Section 6102 of the Patient Protection and Affordable Care Act (also known as “PPACA” or simply the “Affordable Care Act”) requires nursing and skilled nursing facilities to have in place an effective compliance and ethics program by March 23, 2013.

The federal government included the provision requiring this mandatory compliance and ethics program in order to detect and prevent criminal, civil, and administrative violations of the Affordable Care Act.

There are 8 required components for a Nursing Facility’s compliance and ethics program under the PPACA:

1) Compliance procedures applied to the facility and its agents that are reasonably capable of reducing criminal, civil and administrative violations of the PPACA

2) “High level personnel” of the facility must oversee compliance with the program and these individuals must have the resources and authority to assure compliance

3) The facility must exercise due care not to delegate substantial discretionary authority to individuals whom it knows or should know have a propensity to engage in violations of the PPACA

4) The facility must take steps to communicate effectively its compliance standards and procedures to all employees and other agents, such as by requiring participation in training programs or by issuing publications explaining what is required

5) The facility must take reasonable steps to comply with its ethics program’s standards and procedures, such as by utilizing auditing systems designed to detect violations of the PPACA. The facility should also have in place a reporting system whereby its employees and agents could report PPACA violations by others without fear of retribution

6) The facility’s program must consistently enforce its standards through appropriate disciplinary mechanisms, including discipline of individuals responsible for the failure to detect a violation

7) When the facility detects a violation, it must take reasonable steps to respond appropriately to the offense and to prevent further similar offenses, including any necessary modification to its program to prevent and detect violations of the PPACA

8) The facility must periodically undertake reassessment of its compliance program to identify changes necessary to reflect any changes within the facility

There have not been any regulations published to date that address this provision of the PPACA. The Office of Inspector General (OIG)’s Compliance Program Guidance for Nursing Facilities and the OIG Work Plans can serve as tools for the development of a compliance program under the PPACA. Finally, every compliance and ethics program must be tailored to the issues of each facility.

For additional guidance in implementing the mandatory compliance and ethics program under the PPACA, contact DLM Legal’s health care practice attorneys at info@dlmlegal.com or 216.635.0002.