CMS MA-PD Requirements for Vendors
Gundersen St. Joseph's Hospital and Clinics values its relationships that have developed over the years with those serving as consultants, independent contractors, and suppliers of services and herein after referred to as "vendors". Because Gundersen St. Joseph's Hospital and Clinics contracts with insurance companies providing Centers for Medicare and Medicaid Services (CMS) approved Medicare Advantage – Prescription Drug (MA-PD) plan coverage for provider services to Medicare beneficiaries, we are required by CMS compliance program guidelines to provide certain compliance program information about CMS requirements that affect our vendors.
CMS has outlined certain MA-PD Compliance Program Guidelines as applicable to vendors providing services to health care providers. These CMS guidelines are described in CMS' Medicare Managed Care Manual (Chapter 21) and Prescription Drug Benefit Manual (Chapter 9), and the related provisions for Medicare Advantage Organizations (MAO) and Medicare Prescription Drug Plans (PDP) (Chapter 42 of the Code of Federal Regulations, Parts 422 and 423, collectively referred to as "Parts C & D".
Some of these CMS guidelines are:
- Screening of employees prior to hire and thereafter to ensure they are not excluded from participation in federal health care programs,
- A Code of Conduct
- Annual compliance and fraud, waste and abuse trainings for your employees that meets Medicare standards
- Reporting to Gundersen St. Joseph's Compliance Officer any suspected Medicare program violations including fraud, waste and abuse that affect Gundersen St. Joseph's payments
As a vendor to Gundersen St. Joseph's, please be aware of the Gundersen St. Joseph's Standards of Conduct and its policies and procedures. Alternatively, a vendor may have their own Standards of Conduct, and comparable policies and procedures to meet CMS requirements.
Additional Gundersen St. Joseph's resources related to MA-PD:
CMS Training Resources:
Here's where you'll find CMS training resources for Medicare Parts C and D Fraud, Waste and Abuse Training and Medicare Parts C and D General Compliance Training.
An additional CMS resource is the: CMS Medicare Learning Network Compliance Program Trainings, Resources and FAQ.
Conflicts of Interest
You may view our Conflicts of Interest policy below and its Disclosure Statement by clicking on the links below. If you have questions, concerns or would like to report a conflict of interest, please contact the Compliance Office for the Gundersen Regional Hospital Affiliates at (715) 538-1784.
We encourage you to share this Compliance Program information with your employees. Please feel free to contact the Compliance Officer for Gundersen Regional Hospital Affiliates at (715) 538-1784 to report any concerns or if you have any questions.