AtlantiCare Leader Handbook

Regulatory Compliance- Joint Commission & Others As a health care organization, AtlantiCare is subject to comply with numerous health and safety requirements set by the New Jersey Department of Health, the Joint Commission, the Centers for Medicare and Medicaid Services (CMS) while participating in the Medicare and Medicaid programs as well as other established rules set by multiple agencies. These rules, regulations, and policies on safe practices must be followed since all we do falls into a regulatory category. Also, the Joint Commission is AtlantiCare’s deeming organization. Our organization is surveyed on quality of care, competency, and overall satisfaction based on the rules and regulations set in place both by CMS and The Joint Commission. Therefore, compliance is mandatory. Leader Expectation(s): Newly hired and promoted leaders will be required to attend a two-hour long regulatory and accreditation orientation. At the end of the session, leaders will be equipped with necessary information and the expectation to know the basic principles of a healthcare quality and safety program, the significance of quality and safety programs (impact on care), financial implications of quality and safety outcomes, the significance of Regulatory and Accreditation, and their roles in quality, safety, and accreditation, which will include onsite surveys by external regulatory agencies, implementation of action plans on respective business units, and overseeing/monitoring of continuous readiness programs. Location on Starfish: Designations Corporate Compliance/Compliance Line Purpose of Compliance Program: • Promotes continued commitment to adhere to laws, regulations, and internal policies & procedures • Advances the prevention of fraud, waste, and abuse • Works to detect and prevent misconduct • Furthers the mission of providing quality care to patients and building healthy communities • Enhances the reputation of AtlantiCare and its employees as ethical providers of healthcare services Reporting Potential Compliance Concerns: Employees are expected to report any compliance concerns through management, Corporate Compliance, Legal, or the Compliance Line (609-407-7788; internally at 3-7788). Leader Expectation(s): Leaders are expected to understand why Corporate Compliance exists, the risks of fraud, waste, and abuse, and the importance of ethical behavior. Leaders are expected to hold their teams accountable, know ways to report concerns, and ensure their employees are aware as well. HIPAA The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to accomplish four primary objectives:

• Assure health insurance portability by eliminating preexisting medical conditions • Reduce healthcare fraud and abuse • Enforce standards for health information • Guarantee security and privacy of health information

Leader Expectation(s): Leaders are expected to know healthcare data security and privacy standards with emphasis on minimum necessary access, use and disclosure of protected health information under the HIPAA Privacy Rule. Leaders are expected to hold their teams accountable to these standards. Refer to the policy site and reach out to the Legal department with questions or concerns.

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