MM Curator summary
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[MM Curator Summary]: NY MCOs will have to ramp up their internal efforts to fight FWA.
On December 28, 2022, the New York State Office of the Medicaid Inspector General (OMIG) finalized the proposed rule published on July 13, 2022, that significantly revises the provider and Medicaid managed care organization (MMCO) compliance obligations in New York with no substantive changes. The new regulations became effective immediately upon issuance; however, OMIG enforcement will be delayed until March 28, 2023 (90 days after the effective date of the regulations).
As we previously reported, the rules incorporate some of OMIG’s guidance issued to providers on compliance program best practices and expectations. Additionally, the rules expand the requirement for MMCOs to have a Special Investigations Unit (SIU); build upon existing requirements related to MMCOs’ requirements governing plans’ fraud, waste and abuse prevention programs; and codify OMIG’s self-disclosure protocols for providers and MMCOs, with limited changes. In conjunction with the promulgation of these new compliance regulations, OMIG will be providing ongoing guidance and training in the form of statewide presentations, webinars and compliance program reviews. OMIG has published new compliance guidance materials on its website under the Compliance Library tab, including a document that compares the requirements in effect prior to these final regulations to the current requirements.
We strongly recommend that providers and MMCOs perform a compliance program effectiveness review utilizing these new standards, as OMIG intends to commence compliance program audits of providers to assess their compliance with these new standards. OMIG indicated in a recent presentation that a score of less than 60% compliance may result in enforcement actions, and even a “passing” score likely will result in corrective actions.