Below you will find links to publicly-available regulation and guidance documents regarding exclusions and overall compliance.

Federal Regulations

• Social Security Laws, Title XI, Sec. 1128 [42 U.S.C. 1320-a-7] – Exclusion of Certain Individuals and Entities from Participation in Medicare and State Health Care Programs
• Code of Federal Regulations, Title 42, Volume 5, Part 1001, Subpart D42CFR1001.1901 – Program Integrity, Medicare and State Health Care Programs – Waivers and Effect of Exclusion

Federal Guidances

• Oct 2010 – OIG Guidance for Implementing Permissive Exclusion Authority Under Section 1128(b)(15) of the Social Security Act
• Sept 1999 – OIG Special Advisory Bulletin – The Effect of Exclusion From Participation in Federal Health Care Programs

CMS Guidances

• March 25, 2011 – CMS Final Guidelines and Rules (42 CFR Part 455.436) – Sanction Screening Checks for Exclusions [see page 37]
• CMS Final Guidelines and Rules (ACA Sect. 6501) – Termination of Providers [see page 776]
• Feb 2, 2011 – CMS Final Rule, 42 CFR Part 1007 – Medicare, Medicaid, and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers
• Jan 2009 – CMS Directive to State Medicaid Directors
• June 2008 – CMS Directive to State Medicaid Directors

NY State Regulations & Guidances

• June 2009 – Part 521 of Title 18 NYCRR – Compliance Programs for Medical Assistance Provider
• NYS DOH, OMIG Supplemental Guidance to the Compliance Program Guidance for Hospitals
• NYS DOH, OMIG Compliance Program Guidance for Hospitals
• NY State Exclusion Regulation, 18 NYCRR, Section 515.5 – Sanctions; effect.
• NY Public Health Law – Article 1, Title 3, § 32 – OMIG Functions, Duties and Responsibilities
• NY Social Services Law – Article 5, Title 11, § 363-D – Provider Compliance Program