Call us at 1-833-252-2737 (TTY 711)

8AM-8PM Monday-Friday

Call us at 1-833-252-2737 (TTY 711)

8AM-8PM Monday-Friday
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The Role of Compliance in Providing Quality Care

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This blog post is guest written by Karen Eastmond, Chief Compliance Officer at CenterLight Health System.


What is Compliance?


Federal and State regulations require healthcare organizations such as Centerlight Health System to have Compliance Programs. These programs provide the framework which helps us to:

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Promptly respond to compliance issues as they are raised

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Investigate potential compliance problems as they are identified in the course of self- evaluations and audits, and

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Correct any identified problems promptly and thoroughly to reduce the potential for recurrence, and ensure ongoing compliance with regulatory requirements.

Our compliance program is designed to:

Prevent, Detect, & Correct

Compliance provides our organization with the tools necessary to meet legal, ethical and professional standards to support quality care. The framework described above protects CenterLight from regulatory sanctions and litigation. More importantly, it also protects our participants by assuring the provision of quality care.

 

How do we PREVENT potential Issues?

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Provide Training on key program requirements

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Develop Policies and procedures to guide staff on important processes to take to comply with regulatory requirements and standard protocols

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Respond promptly to participants, staff, providers when issues arise

 

DETECTing potential Issues

  • We provide a Reporting mechanism allows staff, participants or providers to report an issue confidentially in good faith

  • We conduct Self-assessments and independent assessments to confirm appropriate mechanisms are in place 

  • Our program provides an Assurance of  non-retaliation for good faith participation in the Compliance Program

 

CORRECTing any identified issues

  • By responding in a timely manner by conducting reasonable inquiry into reports of any misconduct

  • Putting Corrective actions in place in response to the potential violation. For example, repayment of over-payments, improved internal procedures, disciplinary actions against responsible employees.



What is quality care?

SAFE, TIMELY, EFFICIENT, EFFECTIVE AND PARTICIPANT-CENTERED CARE

Our goal is to provide all the care and services our participants need as determined by the Interdisciplinary Team. The Compliance program ensures policies and procedures are in place to guide the team in doing their work.


DOING THE RIGHT THINGS IN THE RIGHT WAY AT THE RIGHT TIME.

Our participants and their caregivers depend on us to help keep them healthy and living safely in their homes and communities for as long as possible. We strive to have a strong Compliance program and place emphasis on building a culture of integrity, where our staff would be able to respond to our participants’ needs. This is made possible when everyone knows their roles, that there is a clear understanding of the organization’s expectations, and that the staff has the support they need to perform their tasks.


CARE AND SERVICES ARE PROVIDED BY WELL-TRAINED AND QUALIFIED STAFF FREE FROM SANCTIONS AND EXCLUSIONS.

CenterLight integrates compliance practices in our hiring process. Staff go through background checks before they can become part of the team, in order to ensure participants will not be receiving care from individuals who have previously committed fraudulent activities. In addition, continuous training and education help employees gain necessary knowledge and remain abreast of current information, policies and procedures, regulations, processes and tools that help in providing high quality care.


AN ENVIRONMENT FREE FROM DISCRIMINATION AND RETALIATION

Participants, employees and all stakeholders are entitled to a safe environment where care is received or provided, without any fear of retaliation if they report any issues or non-compliant behavior.

CenterLight provides services to all participants regardless of race, cultural heritage, national origin, race, age, gender, disability source of payment, and all other perceived differences. The same applies to all employees, who are entitled to work in an organization where they are treated with respect.

QUALITY MEASURES BASED ON PLAN, DO, CHECK, & ACT

Compliance interfaces with the Quality team to help promote the monitoring of participants’ health, including helping to ensure all staff provide services when they are requested; and does everything necessary, under the full extent of their responsibilities and in a compliant and compassionate manner, to help prevent issues from escalating. This monitoring helps to keep track of important measures such as hospitalization, response rates to service delivery requests, timely assessments, and others that directly contribute to quality care.

H3329_2019_BLOGCompliance Approved MMDDYYYY
Pending CMS and DOH approval
Last updated November 8, 2019

Icons on this blog are free for commercial use or purchased under basic license, unless otherwise indicated below.
  • Alarm clock icon is free for commercial use. Artist: Mariano Tardon
  • Magnifying glass icon used under the Creative Commons License. Artist: Iconika
  • Training icon used under the Creative Commons License. Artist: MD Badsha Meah
  • Icon for "available 24 hours" used under the Creative Commons License. Artist: Eucalyp Studio
 

About the Writer

Karen Eastmond is Chief Compliance Officer at CenterLight and has worked here for 8 years.

Karen
If you have questions, please call us at 1-877-212-8877, Monday-Friday, 9:00 a.m. - 5:00 p.m. TTY users should call 711. You may also request a callback from one of our representatives by completing the form below:
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We welcome your inquiries. Please call our Participant Services Department at 1-833-CL-CARES (1-833-252-2737) Monday-Friday from 8:00 AM through 8:00 PM. TTY users should call 711. You may also write to us at 136-65 37th Ave., Flushing, NY 11354.

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2017_WEB_002 Approved 09252018
Last updated on April 30, 2024
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2017_WEB_002 Approved MMDDYYYY
Pending DOH and CMS Approval
Last updated on December 27, 2017
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_ElectronicFundsTransfer Approved 01192022
Last updated on December 28, 2021

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_SDR_Training Approved 01192022
Last updated on December 21, 2021

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2017_WEB_002PressRoom Approved 02062018

Last updated on May 8, 2018
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2017_WEB_Caregivers Approved MMDDYYYY
Pending DOH and CMS Approval
Last updated on December 7, 2017
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_003r1_M Approved 01072019
Last updated on January 4, 2019

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_004r1_M Approved 01072019
Last updated on January 4, 2019

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_JanuaryBLOG Approved 02132019
Last updated January 30, 2018

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2023HomePage Approved 01102023
Last updated on December 27, 2022


CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_Activities Approved 11262018
Last updated on December 31, 2018

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_005r1_M Approved 01072019
Last updated on January 4, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_006r1_M Approved 01072019
Last updated on January 4, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_007r1_M Approved 01072019
Last updated on January 4, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_WEB_Activities_Approved 03122019
Last updated on March 2, 2020
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_WEB_May Approved 05152019
Last updated on May 13, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_Caregiver_r001 Approved 03132019
Last updated on February 25, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_CDPAS Approved 03132019
Last updated on February 25, 2019

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_ProviderHomeV3 Approved 01192022
Last updated on March 29, 2022

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_CDPAS_caregiver Approved 03132019
Last updated on February 25, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_CDPAS_caregiver_var1 Approved 05032019
Last updated on April 18, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_July2019_BLOG_home Approved 07232019
Last updated July 5, 2019
Participants are enrolled in CenterLight Teamcare at the time of filming.

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_LifeAtTeamcare_r001 Approved 05152019
Last updated on May 29, 2019
Participants are enrolled in CenterLight Teamcare at the time of filming.

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_LifeAtCenterLight Approved 06022023
Last updated on May 22, 2023

Participants are enrolled in CenterLight Teamcare at the time of filming.

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_Betty_landingpage Approved 07232019
Last updated on July 3, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_caregiverbettyvid Approved MMDDYYYY
Pending CMS and DOH approval Last updated on August 19, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2021_TeamcareHome_JUN Approved 07022021
Last updated on June 11, 2021
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2020_Provider_February Approved MMDDYYYY
Pending CMS and DOH approval
Last updated on September 28, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2020_WEBWhereWeAre Approved 01132020
Last updated on January 3, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2020_WEB_covid19updates Approved 04072020
Last updated on March 17, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2020_WEB_FBevents Approved 04172020
Last updated on April 14, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2021ParticipantCorner Approved 03192021
Last updated on March 4, 2021

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_providernews1 Approved 01262021
Last updated on December 30, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2021ParticipantInfo Approved 01192022
Last updated on April 30, 2024

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_OTC Approved 04142021
Last updated on April 2, 2021

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_ProviderNewsMar2022 Approved 04202022
Last updated on March 29, 2022

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_myneedscard_web_v3 Approved 09062022
Last updated on September 14, 2022

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_ProviderLookUp Approved 01192022
Last updated on December 28, 2021

Photo credit: Linda Farwell Photography