Change in NYS Compliance Certification Process

Tucked away on page 8 of the October 2020 Medicaid Update, published on November 2, 2020, was notification to providers of a change in the provider certification process required under NYS Social Services Law §363-d. ​Effective immediately, providers do not have to certify in December. However, certification is still required.

Going to the NYS OMIG website, there are further instructions. Providers will not be using the "SSL Certification" form on the OMIG website. Instead, a provider will now record (attest to) their adoption and maintenance of an effective compliance program on their annual "Certification Statement for Provider Billing Medicaid." This annual certification occurs on the anniversary date of the provider's enrollment in Medicaid. The Deficit Reduction Act (DRA) requirements have also been incorporated into Social Services Law §363-d so there is no separate DRA certification requirement. By completing the annual "Certification Statement for Provider Billing Medicaid", providers are also attesting to complying with DRA requirements.

Per the OMIG website, approximately 45-60 days before the anniversary of a provider's enrollment, the NYS Department of Health (NYSDOH) sends by mail a package of information and materials to the provider, which includes the Certification of Statement for Provider Billing Medicaid Form. This Form must be completed and returned to NYSDOH by the enrollment anniversary date.

Compliance departments should note that there is no longer a requirement that the compliance officer sign this attestation. Current directions require that the signature of the provider, an officer, or director be notarized before submission to the NYSDOH. During this changeover, TrusiakLaw PLLC recommends that compliance personnel coordinate with personnel currently completing this form to verify that the form is accurately completed and track that all certifications are completed as they become due.

Earlier this year, there were additional changes in NYS Social Services Law §363-d that took effect April 1, 2020. Now, there are monetary penalties for providers who fail to implement and maintain an effective compliance program. For a first offense, the statute allows providers to be fined $5000 per month for a maximum of 12 months. If that same provider again fails to implement and maintain an effective compliance program within 5 years of the first instance, the penalty increased to $10,000 per month for a maximum of 12 months.

Providers with questions regarding compliance programs and certification programs are welcome to contact TrusiakLaw PLLC, www.trusiaklaw.com.