Home Health & Hospice Week

Tips for small providers, private equity included in new instructions.

Think you know everything you need to know about the feds’ compliance guidance for home health and hospice agencies? Think again.

The HHS Office of Inspector General has completed the initial step in its first major overhaul of its compliance guidance documents in 15 years. On Nov. 6, the OIG issued its 91-page General Compliance Program Guidance (GCPG).

Reminder: Previously, the OIG issued industry-specific guidance documents only. The OIG published CPGs for home health agencies back in 1998 and for hospices in 1999. Then this April, the OIG announced it would revamp its guidance structure by issuing one central guidance document that applies to all providers, and multiple industry-specific guidance documents (see HHHW by AAPC, Vol. XXXII, No. 17).

The new GCPG “is a reference guide for the health care compliance community and other health care stakeholders,” the OIG says on its GCPG webpage. “The GCPG provides information about relevant Federal laws, compliance program infrastructure, OIG resources, and other information useful to understanding health care compliance.”

The seven sections of the new GCPG cover topics including the seven elements of a compliance plan to adaptations for small and large entities. And it includes many elements previously contained only in Corporate Integrity Agreements, note attorneys Ritu Kaur Cooper, Katherine Kuchan, and Scott Taebel with law firm Hall Render.

Something new: “In a departure from previous guidance … OIG has reworked its approach to promote the use of incentives for participation in the organization’s compliance program, rather than solely the use of consequences for noncompliance,” highlights attorney Melissa Wong with law firm Holland & Knight in Boston.

“This new concept advocates for the use of creative ways to incentivize, for example, an achievement of compliance goals or actions that reduce compliance risk, or to reward performance of compliance activities outside of the individual’s job function, such as mentoring colleagues on compliant conduct or serving as a compliance representative within their department or team,” Wong details. “The incentive can be the basis for additional compensation, significant recognition or other, smaller forms of encouragement,0” she elaborates.

The new document also “provides much more specific and detailed guidance on which features could be traded off or not when implementing a customized compliance program” for small or large providers, Wong adds.

“For small entities, the GCPG suggests concrete ways to implement the seven elements of a compliance program with limited resources and personnel, such as designating a compliance contact when resources do not allow a full-time compliance officer, using existing or template policies and procedures and training materials, and offering an ‘open door’ policy in lieu of a formal communication program,” note attorneys with law firm Sidley Austin in online analysis.

Tone from the top: Additionally, “in discussing com­pliance program best practices in the GCPG, OIG emphasizes the importance of an organization’s leadership, including the Chief Executive Officer (CEO) and board of directors, setting and enforcing strong compliance expectations,” emphasize attorneys with law firm Morgan Lewis in online analysis.

And the new guidance singles out private equity for special attention. PE companies and investors must make sure any financial incentives are compliant, among other safeguards, the Morgan Lewis lawyers say.

“It is notable, and consistent with the government’s established skepticism and scrutiny of PE investment in healthcare, that HHS OIG chose specifically to call out PE’s responsibility to understand the laws and guidance,” the Sidley attorneys note.

More to come: “The GCPG is the first of many CPGs expected to be released by OIG in the coming years,” Kaur Cooper, Kuchan, and Taebel point out in online analysis. “Beginning in 2024, OIG plans to publish industry segment-specific CPGs (ICPGs),” they say.

Home health and hospice ICPGs will come, but CMS has indicated guidance documents for Medicare Advantage and nursing facilities will be first.

The ICPGs will keep providers more on their toes. “OIG plans to periodically update these ICPGs to address newly identified risk areas and compliance measures and to ensure timely and meaningful guidance,” Kaur Cooper, Kuchan, and Taebel say.

Providers tempted to put compliance plans on the back burner should think again, the attorneys urge.

“OIG has spent a great deal of time and effort creating the GCPG, so it will likely be considered THE primary resource and the minimum standard for compliance programs moving forward,” the Hall Render attorneys stress. “We recommend each organization, either with existing compliance programs or those in the developmental stage, comprehensively review the GCPG and reference it when assessing whether your current program conforms with OIG’s expectations,” they say.

“Now that so many of the concepts from CIAs are present in the GCPG, it would behoove any organization to reevaluate their compliance program to ensure it is aligned with the GCPG and any forthcoming recommendations from OIG,” they advise.

Note: Links to the guidance are at https://oig.hhs.gov/compliance/general-compliance-program-guidance.