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CenCal Health’s Commitment to Compliance

CenCal Health is committed to conducting its business operations in compliance with regulatory and contractual obligations while also delivering high quality and accessible health care services. To achieve this, CenCal Health incorporates the seven elements of an effective compliance program into its Compliance Plan. Click below to learn more about the seven elements.

Implementing Written Policies, Procedures, And Code Of Conduct
CenCal Health uses a variety of policies and procedures to document regulatory and contractual requirements and processes to ensure compliance with those requirements. All staff members are notified and trained on new and or revised policies and
procedures. Policies and Procedures are reviewed periodically to ensure compliance with the most up-to date healthcare rules, regulations, contract amendments, and business risks.

Additionally, CenCal Health has adopted the Code of Conduct (the Code) with respect to business conduct and practices governing CenCal Health’s affairs. The Code promotes legal, ethical, and moral behavior meant to support integrity in all organizational
actions. Employees are required to adhere to the Code at all times while conducting CenCal Health business.

Designating A Chief Compliance Officer, Compliance Committee, And High-level Oversight

CenCal Health has a designated Chief Compliance Officer who is responsible for the oversight, coordination, and implementation of the CenCal Health Compliance Plan. The Chief Compliance Officer is appointed by the Chief Executive Officer (CEO) and reports directly to the CEO and Board of Directors.

Additionally, CenCal Health has a Compliance Committee, made up of CenCal Health officers and employees. The Compliance Committee is responsible for the development and oversight of a comprehensive Compliance Program.

The Board of Directors also exercises oversight over the implementation and effectiveness of CenCal Health’s Compliance Program.

Educating Employees And Conducting Effective Training

CenCal Health provides general and specialized trainings to staff, Board of Directors, Subcontractors, and Downstream Subcontractors that promote and verify their understanding of CenCal Health’s Compliance Plan, CenCal Health policies and procedures, applicable terms and conditions of CenCal Health’s Medi-Cal managed care contract, and Federal and State requirements.

Training is required for all staff, upon hire and annually thereafter.

Developing Effective Lines Of Communication

CenCal Health maintains effective lines of communication to ensure its staff, members, Network Providers, contractors, and Subcontractors and Downstream Subcontractors can report any compliance concerns upon discovery.

Staff are informed about the ways they can reach the Compliance Officer directly, the multiple avenues for reporting, and CenCal Health’s non-retaliation policy.

If you suspect any compliance concerns, report it to CenCal Health here.

Enforcing Well Publicized Disciplinary Standards

CenCal Health establishes appropriate consequences for instances of noncompliance. Consequences for instances of noncompliance are outlined in CenCal Health’s Employee Handbook. The Employee Handbook includes detailed information on when disciplinary action is appropriate. Disciplinary action may include counseling, verbal or written warnings, suspension, and/or termination.

Monitoring And Auditing Programs

At least annually, CenCal Health conducts risk assessments to evaluate risk associated with CenCal Health’s business operations. From the evaluation of the risk assessment, CenCal Health develops an annual auditing and monitoring work plan to prioritize and address high-risk items for the coming year.

Additionally, CenCal Health conducts internal auditing and monitoring as a proactive approach to continually identify and mitigate compliance risks.

Responding Promptly To Detected Offenses And Compliance Issues

CenCal Health’s Chief Compliance Officer maintains a system to promptly respond to and conduct investigations of reported or detected instances of non-compliance or compliance issues. Depending on the nature of the referral, outcome, and severity, of
the compliance issue, recommendations may be made internally for corrective action.
Link to Corrective Action Plans.

Important Documents

  • Delegate Matrix
  • Notice of Privacy Practices
  • CenCal Health’s Compliance Plan

Report Compliance, Fraud, Waste, Abuse, or HIPAA Concerns
If you suspect any compliance, fraud, waste, abuse, or HIPAA concerns, report it to CenCal Health here.