Does the “Compliance and Ethics” Process Intersect with QAPI at Any Stage?
Jeannine LeCompte, Compliance Research Specialist
A common question about the Quality Assurance and Performance Improvement (QAPI) program and the upcoming “Compliance and Ethics Program”—which each deal with different aspects of a long-term care (LTC) facility’s operations—is if these two processes ever intersect.
As outlined earlier, the compliance and ethics program entails a system of oversight and monitoring designed specifically to prevent criminal and civil liability from unethical violations by staff in the categories of fraud, waste, and abuse of Medicare and Medicaid funding. The program must ensure that all of its systems are subjected to a written auditing and analytical system and can order and direct investigations.
QAPI, on the other hand, is designed to improve care through development, implementation, and maintenance of an effective, comprehensive, data-driven program focused on systems and outcomes of care and quality of life.
The compliance officer has day-to-day oversight over compliance and ethics for the facility, while the compliance and ethics committee oversees the success of the entire program. QAPI, on the other hand, is controlled by the Quality Assessment and Assurance (QAA)/QAPI committee composed of staff who understand the characteristics and complexities of the care and services delivered by each unit and/or department.
This committee should, at a minimum, include the director of nursing; medical director or designee; at least three other staff—one of whom must be the administrator, owner, board member, or other individual in a leadership role with knowledge of facility systems and authority to change those systems.
It is likely that the compliance officer would be involved in the functioning of the QAA/QAPI Committee—although, it is important to remember, this is not specifically mandated.
It makes sense for both processes to share information and reports to ensure that the company is fully compliant at all levels and that there haven’t been noncompliant practices which have gone undetected.
The compliance and ethics program will also be tasked with reviewing any and all system breakdowns, and whether the measures put in place will effectively prevent any further lapses. In other words, the compliance and ethics program could in theory—depending upon the circumstances of course—play an important role in implementing a QAPI outcome.
Finally, all LTC facilities should be aware that although the compliance and ethics program will not be enforced by surveyors until November 28, 2019, the OIG requirements have been in effect since 2010 and are already being actively enforced.
