It has been just over one year since nursing facilities had to establish compliance and ethics programs in order to participate in federal health programs, as required by the Affordable Care Act (ACA). Confidential hotlines can play a major role in effective compliance and ethics programs at nursing facilities.

Section 6102 of the Act, “Accountability Requirements for Skilled Nursing Facilities and Nursing Facilities” required that nursing facilities “have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care ….”

There are eight required components, summarized as follows:

1. Compliance standards and procedures designed to reduce the prospect of criminal, civil, and administrative violations under this Act

2. Specific high-level individuals with overall responsibility to oversee compliance with such standards and procedures and have sufficient resources and authority to assure such compliance

3. Due diligence to avoid delegating substantial discretionary authority to individuals whom the organization knew, or should have known, had a propensity to engage in criminal, civil, and administrative violations under this Act

4. Efforts to effectively communicate the standards and procedures to all employees and other agents, such as by requiring participation in training programs or by disseminating publications that explain in a practical manner what is required

5. Reasonable steps to achieve compliance with its standards, such as by utilizing monitoring and auditing systems and by having in place and publicizing a reporting system whereby employees and other agents could report violations by others within the organization without fear of retribution

6. Consistent enforcement through appropriate disciplinary mechanisms

7. All reasonable steps taken to respond appropriately to an offense once it is detected and to prevent further similar offenses

8. Periodic reassessments of the compliance program to identify changes necessary to reflect changes within the organization and its facilities

March 23, 2013 was the deadline by which skilled nursing facilities were required to implement compliance and ethics programs, or risk being excluded from participating in Medicare, Medicaid, or other federal health programs. In addition to the risk of such exclusion, facilities that lack compliance programs that address all eight components may face severe sanctions.

While the ACA does not specifically require hotlines, confidential ethics and fraud hotlines represent a common method for complying with requirements for a reporting system.

By implementing ethics and fraud hotlines, skilled nursing facilities and other nursing facilities can demonstrate compliance with the fifth required component, “having in place and publicizing a reporting system [to] report violations … without fear of retribution.”

Of course, “compliance” is not the only benefit nursing facilities will experience with an effective ethics hotline, particularly in conjunction with ethics training – another ACA requirement. The presence of a confidential hotline contributes to staff confidence in their facility’s ethics culture. Calls to the hotline also represent an early-warning system that enables responsible leaders to monitor potential issues and address them before they develop to the point that external agencies such as the U.S. Department of Health and Human Services must be involved.

Ethical Advocate can assist nursing facilities in implementing and managing ethics hotlines and in providing ethics and compliance training.

References:

Patient Protection and Affordable Care Act, Public Law 111-148. http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf