OMIG Compliance Program Certification Due December 2016

Carla Erhartic

Compliance Program Certification information and forms for 2016 are now available on the New York State Office of the Medicaid Inspector General’s (OMIG) Certification Page by accessing the red “SSL Certification Link”.   The actual Certification Form to be completed and submitted may be accessed at this link.

As a reminder, all New York State Medicaid providers (and managed care plans) who are subject to the mandatory compliance program obligation set out in NYS Social Services Law Section §363-d and 18 NYCRR Part 521 must certify annually during the month of December that they have adopted and implemented a compliance program that meets all statutory and regulatory requirements via the certification form on the OMIG website.

 Those entities that are subject to the mandatory compliance certification requirement include:

  • Article 28 providers (e.g., hospitals, D&TCs, clinics, and skilled nursing facilities)
  • Article 36 providers (CHHAs and LHCSAs)
  • Article 16 and 31 providers (OASAS and OMH licensed and certified programs); and,
  • Any person or provider or affiliate (including MCOs) who either

has claimed or reasonably expects to claim $500,000 in Medicaid payments in any consecutive twelve month period. This would include pharmacy providers and drug manufacturers, DME suppliers, primary care practitioners, surgical specialists, assisted living program providers (ALPs), or any Medicaid provider or MCO who meets the $500,000 standard.

New for this year, providers that bill or claim for services under more than one FEIN or SSN may be able to submit one certification covering all of their FEINs/SSNs subject to the compliance requirement. Providers can take advantage of this if the compliance program they are certifying to applies to all FEINs or SSNs; the reason for certifying is the same among all the FEINs/SSNs (i.e., they are certifying to complete the annual December certification); the Compliance Officer and the Certifying Official are the same for all FEINs and SSNs; and all the answers to the eight Compliance Questions that ask whether the compliance program satisfies each of the eight elements are answered the same. Thus, those providers that use a single compliance program to cover multiple FEINs/SSNs and have the same Compliance Officer and Certifying Official for all FEINs/SSNs should be able to use a single certification to cover multiple service lines, instead of completing separate certifications for each FEIN/SSN.

Also new this year, OMIG is requiring that providers identify their name and address and also identify their Compliance Officer and their Certifying Official, and include the name, title, phone number, and email address of both individuals on the Certification Form. This is likely to verify that providers are adhering to compliance guidance issued this fall (Guidance 2016-01) that requires that the Certifying Official be the one to complete and submit the Certification Form, and not the Compliance Officer. That Guidance discusses that the Certifying Official should be different than the Compliance Officer, and should be the person to whom the Compliance Officer reports on the activities of the compliance program. The Certifying Official should be a provider’s chief executive, owner, or other senior level staff, or a member of the provider’s governing body to whom the Compliance Officer periodically reports.

Now that certification form for 2016 is “live”, providers subject to the certification requirement have until December 31, 2016 to complete the certification. In addition to the certification required under NYS Social Services Law Section §363-d, those providers that make $5 million or more in Medicaid payments during the Federal fiscal year (October through September) will also need to complete a separate Federal Deficit Reduction Act of 2005 (DRA) Certification that is also available on the OMIG website. Similar to the NYS certification obligation, providers subject to the DRA must complete the DRA certification on or before January 1.