Provider Compliance Programs Required for Medicaid Re-enrollment

The ACA applicant or re-enrolling provider must certify that it has a compliance program containing the core elements as established by the Secretary of Health and Human Services referenced in Section 1866(j)(8) of the Social Security Act (42 U.S.C. Sections 1395cc(j)(8), as applicable.
• Conducting internal monitoring and practice standard
• Implementing compliance and practice standards
• Designating a compliance officer or contact
• Conducting appropriate training and education
• Respond appropriately to detected offenses/ develop corrective actions
• Developing open lines of communication
• Enforcing disciplinary standards through well-publicized guidelines

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