Provider Medicaid Compliance Certification Requirements Changing

Effective immediately, providers are no longer required to complete the annual December certification, otherwise known as the “SSL Certification,” using the form located on the Office of the Medicaid Inspector General’s (OMIG) website. Instead, a provider adopting and maintaining an effective compliance program will now record (attest to) this as part of their annual Certification Statement for Provider Billing Medicaid. This annual certification occurs on the anniversary date of the provider’s enrollment in Medicaid.

Pursuant to New York State Social Services Law (SSL) §363-d, providers must certify to the Department of Health (DOH) upon enrollment in the Medicaid program that they are satisfactorily meeting the requirements of SSL §363-d. Furthermore, compliance with the requirements of SSL §363-d is a condition of payment under the Medicaid program.

Providers can find their anniversary dates on their initial Medicaid enrollment welcome letters. Additionally, each year, approximately 45 to 60 days before the anniversary of a provider’s enrollment, DOH sends by mail a package of information and materials to the provider, which includes the Certification Statement for Provider Billing Medicaid form. This form must be completed and returned to DOH by the provider’s enrollment anniversary date.

The federal Deficit Reduction Act (DRA) requirements have been incorporated into SSL §363-d. As a result, there is no longer a separate DRA certification requirement. By submitting the annual Certification Statement for Provider Billing Medicaid form, providers are attesting to satisfactorily meeting the requirements of SSL §363-d, which includes the DRA. 

All Medicaid providers subject to the mandatory compliance program requirements in SSL §363-d will be impacted by these changes. 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.

A memo from LeadingAge NY general counsel Hinman Straub also summarizes the change to the certification process. Questions on the new process may be directed to OMIG's Bureau of Compliance at compliance@omig.ny.gov.

Contact: Dan Heim, dheim@leadingageny.org, 518-461-2934