Medicaid Provider Compliance Certifications Due by End of Year

The Office of the Medicaid Inspector General (OMIG) recently reached out to LeadingAge NY to advise us of a change to OMIG’s compliance certification process, which will go into effect in December 2018.

Specifically, Medicaid providers subject to the mandatory compliance program obligation will need to complete their annual certification using their Provider Identification Numbers (Provider IDs), rather than their Federal Employer Identification Numbers (FEINs). The updated certification form is posted on OMIG’s website, as is a brief informational webinar on the updated process. For those providers subject to the Deficit Reduction Act of 2005 (DRA), the DRA certification form has not changed.

Medicaid providers subject to mandatory compliance program obligations must complete an online form before Dec. 31, 2018 certifying that they have implemented a compliance program that meets the regulatory requirements. In addition, those Medicaid providers subject to the DRA provisions must complete a second, separate online certification by the end of the year. Both certifications can be accessed on the Compliance page of the OMIG website.

Compliance Program Certification Required by New York State Law and Regulations

Section 521 of Social Services Regulations (18 NYCRR 521) specifies that "upon applying for enrollment in the medical assistance program, and during the month of December each year thereafter, a required provider shall certify to the department, using a form provided by the Office of the Medicaid Inspector General on its Web site, that a compliance program meeting the requirements of this Part is in place." Nursing homes, home care agencies, and other organizations that can reasonably expect to claim or order $500,000 in Medicaid services or supplies, or receive at least $500,000 in Medicaid payments, in a 12-month period are covered by the requirements.

Detailed information on providers required to certify and on the elements that must be included in a compliance program is available here. The online certification form (i.e., the “SSL Certification”) can be accessed here. In 2016, OMIG issued detailed Compliance Program Review Guidance, which LeadingAge NY counsel Hinman Straub analyzed and summarized. Both the summary and guidance are available here.

Compliance Program Certification Required by the Federal DRA

Medicaid providers subject to the DRA must certify that they are meeting its requirements. OMIG’s online certification form (“DRA Certification”) sets out the specific points required in that certification. A Frequently Asked Questions (FAQ) document specifies who must file the DRA certification and describes compliance requirements. Generally, providers that receive more than $5 million in Medicaid payments must complete the DRA certification.

OMIG points out that while the mandatory compliance requirements contained in state law and regulation address similar areas as the DRA requirements, there are significant differences in which providers are covered and the scope of provider responsibilities. Please note that when each certification is submitted, the system generates a confirmation page that should be printed and kept on file as documentation of timely submission.

Questions can be submitted by email to compliance@omig.ny.gov (please indicate “Certification Question” in the subject line) and are also fielded by the Bureau of Compliance at 518-408-0401.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866