SAMPLE POLICY WORK

–

Frequency: Conducted on a quarterly basis.

– Responsibility: The Compliance and Regulatory Affairs Team will perform audits across all departments. – Process: • Identify critical compliance checkpoints based on regulatory mandates. • Utilize checklists and standardized audit forms to verify consistency in policy implementation. • Document any discrepancies and develop corrective action plans promptly. – Outcome: Ensures early identification and rectification of any deviations from established compliance standards. 2. External Audits: – Frequency: As scheduled by external regulatory bodies and during routine inspections. – Responsibility: Executive Leadership and Quality Assurance Teams, in collaboration with the Compliance Staff, are responsible for preparing and supporting external audit processes. – Process: • Gather and present necessary documentation, including updated policies, training records, and audit logs. • Respond promptly to feedback and recommendations from auditors. – Outcome: Maintains transparency and ensures that regulatory expectations are consistently met.

B. Training and Education Programs 1. Initial Onboarding and Orientation:

– Content: New hires receive comprehensive training on all compliance policies, including an overview of the CAC Waiver, TennCare Rule 1200- 13-01-.28, and other pertinent regulatory standards. – Delivery: Training sessions are conducted both in-person and via digital platforms to ensure wide accessibility. – Verification: Completion is tracked through documented training logs and assessments to gauge understanding and readiness. 2. Ongoing Refresher Courses: – Frequency: Conducted annually or whenever significant regulatory changes are introduced. – Content: Reinforce foundational compliance principles, review any amendments to policies, and discuss recent audit findings and corrective actions.