RESOLUTION NO. 200 of 2010 DATED: September 28, 2010

WHEREAS, the Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) excludes individuals and entities from participation in Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP) and all Federal health care programs (as defined in section 1128B(f) of the Social Security Act (the Act)) based on the authority contained in various sections of the Act, including sections 1128, 1128A, and 1156, and

WHEREAS, when the HHS-OIG has excluded a provider, Federal health care programs (including Medicaid and SCHIP programs) are generally prohibited from paying for any items or services furnished, ordered, or prescribed by excluded individuals or entities (Section 1903(i)(2) of the Act; and 42 CFR section 1001.1901(b)) this payment ban applies to any items or services reimbursable under a Medicaid program that are furnished by an excluded individual or entity, and extends to:  

  ·   all methods of reimbursement, whether payment results from itemized    
      claims, cost reports, fee schedules, or a prospective payment system;

  ·   payment for administrative and management services not directly related
      to patient care, but that are a necessary component of providing items
      and services to Medicaid recipients, when those payments are reported on
      a cost report or are otherwise payable by the Medicaid program;

  ·   payment to cover an excluded individual's salary, expenses or fringe
      benefits, regardless of whether they provide direct patient care, when
      those payments are reported on a cost report or are otherwise payable by
      the Medicaid program.

, and

WHEREAS, in addition, no Medicaid payments can be made for any items or services directed or prescribed by an excluded physician or other authorized person when the individual or entity furnishing the services either knew or should have known of the exclusion. This prohibition applies even when the Medicaid payment itself is made to another provider, practitioner or supplier that is not excluded. (42 CFR section 1001.1901(b)), and

WHEREAS, as part of the conditions of participation in the Medicaid program, providers are required to keep current with changes in Medicaid regulations and statutes. Additionally, when submitting a Medicaid claim, providers attest that the entity shall be subject to and bound by all rules, regulations, policies, standards, fee codes and procedures as set forth in Title 18 of the Official Compilation of Codes, Rules and Regulations of New York State and other publications of the Department, including Medicaid Management Information System Provider Manuals and other official bulletins of the department, and

WHEREAS, such Medicaid providers, in New York, must annually certify to the NYS OMIG that it is and remains compliant with OMIG mandatory Medicaid compliance requirements, and

WHEREAS, the County of Montgomery (the "County") must comply with OMIG mandatory Medicaid compliance requirements since the County receives payments under the State Medicaid Plan, through the activities of its various departments operating under Articles 28 or 36 of the Public Health Law, Articles 16 or 31 of the Mental Hygiene Law and/or receives payments in excess of $500,000 each year and shall continue to do so into the foreseeable future,

RESOLVED, that the Montgomery County Board of Supervisors, in light of the aforementioned and in accordance with its statutory duties, does hereby order that the attached Montgomery County Corporate Compliance Excluded Provider Checks Policy and Procedure be and are adopted and apply to the entire County, and

FURTHER RESOLVED, each head of each County department shall be responsible for identifying all relevant employees of his/her respective department, and any contractors, vendors, agents or assigns and adhering to the said Montgomery County Corporate Compliance Excluded Provider Checks Policy.

RESOLUTION ADOPTED with Aye(1868). (9/28/2010)