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CMS Final Rule Removes Certain Training Requirements in CY 2019

CMS Final Rule Removes Certain Training Requirements in CY 2019

It's that time of year again, the holiday season is dwindling down with New Year's Day approaching. In the compliance world, it is the time of year when Plan Sponsors ask for attestation from providers that certain compliance program elements are implemented. In 2018, just like previous years, this included attesting that General Compliance and Fraud, Waste, and Abuse training has been completed by those required to do so.  

Background

The Centers for Medicare & Medicaid Services (CMS) requires certain compliance program elements to be implemented, that are applicable to the first tier, downstream, and related entities (FDRs) of the Medicare Advantage program and for Plan D Sponsors. These requirements include:  

  • Written policies and procedures and standards (code) of Conduct.
  • Exclusion List Screening (e.g., OIG's Exclusion List).
  • The availability of a system to receive reports (reporting mechanism) of suspected noncompliance and/or FWA that is confidential, allows anonymity and includes a policy of non-intimidation and non-retaliation.
  • Monitoring and auditing downstream entities.
  • Identification of use of offshore subcontractors.
  • And General Compliance and Fraud, Waste, and Abuse (FWA) Training (unless you are deemed to have met this requirement).

Final Rule (goes into effect January 1, 2019)

In 2018, CMS enacted a Final Rule removing certain training requirements previously applicable to FDRs. Beginning in Calendar Year (CY) 2019, CMS will no longer be requiring their unmodified General Compliance and FWA training to be completed by FDRs (e.g., healthcare providers). According to CMS, in part, this will reduce administrative burden while allowing flexibility for Plan Sponsors to oversee FDR compliance efforts. This means Plan Sponsors will still have the discretion to include compliance training requirements, but they will not be required to ensure unmodified CMS training is completed. In fact, CMS will be removing the training from their website and will no longer provide updates to their content. CMS commented that one of the reasons for this is there was not a clear understanding of who needs to take the training.

What does this mean for your organization?

Healthcare Compliance Pros has closely examined the Final Rule and have looked at several Plan Sponsor attestation forms. In the Final Rule, CMS has said that FDRs with robust internal compliance programs (such as HCP clients) may not be required to complete FWA and General Compliance training; however, Plan Sponsors may distribute some kind of provided compliance training because they have the discretion to do so. Based on our review of Plan Sponsor attestation forms, we expect Plan Sponsors may not have their own compliance training developed or may still ask for completion of the unmodified FWA and General Compliance training even though CMS no longer is updating or requiring the training to be completed (e.g., training will be the CY 2018 version).   

HCP has decided to take a "wait and see" approach to ensure all of our clients are covered.  Therefore, we will continue to have the FWA and General Compliance training courses available to clients who need it until we can be certain Plan Sponsors will no longer ask for attestation indicating the training was in fact completed.

What we do know for certain is in CY 2019, CMS and Plan Sponsors will continue to require FDRs to have all other compliance elements implemented, including:

  • Written policies and procedures and standards (code) of Conduct.
  • Exclusion List Screening (e.g., OIG's Exclusion List).
  • The availability of a system to receive reports (reporting mechanism) of suspected noncompliance and/or FWA that is confidential, allows anonymity and includes a policy of non-intimidation and non-retaliation.
  • Monitoring and auditing downstream entities.
  • Identification of use of offshore subcontractors.

In the first quarter of CY 2019, Healthcare Compliance Pros will be developing and enhancing training modules that we believe will end up replacing the CMS unmodified training, while arming you with what you need to adhere to attestation requirements from Plan Sponsors in 2019 and beyond. We will keep you posted with our Compliance Insider as we make these exciting changes!  

If you have any questions about this Final Rule and 2019 training requirements, please do not hesitate to contact us by email: [email protected] or by phone 855-427-0427.

 

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