Medicaid Compliance Plan
The Institute for Human Services, Inc. has implemented and maintains a Compliance Program with all required elements as outlined in Social Security Law Section 363-d and Part 521, entitled “Provider Compliance Programs,” of Title 18 of the Codes, Rules, and Regulations of the State of New York. IHS, its Governing Board, Administrators, and Management teams are committed to delivering quality and efficient patient transportation services to the highest standards of ethical and professional business conduct. Maintaining full compliance with all applicable State and Federal laws affecting the delivery and payment of healthcare related transportation services, including those regulations that prohibit fraud, abuse, and the waste of health care resources, is of the highest priority.
The purpose of this Compliance Program and its component policies and procedures is to establish and maintain a culture within IHS that promotes quality and efficient patient care; high standards of ethical and business conduct; and the prevention, detection, and resolution of conduct that does not conform to IHS standards and policies, applicable law, and health care program or payor requirements. The Compliance Program applies to all IHS personnel, its Governing Board, administration, employees, volunteers, interns, and other entities providing services on behalf of IHS.
Training and Education
All employees, Governing Board, volunteers, and interns will participate in orientation and annual refresher educational events. Any employees, Governing Board, volunteer, and intern that fails to attend the required training will be subject to disciplinary action up to and including termination.
Medical Necessity and Quality of Care
The Institute for Human Services only accepts Medicaid transportation trips from Medical Answering Services, New York State Transportation Broker. Medical Answering Services is responsible for ensuring that the client is Medicaid eligible on the service date. The Institute for Human Services is prohibited from accepting Medicaid trips from any other source.
All trips assigned to the volunteer driver by the Institute for Human Services employees will be reimbursable. It is not permissible for a volunteer driver to schedule appointments directly with a client.
The Institute for Human Services prides itself on the delivery of personalized, compassionate, and professional transportation services. All the volunteer drivers are trained in HIPPA compliance, have their MVR reviewed, participate in the LENS program, and have a background check completed prior to accepting assignments.
The Institute for Human Services, Inc. has appointed an employee with vested responsibility for the Compliance Program Operations.
Communication, Anonymous and Good Faith Reporting
The Institute for Human Services, Inc. is committed to maintaining the integrity of its business operations and the anonymity of good faith reporters. The Institute for Human Services, Inc. has established three methods for reporting compliance issues:
- The lock box located at IHS office building is secure and maintained by the compliance officer.
- The compliance email, firstname.lastname@example.org, is an acceptable manner to report suspected Medicaid violations.
- Complaints may be labeled as confidential and mailed to the compliance officer:
50 Liberty Street
Bath, N.Y. 14810
All complaints, records, and reports will be kept confidential.