Schedule

• Post-acute provider types (both facility-based and home-based)

• Structure and background of the Medicare Program

• Part A-D of the Medicare program as they related to post-acute providers, including coverage of post-acute care, current reimbursement for post-acute services, and other information relative to post-acute care

• Medicaid fundamentals: Overview of the Medicaid program, eligibility criteria, covered benefits, reimbursement and financing, Medicaid Waiver programs, and PACE

This presentation will provide an overview of recent developments in defending against and appropriate use of statistical methods in investigations as well as in operational and compliance issues. This presentation will provide an overview of:

• Practical takeaways in defending against government audits, including those involving statistical extrapolations

• Recent developments regarding the so-called “60-day Rule” and approaches to voluntary repayments

• Common payment issues with Medicare Advantage plans and practical tips for dealing with MA plans

• Related case law and compliance topics

• Define neglect in the context of nursing homes

• Neglect citations and factors contributing to citations

• Practical application of psychosocial guidelines in evaluating scope and severity of abuse and neglect citations

• Best practices for responding to and preventing abuse/neglect citations

The speakers will discuss fraud and abuse activity in long term care and post-acute settings related to medical directorships. The speakers will cover:

• Recent civil and criminal activity involving medical directorships in LTC and post-acute settings

• Medical director roles and responsibilities in different settings, including Conditions of Participation and Conditions for Coverage

• Key contractual arrangement terms

• Fair market value compensation & commercial reasonableness

• Notable trends in CMS survey and enforcement activity

• Key developments in CMS regulation of skilled nursing facilities, including the newly finalized rule relating to ownership transparency, proposed rules concerning minimum staffing standards and appeal rights for changes in patient status (observation stays), and proposed rules anticipated to be released in 2024

• New and anticipated policy developments from other federal agencies with impact on skilled nursing facilities, such as employment, labor and occupational safety and health

• Outlook for Congressional activity on selected issues affecting the sector in 2024

This interactive session will explain general federal and state wage & hour standards for employee compensation, including:

• Common record-keeping mistakes, including meal periods and rest breaks

• Hourly overtime and salaried exemptions

• Bonus packages, commissions, and other incentive pay

• The DOL’s new rule for use of independent contractors

• Remote/hybrid workers

Overall, attendees will learn how long-term care operators can be at risk for DOL audits and other wage liabilities to take back home after the session in order to conduct an internal or external review of their compensation practices, or perhaps attendees will take new ideas on how to incorporate innovative pay practices to improve workforce recruitment and/or retention.

• Profile of LGBTQ+ residents and why they are likely to need long term care

• Background regarding Section 1557 of the Affordable Care Act (will cover at least the highlights of the final rule if it is timely released before the conference; otherwise, will provide background regarding current law)

• Why nursing homes should comply with sex nondiscrimination regulations (i.e., survey implications, etc.)

• Sex discrimination in assisted living facilities

• The role of HHS Office of Civil Rights and enforcement actions

• Best practices to prevent, mitigate, and/or respond to enforcement activities

• The home health and hospice focus areas identified in the OIG Work Plan

• The increased scrutiny of home health and hospice and the new fraud prevention measures for hospice

• The recently implemented hospice survey enforcement actions and the Special Focus Program, as well as MedPAC’s new project to analyze lifetime hospice length of stay

• Recent government enforcement examples

• Audit and compliance strategies and practice tips for home health agencies and hospices to weather through the audit, survey and enforcement storm

• The legal, ethical, and medical implications of medical aid in dying (“MAID”) along with case studies

• The legal, ethical and medical bases for “wrongful life” lawsuits where a person’s end-of-life wishes or medical orders were not followed, including relevant case studies

• The federal and state requirements, and accepted professional ethical guidelines, that respect patient autonomy in end-of-life decisions including areas such as voluntary stopping eating and drinking (“VSED”)

• The legal, medical, and ethical components of “dementia directives” that request cessation of hand feeding (Stopping Eating and Drinking by Advance Directive [SED by AD])

• The trend of increasing lawsuits and regulatory actions against hospice providers, including common allegations

• Recovery from COVID pandemic

• Future priorities and what will the space look like

• Challenges and Opportunities moving forward

The only constant is change. Change in health care, in regulations/legislation, in consumers’ wants and needs, in the economy, in the political landscape, in the workforce, in culture, in technology, etc.  As such, post-acute care providers and those who represent them must be aware and be able to adapt to meet these changes head on. Please join us for a vibrant, critical conversation with leaders from our industry associations – Mark Parkinson, President and CEO of the American Health Care Association, LaShuan Bethea, Executive Director of the National Center for Assisted Living, Bill Dombi, President of the National Association for Home Care and Hospice and Katie Sloan, President and CEO of LeadingAge. We will learn as they share the current and future priorities of post-acute care associations and we will put them in the hot seat to answer any pressing questions from our audience. Don’t miss out on this opportunity.

This presentation will discuss how to measure the effectiveness of your organization's compliance and ethics program utilizing CMS's Requirements of Participation. This will be done as follows:

• Analyzing and discussing CMS's requirements for a compliance and ethics program

• Other applicable compliance and ethics guidance

• Comparing and contrasting CMS's requirements for a compliance and ethics program to other similar guidance i.e. DOJ, Federal Sentencing Guidelines etc.

• Why compliance effectiveness matters

• How to utilize data and metrics to drive your compliance and ethics program

• Provide a free tool that will allow attendees to measure the effectiveness of their program

• DAB/ALJ case law update

• False Claims Act and fraud and abuse litigation

• Arbitration agreement litigation

• HIPAA, Data Breach, and Privacy litigation and enforcement

• Survey litigation

• Ownership disclosure

This program will explore the ongoing threats and challenges to long-term care providers (including skilled nursing facilities and assisted living facilities) arising from the COVID-19 pandemic and its aftermath. The program will primarily focus on best practices for retaining:

• COVID-19 financial support provided through

  • The CARES Act, including the: (i) Payroll Protection Program (“PPP”), (ii) Provider Relief Fund (“PRF”), and (iii) Employee Retention Credit (“ERC”)

  • The American Rescue Plan Act (“ARPA”)

• Increased reimbursement or other financial support provided by State Medicaid programs, if applicable

• Payments received from the Medicare program utilizing the Part A waivers associated with the three-day qualifying hospital stay and 100-day benefit period

• A framework for managing these risks to maximize opportunities for recovery, including developing compliance tools for audits and other internal efforts

• A description of the various audit processes and how affected providers can appeal adverse findings

• Define neglect in the context of nursing homes

• Neglect citations and factors contributing to citations

• Practical application of psychosocial guidelines in evaluating scope and severity of abuse and neglect citations

• Best practices for responding to and preventing abuse/neglect citations

Palliative care is a buzzword, but the term means different things to different people. Despite years of use, there is no set definition and no reimbursement for community-based palliative care in Medicare.  This session will help to demystify palliative care, and clarify regulation, oversight and reimbursement now and in the future:

• Palliative medicine reimbursement under Part B

• Community-based palliative care models under Medicare Advantage (as supplemental benefits)

• Innovation models and Palliative Care (GUIDE Model and others)

• State payment of and licensing for palliative care

• Legislative advocacy (PCHETA)

• Crystal ball for palliative care

• Notable trends in CMS survey and enforcement activity

• Key developments in CMS regulation of skilled nursing facilities, including the newly finalized rule relating to ownership transparency, proposed rules concerning minimum staffing standards and appeal rights for changes in patient status (observation stays), and proposed rules anticipated to be released in 2024

• New and anticipated policy developments from other federal agencies with impact on skilled nursing facilities, such as employment, labor and occupational safety and health

• Outlook for Congressional activity on selected issues affecting the sector in 2024

• The 2025 Medicare home health payment rule updates

• Nationwide expanded Medicare Home Health Value Based Purchasing Demonstration

• Review Choice Demonstration

• Hospice special focus program overview and updates on survey reforms

• Hospice claims oversight

• Hospice practices under review

• 2024 MedPAC recommendations on home health and hospice

• Status of home care expansions in Medicare

• Recent Enforcement Actions, including Comprehensive Healthcare

• Developments in FCA caselaw on “Worthless Services”

• Enforcement actions involving self-dealing and financial fraud

• Enforcement of minimum staffing regulations

• Transparency on ownership and financial transactions

• Compliance takeaways

Providers and their counsel should prepare for the impact of CMS’s transparency initiatives focused on the post-acute sector in particular and other providers more generally. CMS and many states have increased their scrutiny of changes of ownership (CHOWs) and changes of operators (CHOPs), often resulting in long delays. Likewise Medicare and Medicaid revalidations for existing providers are also fraught with pitfalls for the unwary.

• Anticipate the consequences of skilled nursing facilities being assigned to the highest risk category for initial enrollments, CHOWs and CHOPS

• Best practices for handling those consequences

• Strategize about best practices for completing revalidation applications

• Consider how counsel and compliance officers can ensure smoother processing of critical data

• The legal, ethical, and medical implications of medical aid in dying (“MAID”) along with case studies

• The legal, ethical and medical bases for “wrongful life” lawsuits where a person’s end-of-life wishes or medical orders were not followed, including relevant case studies

• The federal and state requirements, and accepted professional ethical guidelines, that respect patient autonomy in end-of-life decisions including areas such as voluntary stopping eating and drinking (“VSED”)

• The legal, medical, and ethical components of “dementia directives” that request cessation of hand feeding (Stopping Eating and Drinking by Advance Directive [SED by AD])

• The trend of increasing lawsuits and regulatory actions against hospice providers, including common allegations

This session will provide:

• Practical guidance for navigating the long term care facility survey process

• An overview of the survey enforcement appeal process (i.e., DAB hearing request and appeal to court)

• Practical tips to navigate the enforcement appeal process, including managing deadlines, making the determination to appeal to the DAB, strategies to approaching CMS regarding settlement, and more

We hope this session will provide additional tools for LTC facilities to confidentially navigate the survey itself and how to put forth its best case if and when it faces such adversity that is the survey enforcement appeals process.

• If a senior living resident is accidentally locked out of the building and dies from exposure, should it matter whether the facility is independent living, assisted living or memory care?

• Despite the differing levels of care demarcated by licensure regulations and by resident contract language, senior living communities often provide services to seniors with the same or similar levels of acuity, who may face the same risks of adverse outcomes.  At the same time, operators are prohibited from inquiring about resident disabilities in many situations

• Even where there are no regulatory obligations and notwithstanding well-crafted contract disclaimers, courts have used common law standards of care to hold operators liable for failure to monitor resident health and safety and to intervene to prevent injury or decline in functioning.  See, e.g., Rowland v. Independence Village of Oxford, 974 N.W. 2d 228 (Mich. Supr. Ct. 2022)

• Senior living operators need to understand and adapt to this trend by adjusting their admission policies, forms of contracts, discharge policies and service plans, and how they respond to incidents where residents are at risk of injury or an adverse health outcome

• Difficulties of balancing patient and family needs with available resources while complying with regulatory requirements while planning the discharge from Acute Care

• Regulatory requirements for Post-Acute Care admission

• The multiple types and age-ranges of patients requiring Post-Acute Care, especially since Covid

• The pitfalls of poor transitions

• The home health and hospice focus areas identified in the OIG Work Plan

• The increased scrutiny of home health and hospice and the new fraud prevention measures for hospice

• The recently implemented hospice survey enforcement actions and the Special Focus Program, as well as MedPAC’s new project to analyze lifetime hospice length of stay

• Recent government enforcement examples

• Audit and compliance strategies and practice tips for home health agencies and hospices to weather through the audit, survey and enforcement storm

• The new state Clinically Integrated Networks (CINs) of SNFs, ALFs, and HHAs that the American Health Care Association has helped build since 2020

  • How the reimbursement landscape is changing, propelling LTC/PAC providers to come together to form CINs

  • How LTC/PAC CINs are different and similar to CINs of physicians and other more traditional provider types

  • How CINs can shape and advance value-based models for LTC/PAC by creating volume which was previously a barrier to such models

• Challenges and benefits of CINs in both value based contracting and quality improvement

  • Examples of value based contracts, challenges and benefits

  • Examples of quality programs and improvements, challenges and benefits

• How the CINs formed through 2022 were designed to minimize antitrust risk:

  • Assessing the degree of financial and clinical integration

  • Striving to meet the safety zone for non-exclusive networks set out in 1996 Health Care Antitrust Guidelines

  • Emphasizing quality and efficiency of care so the pro-competitive effects outweigh anti-competitive effects

• Next Steps/Takeaways with VBR and antitrust compliance

  • Next steps members can take to investigate or consider a network, position themselves to participate in value based care, and comply with antitrust

  • Ongoing attention to continuously increasing integration and improving quality and efficiency

The closing of an acquisition or the execution of a new management agreement is just the beginning. This session will discuss the key issues in drafting operations transfer agreements and management agreements and provide practical tips for a successful transfer of operations to a new operator, including:

• Planning for and conducting operational due diligence

• Regulatory considerations and interim agreements

• Transitioning assets, records, IT, and employees

• Evaluating risk and allocating potential liabilities through reps, warranties, and indemnities

• The ins and outs of internal investigations as well as providing tips and strategies for conducting (and resolving) internal investigations

• Events that commonly trigger a need for an internal investigation in the long term care space (e.g., billing issues, compliance audits, employee complaints, license issues, reportable incidents, etc.) as well as processes to have in place prior to investigations to help them go smoothly (e.g., an effective and accessible complaint process)

• Steps to take in an internal investigation and whether and when to involve counsel, covering issues of confidentiality and privilege during the investigative process, as well as tips for assembling the investigative team and preserving and gathering documentation, handling interviews, as well as documenting investigation findings

• Handling investigations that require disclosures (e.g., under the 60-day overpayment rule)

This legal ethics program will examine some common ethical situations that long term care attorneys confront, including:

• How to deal with potential conflicts when you represent multiple parties involved in long term care such as operators, owners, lenders, and investors

• What happens when you and your client disagree on how to proceed

• Communications and dealings with opposing parties, particularly governmental entities

• Ethical issues that arise from the use of technology

• The application of the Model Rules to problematic ethical issues and other hypothetical situations

• An in-depth discussion of federal laws and policy regarding medical marijuana

• Examples of various state medical and recreational marijuana laws and discuss the conflict between federal and state marijuana laws

• Examples of medical marijuana policies adopted by health care providers

• Legal risks and compliance issues for providers that want to allow the use of medical marijuana in their facilities

• Best practices for providers on topics such as the storage and administration of medical marijuana and patient safety issues

• Discuss employment considerations for long term care providers

• Background on the various types of joint ventures that SNF and ALF operators are actively contemplating

• The various joint ventures structures that are being used

• The fraud and abuse concerns that impact all joint ventures including the impact of AO 21-18

• The structural and contractual elements of a JV that pose the greatest regulatory risks

• Best practices in structuring and documenting ancillary services joint ventures

A detailed look at how outside counsel and in-house counsel work collaboratively to respond to and prepare for False Claims Act investigations.  From even before an investigation begins, learn how the different roles and responsibilities can be defined to be most effective in successfully avoiding investigations, securing declinations, and preventing problems.  Two instructors have worked together on multiple investigations and have solid experience to share how to best cooperate

• Profile of LGBTQ+ residents and why they are likely to need long term care

• Background regarding Section 1557 of the Affordable Care Act (will cover at least the highlights of the final rule if it is timely released before the conference; otherwise, will provide background regarding current law)

• Why nursing homes should comply with sex nondiscrimination regulations (i.e., survey implications, etc.)

• Sex discrimination in assisted living facilities

• The role of HHS Office of Civil Rights and enforcement actions

• Best practices to prevent, mitigate, and/or respond to enforcement activities

• Introduction: What is Hospital Care At Home?

  • Current Hospital at Home Regulatory Structure (Acute Care Model: Limitations)

  • Background of CMS Waiver: Statutory Framework: Omnibus Appropriations Act

  • (2022 year-end package; Authority expires on 12/31/24)

• Complexities–Federal and State Regulatory Structures

  • Payment silos: Acute Care fitting into Post-Acute Continuum

  • Overlap with Home Health, Independence at Home, PACE, other payment models

  • Compliance and billing challenges

  • Interaction of CMS waiver/regulations and State facilities licensing requirements

  • COPR or other regulatory approval requirements

  • Site of service/licensing requirements–professional liability coverage and other issues for hospital in-house counsel to consider

• Policy Prognosis–What to Expect in 2024

  • Congress/CMS Next Steps

  • Year-end appropriations questions, IPPS (?) payment structure, CBO score impact

  • State Legislation–Hot Topics and Policy Trends

  • Payment parity and reimbursement requirements in State law

  • Medicaid coverage–the case for health equity as set forth in the data/studies

  • Scope of Practice–paramedics, home health aides, CNAs, etc

• DAB/ALJ case law update

• False Claims Act and fraud and abuse litigation

• Arbitration agreement litigation

• HIPAA, Data Breach, and Privacy litigation and enforcement

• Survey litigation

• Ownership disclosure

This program will explore the ongoing threats and challenges to long-term care providers (including skilled nursing facilities and assisted living facilities) arising from the COVID-19 pandemic and its aftermath. The program will primarily focus on best practices for retaining:

• COVID-19 financial support provided through

  • The CARES Act, including the: (i) Payroll Protection Program (“PPP”), (ii) Provider Relief Fund (“PRF”), and (iii) Employee Retention Credit (“ERC”)

  • The American Rescue Plan Act (“ARPA”)

• Increased reimbursement or other financial support provided by State Medicaid programs, if applicable

• Payments received from the Medicare program utilizing the Part A waivers associated with the three-day qualifying hospital stay and 100-day benefit period

• A framework for managing these risks to maximize opportunities for recovery, including developing compliance tools for audits and other internal efforts

• A description of the various audit processes and how affected providers can appeal adverse findings

Palliative care is a buzzword, but the term means different things to different people. Despite years of use, there is no set definition and no reimbursement for community-based palliative care in Medicare.  This session will help to demystify palliative care, and clarify regulation, oversight and reimbursement now and in the future:

• Palliative medicine reimbursement under Part B

• Community-based palliative care models under Medicare Advantage (as supplemental benefits)

• Innovation models and Palliative Care (GUIDE Model and others)

• State payment of and licensing for palliative care

• Legislative advocacy (PCHETA)

• Crystal ball for palliative care

The closing of an acquisition or the execution of a new management agreement is just the beginning. This session will discuss the key issues in drafting operations transfer agreements and management agreements and provide practical tips for a successful transfer of operations to a new operator, including:

• Planning for and conducting operational due diligence

• Regulatory considerations and interim agreements

• Transitioning assets, records, IT, and employees

• Evaluating risk and allocating potential liabilities through reps, warranties, and indemnities

• Background on the various types of joint ventures that SNF and ALF operators are actively contemplating

• The various joint ventures structures that are being used

• The fraud and abuse concerns that impact all joint ventures including the impact of AO 21-18

• The structural and contractual elements of a JV that pose the greatest regulatory risks

• Best practices in structuring and documenting ancillary services joint ventures

Providers and their counsel should prepare for the impact of CMS’s transparency initiatives focused on the post-acute sector in particular and other providers more generally. CMS and many states have increased their scrutiny of changes of ownership (CHOWs) and changes of operators (CHOPs), often resulting in long delays. Likewise Medicare and Medicaid revalidations for existing providers are also fraught with pitfalls for the unwary.

• Anticipate the consequences of skilled nursing facilities being assigned to the highest risk category for initial enrollments, CHOWs and CHOPS

• Best practices for handling those consequences

• Strategize about best practices for completing revalidation applications

• Consider how counsel and compliance officers can ensure smoother processing of critical data

• The ins and outs of internal investigations as well as providing tips and strategies for conducting (and resolving) internal investigations

• Events that commonly trigger a need for an internal investigation in the long term care space (e.g., billing issues, compliance audits, employee complaints, license issues, reportable incidents, etc.) as well as processes to have in place prior to investigations to help them go smoothly (e.g., an effective and accessible complaint process)

• Steps to take in an internal investigation and whether and when to involve counsel, covering issues of confidentiality and privilege during the investigative process, as well as tips for assembling the investigative team and preserving and gathering documentation, handling interviews, as well as documenting investigation findings

• Handling investigations that require disclosures (e.g., under the 60-day overpayment rule)

This legal ethics program will examine some common ethical situations that long term care attorneys confront, including:

• How to deal with potential conflicts when you represent multiple parties involved in long term care such as operators, owners, lenders, and investors

• What happens when you and your client disagree on how to proceed

• Communications and dealings with opposing parties, particularly governmental entities

• Ethical issues that arise from the use of technology

• The application of the Model Rules to problematic ethical issues and other hypothetical situations

This interactive session will explain general federal and state wage & hour standards for employee compensation, including:

• Common record-keeping mistakes, including meal periods and rest breaks

• Hourly overtime and salaried exemptions

• Bonus packages, commissions, and other incentive pay

• The DOL’s new rule for use of independent contractors

• Remote/hybrid workers

Overall, attendees will learn how long-term care operators can be at risk for DOL audits and other wage liabilities to take back home after the session in order to conduct an internal or external review of their compensation practices, or perhaps attendees will take new ideas on how to incorporate innovative pay practices to improve workforce recruitment and/or retention.

• Difficulties of balancing patient and family needs with available resources while complying with regulatory requirements while planning the discharge from Acute Care

• Regulatory requirements for Post-Acute Care admission

• The multiple types and age-ranges of patients requiring Post-Acute Care, especially since Covid

• The pitfalls of poor transitions

A detailed look at how outside counsel and in-house counsel work collaboratively to respond to and prepare for False Claims Act investigations.  From even before an investigation begins, learn how the different roles and responsibilities can be defined to be most effective in successfully avoiding investigations, securing declinations, and preventing problems.  Two instructors have worked together on multiple investigations and have solid experience to share how to best cooperate