibility across all levels of the organization. Ensure employees are informed of anti-retaliation policies that protect those who report concerns. Document all training sessions and maintain signed records in each employee’s education file for future reference.
- Periodically conduct audits to assess whether all staff are familiar with compliance and ethics policies and guidelines and understand their responsibility to report concerns to their supervisor, the compliance and ethics officer, or via the anonymous hotline. Share audit findings, along with any necessary action steps, with the compliance and ethics committee and the governing body for review and follow-up.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*
