SNF Compliance Planning
The 2010 health care reform legislation, formerly known as the Patient Protection and Affordable Care Act and more recently re-branded as “the Affordable Care Act (ACA),” is replete with new licensing and operational requirements for the entire spectrum of healthcare providers. Skilled nursing facilities (SNF’s) are no exception. With many imminent changes specifically targeting SNF’s and other long-term care facilities, Fenton Nelson has developed resources to assist our clients in preparing to meet new requirements through SNF compliance planning.
Though most changes in the ACA are spread out over the next several years, a few requirements-aimed at increasing the transparency in SNF’s-take effect as soon as March 2011. These include numerous disclosure requirements, including disclosures of ownership and control, specific categories of work performed by direct care staff, resident census data, employee turnover, and more.
Perhaps the most significant change ahead, which will be implemented in March 2012, is the mandate for compliance plans. Although larger business entities, such as hospital systems, have almost universally adopted internal, self-governed compliance plans on their own, the long-term care industry has been slower to follow suit. As of March 2012, compliance planning will be mandatory, not optional.
Fenton Nelson has long assisted clients in designing, implementing, and overseeing skilled nursing compliance plans. Often, health care providers do not discover serious operational or reimbursement problems until a third party acts. Sometimes, the first “indicator” of a problem is government action: notice of a post-payment audit or an investigation. In other cases, providers are surprised by lawsuits concerning care rendered at a facility. In all cases, the most effective way to prevent serious problems and significant liabilities is by developing a program of self-policing to ensure that issues are addressed proactively and that problems are “nipped in the bud.”
Compliance plans serve this function by ensuring that employees, residents, and their families share a common understanding and expectations about everything from resident care to privacy to staff conduct. Implementing and sustaining compliance plans demonstrates a serious commitment to transparency and strict attention to both the law and quality of care. Through the various components of an effective compliance plan, health care providers have the best opportunity of protecting their residents and themselves from risk.
Fenton Nelson offers a unique integrative approach in designing and implementing compliance plans. Often, providers turn to one resource for compliance program design and another resource for legal response. This bifurcation can be not only inefficient but potentially dangerous; it can impede the active “learning” and adaptation that is vital to effective compliance and to the ultimate goal of “damage control before the damage.” Fenton Nelson’s approach integrates the compliance planning and response functions. This ensures that any problems that emerge are not only resolved in adherence with the compliance plan, but that policies, procedures, and training evolve in real time to prevent the same problem from recurring.
Our approach to compliance is informed by a wealth of direct experience in crisis response, investigational defense, and administrative proceedings. There is no substitute for the “tactile” feel of how law enforcement responds to different problems that arise and while it may be tempting to use templated compliance plans, compliance is not something you can “do” from a book. Rather, it is a process that requires the nuanced understanding of the issues and the risks for each unique client that Fenton Nelson can provide.
