In the ever-evolving world of long-term care, ensuring adherence to legal and regulatory standards remains a cornerstone of quality care and organizational integrity. Establishing robust compliance programs is imperative to safeguard resident well-being, uphold ethical principles, and mitigate legal risks. This blog post delves into the convergence of the Office of Inspector General's (OIG) Seven Fundamental Elements of an Effective Compliance Program with Section 483.85 of Title 42 of the Code of Federal Regulations, providing a comprehensive framework for legal best practices in long-term care.
1. Setting the Foundation with Written Policies, Procedures, and Standards of Conduct:
- Compliance with 42 CFR 483.85 necessitates the development of written policies and procedures reflecting the commitment to legal and ethical practices in long-term care facilities. These comprehensive policies, procedures, and standards should cover a spectrum of topics, including resident care, billing and coding, privacy, and employee conduct.
- Echoing the sentiment of the OIG, clear policies and standards foster a culture of compliance, guiding staff members in their daily operations and decision-making.
2. Building Structure through Designated Compliance Officers and Committees:
- The appointment of a compliance officer is mandatory under 42 CFR 483.85 and crucial to oversee the implementation of the compliance program within long-term care facilities. This individual plays a pivotal role in ensuring adherence to legal requirements and facilitating communication across the organization.
- OIG recommends establishing a compliance committee, which fosters collaboration and accountability in maintaining compliance standards.
3. Empowering Through Training and Education:
- Long-term care facilities must equip staff members with comprehensive training on relevant laws, regulations, and organizational policies. Regular education sessions empower employees with the knowledge and skills necessary to fulfill their compliance obligations.
- Embracing the OIG's principle of ongoing education empowers facilities to proactively identify and address compliance issues, thereby enhancing the quality of care and reducing the risk of legal violations.
4. Facilitating Communication and Transparency:
- Both 42 CFR 483.85 and the OIG emphasize the importance of establishing accessible channels for reporting compliance concerns. Open lines of communication enable employees to raise issues promptly, fostering transparency and accountability within the organization.
- Implementing confidential reporting mechanisms, such as hotlines or suggestion boxes, encourages staff members to come forward with potential violations without fear of reprisal.
5. Ensuring Accountability Through Monitoring and Auditing:
- Regular internal monitoring and auditing, as required by 42 CFR 483.85, enable long-term care facilities to assess their compliance efforts systematically. By reviewing processes, documentation, and outcomes, organizations can identify areas of non-compliance and implement corrective measures.
- The OIG's emphasis on proactive oversight aligns with this approach, underscoring the importance of ongoing evaluation to detect and address compliance concerns before they escalate.
6. Upholding Standards Through Disciplinary Guidelines:
- Long-term care facilities must establish clear disciplinary guidelines for addressing instances of non-compliance by employees and agents. Consistent enforcement of standards sends a strong message regarding the organization's commitment to upholding legal and ethical principles.
- By holding individuals accountable for their actions, facilities demonstrate their dedication to maintaining a culture of compliance and integrity.
7. Responding Proactively to Detected Offenses and Implementing Corrective Action:
- In accordance with 42 CFR 483.85, long-term care facilities must respond promptly to detected offenses and implement corrective actions to prevent recurrence. Timely intervention is essential for minimizing the impact of violations and restoring compliance.
- By addressing root causes and implementing preventive measures, organizations can strengthen their compliance efforts and mitigate the risk of future incidents.
When navigating the complex regulatory landscape of long-term care, adherence to legal best practices is vital. Long-term care facilities integrating the OIG's Seven Fundamental Elements of an Effective Compliance Program with the requirements established in 42 CFR 483.85, create framework for ensuring compliance, enhancing resident care, and safeguarding against legal risks. Through proactive measures, ongoing education, and a commitment to ethical conduct, long-term care facilities can fulfill their mission of providing quality care in a compliant manner.
Casey Alesch or any of the attorneys in our Healthcare practice group can assist you in navigating regulatory compliance and developing a comprehensive compliance program tailored to your organization's specific needs. Special thanks to summer clerk Andrew Fisher for his assistance with this blog.
