New Compliance Requirements for New York Medicaid Providers
11/07/2024
New York State Tightens Compliance Programs for Medicaid Providers: What You Need to Know
Important Changes Impacting New York Medicaid Providers
We want to remind you about recent changes to New York State's compliance program requirements for healthcare providers participating in the Medicaid program. The information provided below is based on a notification from Healthfirst.
What's New?
New York State has implemented stricter regulations regarding compliance programs for Medicaid providers. These new requirements are outlined in detail within 18 NYCRR Part 521, found on the Office of the Medicaid Inspector General (OMIG) website.
It means that as a participating Medicaid provider, you are now required to have a satisfactory compliance program that adheres to the new regulations outlined in 18 NYCRR Part 521. This program must be in place to maintain your participation in the Medicaid program.
Key Points:
- You are required to certify that you have adopted and implemented an effective compliance program upon enrollment in the Medicaid program, and annually thereafter.
- The annual certification deadline is December 31.
- Failure to meet these requirements could result in sanctions from Healthfirst, up to and including termination of your contract.
Why Compliance Programs?
Compliance programs serve a vital role in ensuring the integrity of the Medicaid program. They aim to:
- Detect and prevent fraud, waste, and abuse: This protects taxpayer dollars and ensures resources are used efficiently.
- Streamline problem-solving: Compliance programs equip providers with the resources to address issues proactively, minimizing their impact.
- Prevent future issues: Implementing systemic checks and balances helps prevent recurring problems.
Taking Action:
- Complete your 2024 training certification now : Ensure your staff remains up-to-date on compliance requirements. Instructions for completing the certification can be found on the OMIG website.
- Contact your Healthfirst Network Account Manager: They are available to answer any questions you may have regarding the new compliance requirements.
We encourage you to visit the OMIG website for further details on the new compliance program regulations. By adhering to these updated requirements, you can ensure your continued participation in the Medicaid program.
