The U.S. Health and Human Services (HHS) Office of the Inspector General (OIG) published its General Compliance Program Guidelines document (GCPG) in November of 2023, with updates to industry specific guidelines to follow in 2024. This week, the OIG published the updated Nursing Facility Industry Segment Specific Compliance Guidelines (Nursing Facility ICPG). This is the first update to the Nursing Facility ICPG since 2008.
With this update, the OIG has sought to modernize its approach to the compliance program guidelines by using a more user-friendly and accessible format, providing general program guidelines alongside industry specific guidelines, and making the guidance available on its website with interactive links to resources.
The purpose of the compliance guidelines is to help nursing facilities identify their own risks and implement an effective compliance and quality program to reduce those risks. The guidelines are voluntary and non-binding, meaning they do not represent a regulatory requirement. The OIG also notes that the guidelines are not one-size fits all and must be tailored to the unique nature of each facility.
The OIG develops compliance program guidance as “voluntary, nonbinding guidance documents to support health care industry stakeholders in their efforts to self-monitor compliance with applicable laws and program requirements.” These include CPGs directed at 11 different sectors of the health care industry, one of which is nursing facilities.
In the Nursing Facility ICPG, OIG has paid special attention to four risk areas. Within each risk area, the OIG explains the relevance of the topic, cites the requirements of participation (RoP) or other applicable laws that relate to that topic area, and provides recommendations for mitigating those risks. The four risk areas are as follows:
- Quality of Care and Quality of Life
- Medicare and Medicaid Billing Requirements
- Federal Anti-Kickback Statute
- Other Risk Areas
AHCA recommends members review the Nursing Facility ICPG with special attention on risk areas that are relevant to their operations. AHCA is also working on additional educational training to support members’ understanding and application of these guidelines.