Hudson Valley Care Coalition (“HVCC” or the “Company”) is committed to serving as a New York State Medicaid Health Home designated by the New York State Department of Health (“NYSDOH”), in compliance with all applicable laws, rules and regulations. This Code of Conduct, as well as the Company’s compliance policies and procedures, will apply to the Company’s Health Home Compliance Program.
As a Health Home, the Company will arrange for the provision of comprehensive care management, care coordination and transitional care services to New York State Medicaid beneficiaries through contracts with network providers, care managers, Medicaid managed care organizations (“MCOs”) and others. As a Health Home, the Company will also ensure that the medical, behavioral and supportive care needs of Health Home enrollees are addressed in a comprehensive, quality-driven, cost-effective, culturally appropriate and patient-centered manner.
As part of its comprehensive Health Home care management and care coordination responsibilities, the Company is committed to managing Health Home enrollees in appropriate care settings, and to monitoring and evaluating each enrollee’s needs through its network of providers and care managers. The Company is committed to providing such services pursuant to the highest ethical, business and legal standards. These high standards apply to our interactions with everyone with whom we deal. This includes Health Home enrollees, network providers, care managers, treating clinicians, MCOs, other companies with whom we do business, government entities to whom we report, and the public and private entities from whom reimbursement for services is sought and received. In this regard, all personnel must not only act in compliance with all applicable legal rules and regulations, but also strive to avoid even the appearance of impropriety. While the legal rules are very important, we must hold ourselves up to even higher ethical standards.
In short, we do not and will not tolerate any form of unlawful or unethical behavior by anyone associated with the Company (including, but not limited to, employees, contractors, executives, governing body members, volunteers, or any person or affiliate who is involved in any way with the Company), any of our network providers, care managers or others involved in the Health Home model of care (collectively, the “Affected Individuals”). We expect and require all Affected Individuals to be law-abiding, honest, trustworthy and fair in all of their business dealings. To ensure that these expectations are met, the Company has prepared the Code of Conduct. The Code of Conduct, and the standards set forth herein, are designed to assist all Affected Individuals in navigating the various compliance obligations of the highly regulated industry in which we do business. By adhering to the Code of Conduct, you enable the Company to continue achieving its goal of conducting business in a legal and ethical fashion.
All Affected Individuals will be given a copy of this Code of Conduct (the “Code”), and will be required to review and become familiar with its contents. In addition to this Code, the Company will provide formal training regarding the Code and the additional compliance policies and procedures that we have adopted as part of the Compliance Program to all Affected Individuals.
The Compliance Program
The Company’s Compliance Program consists of the following core components:
- The Company has developed and implemented (and will continue to develop and implement) written policies and procedures that describe compliance expectations as embodied in a code of conduct, implement the operation of the compliance program, provide guidance to Affected Individuals on dealing with potential compliance issues, identify how to communicate compliance issues to appropriate compliance personnel and describe how potential compliance problems are investigated and resolved.
- The Company has appointed a Compliance Officer who will be responsible for the day-to-day operation of the Compliance Program, and for maintaining and implementing the Code of Conduct and related compliance policies and procedures. The Compliance Officer will report directly to the governing body on the activities of the Compliance Program.
- The Company will provide Affected Individuals and others associated with the Company, including Board members and senior management, with compliance education and training with respect to compliance issues, expectations and the Compliance Program, both through formal, periodic training seminars, and by maintaining an open line of communication between or among Affected Individuals, the network of Health Home providers and care managers and the Compliance Officer. Such training shall occur periodically and shall be made a part of the orientation for Affected Individuals.
- The Company has established a policy and procedure for receiving reports concerning possible violations of relevant laws and regulations, the Code of Conduct and/or compliance policies and procedures, and for protecting the anonymity of the reporting party so as to open the lines of communication between the Company and Affected Individuals, as well as its network providers and care managers.
- The Company has established disciplinary policies to encourage good faith participation in the compliance program by all Affected Individuals, including policies that articulate expectations for reporting compliance issues and assist in their resolution and outline sanctions for (i) failing to report suspected problems; (ii) participating in non-compliant behavior; or (iii) encouraging, directing, facilitating or permitting either actively or passively non-compliant behavior. Such disciplinary policies will be firmly and fairly enforced.
- The Company has a system for routine identification and assessment of compliance risk areas specific to its Health Home operations through the use of periodic reviews, audits, and other practices. As part of that assessment, and in an effort to detect and prevent fraud, waste and abuse, the Compliance Officer, or a designee, will periodically monitor and/or conduct specific reviews of potential compliance risk areas that may arise from complaints, Helpline calls and risk assessments.
- The Company has a system for responding to and investigating potential compliance issues as they are raised or identified in the course of self-evaluations and audits. Corrective action will be promptly implemented with periodic reviews to verify successful correction.
- The Company has a strict policy of non-intimidation and non-retaliation for good faith participation in the Compliance Program, including, but not limited to, reporting potential issues, investigating issues, self-evaluations, audits and remedial actions, and reporting to appropriate officials as provided in sections 740 and 741 of the New York State Labor Law.
Code of Conduct
The Company has adopted the following Code of Conduct as a central part of our Compliance Program. Everyone should adhere both to the spirit and the letter of the Code, maintain a high level of integrity in their conduct, and avoid any actions that could reasonably be expected to adversely affect the integrity or reputation of the Company. Compliance with the Code of Conduct is a condition of employment/contract and inclusion in our Health Home network of providers and care managers. Violation of any standards set forth herein will result in discipline being imposed, up to and including possible termination of employment or termination of contract with the Company, as the case may be.
- Honesty and Lawful Conduct. All Affected Individuals must act honestly, ethically and legally at all times, both in business and personal matters. No one should take any action that he or she believes violates, or may potentially violate, any statute, rule or regulation.
- Cooperation with the Compliance Program. We require all Affected Individuals to cooperate fully with the Compliance Program. The Program is effective only if everyone works together to ensure its success and understands the requirements under the law and the Code. In particular, all Affected Individuals must (i) cooperate with all inquiries concerning Health Home services, including, but not limited to, inquiries concerning improper business practices, care coordination, care management and billing/claim submission practices, (ii) respond to any audits, reviews or inquiries, and (iii) actively work to correct any improper practices that are identified.
Code of Conduct Standards
The Code of Conduct provides a high-level overview of the expectations that the Company has for all Affected Individuals. To that end, the Company has adopted the following standards of conduct (“Standards”) that all Affected Individuals are expected to follow. These Standards outline and summarize the basic concepts underlying the Company’s Code of Conduct and its Compliance Program (which is described in more detail in Section III, below). These Standards must be carefully reviewed and closely followed.
Compliance with this Code of Conduct and the Company’s Compliance Program, while mandatory for all Affected Individuals, does not in any way relieve or otherwise detract from the obligation of all network providers, care managers and other individuals and entities to implement and maintain their own effective compliance programs if they are required to do so by applicable law. Network providers, care managers, third party billing entities and others associated with the Company are solely responsible for implementing and maintaining their own compliance programs in connection with their participation in the Health Home network.
It is a violation of this Code of Conduct to intimidate, punish or conduct reprisals against anyone who has reported a suspected violation of any law or regulation, the Code of Conduct or any Compliance Program policies or procedures. It is also forbidden for any anyone to punish or conduct reprisals against another individual who has participated or cooperated in an investigation of such matters in good faith. Retaliatory actions and intimidation violate this Code of Conduct and are strictly prohibited.
Compliance with the law and high ethical business standards
The Company operates in a heavily regulated industry and is subject to a large number of federal and state civil and criminal laws and regulations. Violation of these laws and regulations can result in harm to the public, severe financial penalties and, in some cases, criminal fines and/or imprisonment. The Company’s Code of Conduct and Compliance Program are designed to detect and prevent such violations. Accordingly, it is critical that all Affected Individuals comply with all applicable federal and state laws and regulations, as well as all policies and procedures that comprise the Compliance Program.
While one of the objectives of the Company’s Compliance Program is to educate all Affected Individuals about the basic requirements of these laws and regulations, the Company does not expect anyone to become an expert in these areas. For precisely this reason, if an individual is not sure whether a particular activity or practice violates the law (or any of the Compliance Program policies or procedures), the individual should not – under any circumstances – “guess” as to the correct answer. Instead, the individual should seek appropriate guidance from his or her supervisor or the Compliance Officer. No one will be penalized for asking compliance-related questions. To the contrary, the Company is intent on creating a culture in which every individual is comfortable asking the questions necessary to ensure that he or she understands and performs his or her tasks and obligations in full compliance with applicable law.
Affected Individuals are required to adhere to the high standards of business ethics as set forth in this Code, and acknowledge that such adherence is a condition of employment/contract and a factor that will be considered in his or her performance evaluation.
Non-retaliation, non-intimidation, whistleblower policy
Pursuant to its Compliance Program, Hudson Valley Care Coalition, Inc. (the “Coalition”) is committed to maintaining compliance with all laws and regulations, including those governing quality of care, documentation, coding, billing and its relationships with other providers.
In furtherance of the Compliance Program and the requirements of Section 715-b of the New York Not-for-Profit Corporations Law, the purpose of this Policy is to ensure that all personnel understand the Coalition’s commitment to prohibiting intimidation, retaliation, harassment, discrimination or other retaliation for “good faith participation in the Compliance Program”. Intimidation and retaliatory action in any form by any individual associated with the Coalition is strictly prohibited and is itself a serious violation of the Code of Conduct and this Policy. Prohibited retaliation includes, but is not limited to, any adverse employment action and any other negative treatment, including intimidation that results from good-faith participation in the Compliance Program.
No director, officer, employee or volunteer of the Coalition who in good faith reports any action or suspected action taken by or within the Coalition that is illegal, fraudulent, or in violation of any adopted policy of the Coalition shall suffer intimidation, harassment, discrimination or other retaliation, or in the case of employees, adverse employment consequences.
Questions and Concerns or to Report a Complaint. Neither this Code nor our Compliance Program can cover every situation that you might face. As a result, if you are unsure of what the proper course of conduct might be in a specific situation, or if you believe that the Code of Conduct or any Compliance Program policies or procedures (whether set forth in this Code or elsewhere) may have been violated, you are expected to contact the Compliance Officer, Amie Parikh, at:
Phone: (914) 502-1374
Regular Mail: Hudson Valley Care Coalition
2 Church Street Suite 208, Ossining, New York 10562
or by calling the Compliance “Helpline” at 855-908-5556
You may contact the Compliance Officer at any time, either in person, by telephone or in writing, with any compliance-related question or concern you may have. Questions or concerns may be raised anonymously, if you wish. All reports will be held in the strictest confidence, unless the matter is turned over to law enforcement.
As enacted by Section 75 of the Non-Profit Revitalization Act of 2013.
 Adopted policies for which the Coalition may provide whistleblower protection include, without limitation, policies formally adopted by the Board of Directors that are designed to: prevent financial wrongdoing, such as internal and external financial controls, accounting policies, and policies prohibiting fraud, theft, embezzlement, bribery, kickbacks, and abuse or misuse of corporate assets; conflict of interest policies; policies addressing unethical conduct; and harassment and discrimination policies. Some complaints of violations of policies adopted by the Board may not be entitled to whistleblower protection. This could include, for instance, a complaint that a co-worker is wearing sandals in violation of a dress code that is contained in the employment manual adopted by the Board.