Adoption Date: 1/19/2010, Revised: 11/16/2010
5000 - NON-INSTRUCTIONAL/BUSINESS OPERATIONS
Fiscal accounting and reporting
5574 MEDICAID COMPLIANCE PROGRAM POLICY
The
School District shall comply with New York State and federal laws and
regulations related to the School District's participation as a provider
of care, services or supplies under the Medicaid program.
The
School District as a provider receiving or submitting Medicaid claims of
at least $500,000 in any consecutive twelve-month period, has
established and implemented a Medicaid Compliance Program designed to
detect and prevent fraud, waste and abuse.
As required by the New
York State Office of the Medicaid Inspector General (hereinafter
referred to as the OMIG), the School District's Medicaid Compliance
Program is comprised of the following core elements:
- Written
policies and procedures that describe compliance expectations as
embodied in a code of ethics applicable to all School District
personnel, including Board members. Such compliance expectations or
standards of conduct shall include provisions designed to: implement the
operation of the Medicaid Compliance Programs; provide guidance to
employees and others on dealing with potential compliance issues;
identify how to communicate compliance issues to appropriate personnel;
and describe how issues are investigated and resolved;
- A
designated employee who will be responsible for the day-to-day
operation of the Medicaid Compliance Program. This employee's job duties
may be exclusively related to Medicaid compliance issues or may be
combined with other duties, provided that the Medicaid compliance
portions of the employee's duties are satisfactorily fulfilled. The
designated employee shall report directly to the School District
Superintendent or the Superintendent's designee and shall also
periodically report directly to the Board of Education on the School
District's Medicaid Compliance Program activities;
- Training
and education of all affected School District employees and other
persons associated with the School District's Medicaid Compliance
Program, including, but not limited to, members of the District's Board
of Education. Such training shall occur periodically and shall be made a
part of any required training or orientation for new employees, Board
members, volunteers and/or others on dealing with the School District's
Medicaid Compliance Program;
- Communication lines and
processes directed to the School District's designated employee who will
be responsible for the day-to-day operation of the Medicaid Compliance
Program. Such communication lines and processes shall be accessible to
all School District employees, Board members, volunteers and others
associated with the School District's Medicaid Compliance Program. The
communication lines and processes are designed to allow employees to
report compliance issues, including the anonymous and confidential good
faith reporting of any practice or procedure related to Medicaid
reimbursement of school or preschool supportive health services, that an
employee believes is inappropriate;
- Disciplinary
procedures that encourage good faith and fair dealing in the School
District's Medicaid Compliance Program by all affected individuals. Such
disciplinary procedures shall include procedures that articulate
expectations for reporting and assisting with the resolution of
compliance issues and also provide sanctions for the failure to report
suspected problems and participating (either actively or passively) in
non-compliant behavior;
- A system for the routine
identification of Medicaid compliance risk areas in the School
District's Medicaid Compliance Program. Self-evaluation of such risk
areas may be accomplished by, but not necessarily limited to, internal
audits and external audits, as appropriate;
- A system
for responding to, investigating, correcting and reporting compliance
issues as they are raised, including the development of procedures and
systems to reduce the potential for recurrence, identifying and
reporting compliance issues to the OMIG and refunding overpayments; and
- A
policy of non-intimidation and non-retaliation against any person for
the good faith participation in any aspect of the administration of the
School District's Medicaid Compliance Program including, but not limited
to, the reporting of potential issues, assisting as a witness with any
investigation, evaluation, audit, remedial actions or reporting to
appropriate officials as provided in Sections 740 and 741 of the New
York State Labor Law.
- Retention of Medicaid Records
- On
March 10, 2010, the State Education Department, Special Aids and
Medicaid Unit, notified districts of a Settlement and Compliance
Agreement between New York State and the federal agencies. This
Agreement states that the January 2002 record retention directive is no longer in effect and Districts may return to the normal retention policy.
- The following records require a minimum of six (6) year retention period from the date services were paid:
- a) All documents relating in any manner to Medicaid reimbursement for services;
- b) All documents relating in any manner to referrals, prescriptions or orders for these services;
- c) All documents relating in any manner to the provision of these services including, but not limited to, the following:
- The dates that services were provided.
- The
identification and qualifications of the professional who provided the
services or under whose direction the services were provided.
- Progress and other notes, memoranda,correspondence, reports and other documents relating to services rendered, and;
- All Individualized Education Programs (IEPs) for Medicaid-eligible students.
- Questions
related to SSHP or PSHSP retention policy would be directed to the
stack, Special Aids and Medicaid Unit within the New York State
Education Department.
Policy References:
Social Services Law Section 363-d
18 New York Code of Rules and Regulations (NYCRR) Part 521
Policy Cross References:
» 5570 - FINANCIAL OVERSIGHT
» 5571 - Financial Accountability: Allegations of Fraud
» 5572 - Audit Committee
» 5573 - Internal Audit Function
» 6110 - COMPLAINTS AND GRIEVANCES BY EMPLOYEES