November 2, 2009

IMPORTANT REMINDER

In December, school districts subject to the Medicaid compliance program regulations will have to certify that they have in place a Medicaid compliance program or risk administrative sanctions, including exclusion from participation in the Medicaid program.

The regulations require that the Medicaid compliance program include certain specified written policies and procedures.  Because only school boards can adopt policy, school districts need to make sure their board has formally adopted the various policies required by the regulations before they certify they have a Medicaid compliance program in place.

Pursuant to the regulations, the required policies and procedures must: 

  • Describe compliance expectations
  • Implement the operation of the compliance program
  • Provide guidance to employees and others on dealing with potential compliance issues
  • Identify how to communicate compliance issues to appropriate compliance personnel, and
  • Describe how potential compliance programs are investigated and resolved.

 

The Medicaid compliance program also must include, for example:

  • Disciplinary policies that must be fairly and firmly imposed and which:
    •  encourage good faith participation in the compliance program,
    • articulate expectations for reporting compliance issues and assist in their resolution, and outline sanctions for:
      • Failing to report suspected problems;
      • Participating in non-compliant behavior; and/or
      • Encouraging, directing, facilitating or permitting non-compliance behavior.
  • Non-intimidation and non-retaliation policies for good faith participation in the compliance program

School districts should consult with their school attorney and other professional groups with experience in this area to make sure their policies are consistent with the various laws relevant to the development and adoption of such policies.

For more information on this topic please participate in NYSSBA's upcoming webinar, November 12, 2009 from 3:30 -5:00 pm, to be conducted by the NYS Medicaid Inspector General James Sheehan.