Non-compliance is the fastest way to lose your license, your Medicaid enrollment, or worse. Here's what every agency owner must know.

Key Compliance Areas

State Licensing Compliance

  • Maintain active state license — never let it lapse
  • Meet all conditions of licensure (staffing ratios, policies, training)
  • Prepare for unannounced state surveys
  • Correct deficiencies within required timelines

Medicare/Medicaid Compliance

  • Conditions of Participation (42 CFR 484)
  • Proper documentation for every service billed
  • Timely and accurate claims submission
  • Anti-fraud measures and internal monitoring

HIPAA Compliance

  • Privacy Rule: protecting patient health information (PHI)
  • Security Rule: safeguarding electronic PHI
  • Breach notification requirements
  • Staff training and business associate agreements

OSHA Compliance

  • Bloodborne pathogen exposure plan
  • Workplace violence prevention
  • Personal protective equipment (PPE)
  • Injury and illness recording/reporting

Employment Law

  • Fair Labor Standards Act (FLSA) — overtime, minimum wage
  • Workers' compensation requirements
  • Anti-discrimination laws
  • Background check requirements (state-specific)

Building a Compliance Program

1. Appoint a Compliance Officer

Designate someone (even yourself) responsible for compliance oversight.

2. Written Policies and Procedures

Document everything: clinical protocols, billing procedures, privacy practices, safety plans.

3. Training Program

All staff must receive compliance training at hire and annually. Document attendance and comprehension.

4. Internal Monitoring

Regular self-audits: chart reviews, billing audits, personnel file checks.

5. Reporting System

Establish a way for staff to report compliance concerns without fear of retaliation.

6. Corrective Action

When issues are found, document the problem, the fix, and follow-up monitoring.

Common Survey Deficiencies

  1. Missing or incomplete training records — #1 deficiency
  2. Inadequate care plans — not individualized or updated
  3. Background check gaps — missing or expired
  4. Policy manual outdated — doesn't reflect current regulations
  5. Emergency preparedness deficits — no current plan or drills

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Information is for educational purposes. Consult a compliance professional.