Hometown Health is a division Renown Health. Hometown Health through Senior Care Plus has contracted with the Centers for Medicare & Medicaid Services (CMS) to sponsor an MA and MAPD exclusively for its Medicare eligible retirees and their dependents. Hometown Health is committed to fully complying with all the terms and conditions of its contracts with CMS, including the implementation of an effective compliance program that meets the regulatory requirements set forth 42 CFR §§ 422.503 (b)(4)(vi) and 423.504 (b)(4)(vi).
Hometown Health is committed to establishing and implementing effective lines of communication ensuring confidentiality between HTH’s Compliance Officer, members of the Compliance Committee, HTH employees and managers, HTH and Renown Health’s governing bodies and all First Tier, Downstream, and Related entities (FDR). These lines of communication are accessible to all and allow for anonymous and confidential good faith reporting of potential compliance issues as they are identified.
Hometown Health is committed in providing our partners the resources needed to meet the Compliance Program requirements. The resources provided to our partners include: Provider Compliance Document Library, Standards of Conduct, Code of Ethics, Compliance Policy & Procedures, and training links for Compliance training and Fraud, Waste, and Abuse (FWA) training.
Compliance Program Requirements
CMS requires MA and MAPD sponsors to oversee their FDR’s that assist in providing services for Medicare beneficiaries. Some examples of FDRs include but are not limited to: health care providers, facilities, pharmacies, and other vendors contracted with Senior Care Plus in delivering plan benefits. Hometown Health requires its FDR’s to participate in the Hometown Health’s Compliance Program.
Hometown Health’s Compliance Program reflects a good faith commitment to compliance and to the identification, detection, and prevention of Fraud, Waste, and Abuse (FWA). HTH’s Compliance Program standards apply to all persons (management, staff, contractors, vendors) affiliated with HTH through its diverse operations.
It is the responsibility of each individual affiliated with HTH to be familiar and comply with all requirements of the Compliance Program that pertain to their respective areas of responsibility
General Services Administration & Office of Inspector General (OIG)
All FDR’s are required to review the exclusion databases (links provided below) prior to hire and monthly thereafter as applicable for any new employee, temporary employee, volunteer, consultant, or governing body member.
IMPORTANT: Notify Hometown Health immediately if an exclusion has been identified. Excluded members or entities prohibited from receiving payment. Hometown Health requires FDR’s to document the name(s) and date(s) for each database provided and must be made available for review upon request for monitoring and/or auditing purposes.
CMS requires every sponsor and their FDR’s to have policies and procedures that address fraud, waste, and abuse. The policy and procedures must be in place and aid in the detection, correction, and prevention of fraud, waste, and abuse.
Any person involved in the administration or delivery of the MA or MAPD program will receive compliance training and training on FWA within 90 days of initial hiring and at a minimum annually thereafter.
ALERT!! Complete Training and Submit Attestation
For your convenience, Hometown Health has provided the required training and education and attestation links below.
Once you have completed the online trainings, at the end of each training there will be a certificate of completion to fill out. Complete, print, and send a copy of the certificates to firstname.lastname@example.org and keep a copy for your records.
Remember, these trainings are required on an annual basis.
Important links and numbers
First Tier, Downstream, and Related Party (FDR) Required Compliance and Fraud, Waste, and Abuse (FWA) Training:
Report a Compliance Concern
We encourage anyone who is aware of a violation of the Code of Professional Ethics, Policies & Procedures, or the law to report the violation immediately without fear of retaliation.
Confidential Reporting Line at 1-800-611-5097, 24 hours a day, 7 days a week; OR
Compliance Manager, Philip Ramirez 1-775-982-3158; OR
Reporting is CONFIDENTIAL.
Material ID: Y0039_2015_SCPWebVer1 CMS Approved Last Updated 02/20/2015