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Andrew M. Cuomo

Governor

Dennis Rosen

Medicaid Inspector General


The New York State Office of the Mediciad Inspector General (OMIG) has posted on its website DSRIP Compliance Guidance 2015-01 Revised: Special Considerations for Performing Provider System (PPS) Leads' Compliance Programs.

The DSRIP Compliance Guidance is specific to the Delivery System Reform Incentive Payment (DSRIP) Program mandatory compliance programs that must be in place for PPS Leads. It replaces DSRIP Compliance Guidance 2015-01 that was posted on OMIG's website on April 6, 2015.

It is noted that PPS Leads must meet all of the mandatory compliance program obligations set out in New York Social Services Law Section 363-d and 18 New York Code of Rules and Regulations Part 521. DSRIP Compliance Guidance 2015-01 Revised sets out some special considerations that PPS Leads should work into their compliance programs.

The DSRIP Compliance Guidance is available on the OMIG website at:

https://www.omig.ny.gov/dsrip-compliance-guidance

The New York State Office of the Inspector General (OMIG) has posted on its website DSRIP Compliance Guidance 2015-02: Frequently Asked Questions by Performing Provider System (PPS) Leads Relative to Compliance Programs.

This joint publication by OMIG and the New York State Department of Health (DOH) provides responses to DSRIP-related compliance questions. The publication is available on OMIG's website at: https://www.omig.ny.gov/images/stories/compliance_alerts/20150715_dsrip_faqs.pdf

The New York State Office of the Medicaid Inspector General (OMIG) has posted on its website DSRIP Compliance Guidance 2015-01: Special Considerations for Performing Provider System (PPS) Leads' Compliance Programs.

The DSRIP Compliance Guidance is specific to the Delivery System Reform Incentive Payment (DSRIP) Program mandatory compliance programs that must be in place for PPS Leads. It is noted that PPS Leads must meet all of the mandatory compliance program obligations set out in New York Social Services Law Section 363-d and 18 New York Code of Rules and Regulations Part 521. DSRIP Compliance Guidance 2015-01 sets out some special considerations that PPS Leads should work into their compliance programs.

The DSRIP Compliance Guidance is available on the OMIG website.

Home Health Pre-claim Review

In accordance with Chapter 59 of the Laws of 2011, as amended in 2014, certain providers of home health services that exceed $15 million in Medicaid fee-for-service and/or Medicaid managed care reimbursements are required to utilize a verification organization (VO) to perform a pre-claim review. The VO must verify the home health services within a claim or encounter collected from electronic visit verification (EVV) prior to submission of the claim or encounter to the Department of Health (DOH) or to a managed care provider.

The Office of the Medicaid Inspector General (OMIG) has identified the participating providers that are required to utilize a VO. Those providers required to participate will be notified by the OMIG by certified letter. Only providers that receive notification from OMIG are required to have their services verified by a VO. If you have any questions regarding your status under the amended law please contact OMIG at (518) 402-1470.

Providers requiring a VO must select their VO from the OMIG and DOH joint list of approved VOs, which can be found on our website at http://omig.ny.gov under the Resources tab. Follow the Verification Organizations link. Please note that the VO you select does not have to be the same vendor you utilize for your EVV services.

Additional information and resources related to the law can be found on our website at http://omig.ny.gov under the Resources tab. Follow the Home Health Requirements and/or Questions and Answers links.

The New York State Office of the Medicaid Inspector General has posted on its website Compliance Guidance 2015-02, entitled Mandatory Compliance Program Requirement: Holding Company and Joint Venture Structures – Employee Vested with Responsibility for Day-to-Day Operation of the Compliance Program.

This guidance addresses the requirement that a compliance officer be an employee of the Medicaid provider that is required to have a compliance program.

Compliance Guidance 2015-02 is available here.