Schedule

Congressional Outlook: Assisted Living and The Hill
LaShuan Bethea, Executive Dire​ct​or, National Center for Assisted Living
Rae Anne Davis, Chief Strategic Officer & Senior Vice President for Administration, National Center for Assisted Living

• Staffing Mandate Update
• Election Impact
• State Regulatory Overview

Liability and Senior Care
LaShuan Bethea, Executive Dire​ct​or, National Center for Assisted Living
Neville Bilimoria, Duane Morris LLP

• How risk and liability can impact assisted living providers and their operations.
• Best practices in risk management to advise clients on minimizing liability exposure.
• Current liability claims and regulatory trends in assisted living and their potential impact on litigation and compliance strategies

Facilitated Small Group Breakout and Debrief
Christopher C. Puri, Bradley Arant Boult Cummings LLP
Kirstin B. Sumner, Vice President Legal Operations, Brookdale Senior Living

• Implementing HCBS rules for Medicaid waiver recipients in AL
• Increase in enforcement:
  • How to effectively train staff for compliance
  • Being survey ready
  • How to manage surveys in progress
• Resident sexual activity in memory care – consent and resident rights
• Effective incident investigation tips
• Effective training to identify potential abuse or neglect
• Electronic monitoring/granny
• Assistance animals (non-service animals)

Shannon L. Drake, Bradley Arant Boult Cummings LLP
Benjamin J. Sparks, Vice President of Regulatory Affairs, Ensign Services Inc

• 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

Thomas H. Barnard, Baker Donelson
Peter Marino, Chief Legal Officer, CommuniCare Health Services

The "Worthless Service" case has become the catch-all tool for HHS-OIG and DOJ to use the False Claims Act to address patient care concerns at Long Term care facilities. This theory is a creative and expansive use of a fraud statute, and toes the line on mixing standard of care second guessing with allegations of false claims. These types of cases have many unique aspects that are difference that traditional FCA cases, but are the most common theory for cases at SNFs and other resident care. A detailed break down of these cases from an experienced FCA litigator, and inside-advice from a general counsel of a major LTC network will help prepare attendees for these types of cases.

Beth Moskow-Schnoll, Ballard Spahr LLP
Michelle Romeo, Clinical Reimbursement Nurse Consultant, Western PA Consultants, LLC

In December 2023, after a 5-week trial in federal district court, we were able to obtain a full acquittal for Michelle Romeo, my co-presenter, on charges of criminal health care fraud and conspiracy involving several nursing homes in western Pennsylvania. In this presentation, she and I will discuss the following topics:

• The indictment against Michelle and others, including fraud involving minimum data sets
• Government errors in its prosecution, including, among other issues: Too much and not enough data, ignoring important data in residents' medical files, poor investigation (including engaging in confirmation bias), reliance on questionable witnesses, and a failure to understand CMS' RAI Manual and related regulations
• Michelle's role with the nursing homes, her response to the indictment, what it was like going through the trial and lessons learned
• How having Michelle, an expert in the applicable regulations, become part of the defense team, contributed to our success at trial

Tara Ravi, Parker Hudson
Jason Stevens, Senior Vice President and Deputy General Counsel, Wellstar Health System

Increased patient acuity combined with scarcity of available hospital beds and post-acute care beds contributes to emergency department overcrowding. This advanced discussion addresses strategic alliances and affiliations between health systems and post-acute care providers, assisted living providers, and ancillary providers to place higher acuity hospital inpatients into the appropriate settings. This program will examine specific hypothetical examples in a small group setting.

• Defining “difficult hospital discharges”
• Types of strategic alliances between health systems and post-acute care providers, assisted living providers, and ancillary providers to address placement of difficult hospital discharges and coordination of care
• Operational considerations to ensure proper coordination of care between providers
• Federal and state regulatory frameworks implicated in strategic relationships, including the federal Anti-Kickback Statute, state Medicaid laws and pilot programs, and state CON laws
• Recommendations on how to appropriately document services and payments under these arrangements to ensure each party is adequately protected from liability

Mark Reagan, Hooper, Lundy & Bookman, PC
Stuart Schabes, Baker Donelson
Bill Ulrich, President/CEO, Consolidated Billing Services, Inc.

• Although the Paycheck Protection Program (“PPP”), Provider Relief Fund (“PRF”) and Employee Retention Credit ("ERC") were lifelines for Senior Care Providers and played a consequential role for financial survival of during the COVID-19 pandemic, there are increasing signs of serious challenges in the aftermath of the pandemic
• These COVID-19 financial support programs were rolled out in inconsistent and uncertain ways, largely based upon changing Congressional action, the issuance of inconsistent and conflicting forms of sub-regulatory guidance and poor design/implementation
• While the programs were largely successful in pushing out significant monies at a very significant time for providers, many are now seeing problems, including:
  • The Department of Justice (“DOJ”) investigating provider qualification for the PPP  program through Civil Investigative Demands (“CIDs”)
  • The Office of Inspector General (“OIG”) demanding repayments of PRF monies based upon negative audit findings issued by provider-retained CPA firms
  • The Internal Revenue Service (“IRS”) demanding repayment of ERC funds based upon IRS audits and otherwise delaying payments for pending claims as well as most recently the IRS’ issuance of numerous denial letters of certain ERC tax refunds without actually having requested taxpayer’s supporting documentation or legal analysis
• This program will present a view from the trenches on each of these challenges, including:
  • The theories employed by DOJ in CIDs over the “forgivable loans” received through the PPP and the nature of the “alternative test” of provider “net worth’”
  • The dynamics of the three-way battles involving providers, OIG and the CPA firms over the appropriate use of PRF monies under the sub-regulatory guidance
  • The elements of success in the face of IRS audits over the ERC and positioning appeals and refund suits of adverse audit findings
• Along with the COVID-19 financial support programs, CMS also implemented Section 1135 waivers related to Medicare Part A, including a waiver of the 3-Day Qualifying In-Patient Stay for Skilled Nursing Facilities (“SNFs”) and a waiver of the maximum 100-Day Benefit Period
  • This was designed to “free up” access to acute care beds throughout the pandemic
  • These waivers potentially applied not only to new admissions but also to existing long-stay residents, who could potentially be “skilled-in-place”
  • CMS did not provide extensive guidance on the use of such waivers, particularly as to all the “twists and turns” of the pandemic
  • The DOJ and OIG are now investigating SNFs relating to their use of the 1135 waivers
• The program will also focus on best practices for Senior Care Providers in maximizing retention of these funds and minimizing risk

William A. Dombi, President, National Association for Home Care
Andrew B. Wachler, Wachler & Associates PC

• The key risk areas for home health agencies, hospice providers and SNFs
• The latest developments in the Medicare and Medicaid appeal landscape
• Discuss and compare the Medicare and Medicaid appeals processes as well effective strategies for defending claim denials in each process
• An overview of the attendant risks and potential collateral consequences beyond the audit findings
• Forecast the future developments for these provider types

Holly Brenier, CEO, Simpra Advantage, Inc.
Richard Brockman, Burr & Forman LLP

• Exploration of Medicare Advantage Special Needs Plans (SNPs): A detailed examination of the different types of SNPs, their unique benefits and limitations, and the contexts in which they are most effectively utilized
• Evaluating the Feasibility of Provider-Owned SNPs: A balanced analysis presenting arguments for and against the establishment of provider-owned Special Needs Plans, highlighting strategic considerations
• Navigating the Formation and Implementation of SNPs: A comprehensive overview of the regulatory, operational, and financial requirements necessary to develop and implement a successful Special Needs Plan
• Insights and Lessons Learned: Practical advice based on real-world experiences, including key lessons and common pitfalls to avoid during the development and execution of SNPs

Valerie Montague, Nixon Peabody LLP
Ben Woit, Senior Vice President, General Counsel, Legal Services, Benedictine Health System

• Who (who are you/how are you regulated?), what (what data do you hold?), when (when did you evaluate the status of data privacy and security), where (where is your data stored and transmitted), and how (how are you protecting your organization)?
• Making your security risk analysis worth it: Creating a “living” risk management plan
• Addressing your weakest links: Personnel and vendors
• Document, then document some more: Preparing or locating compliance documentation in advance of an incident
• Practice makes perfect: Don’t leave your incident response plan on a shelf

Lynn M. Barrett, Barrett Law, PA

This session will explore recent ethics issues and decisions affecting lawyers, including those relating to:

• A lawyer's use of and potential reliance on artificial intelligence
• A lawyer's duty to assess the facts and circumstances of a client representation
• Conflicts of interest
• Multi-jurisdictional practices; and more!

Best practices and practical tips will also be discussed.

Asha B. Scielzo, AHLA President
Emily M. Solum and Kirstin Sumner, Planning Committee Co-Chairs

Joseph L. Bianculli, Health Care Lawyers, PLC
Tara J. Clayton, Managing Director Marsh Senior Living & LTC Industry Practice
Drew Graham, Hall Booth Smith PC
Alan C. Horowitz, Arnall Golden Gregory LLP

• Chevron and Loper Bright–What changes, and what that means for administrative appeals
• Some administrative law basics
• Kisor and Allina–Chipping away at Chevron
• Avon–a cautionary tale and/or new open doors?
• Creating an effective administrative record
• Real world collateral implications for personal injury defense

Few of us practiced administrative law in pre-Chevron days, so we have grown up in a world where agencies demanded, and courts frequently gave, “deference” not only to agency interpretations of ambiguous statutory and regulatory provisions, but, increasingly, to agency actions and “interpretations of interpretations.” In Loper Bright v. Raimondo, the Supreme Court said that the Administrative Procedure Act “means what it says,” and that under the APA courts must be the ultimate arbiter of whether agency interpretations of regulations, and actions, are objectively reasonable. What does this mean for challenges to regulations, subregulatory guidance, and specific enforcement, reimbursement, and other regulatory actions and sanctions? Must practitioners build administrative records and approach administrative appeals differently? Will there be impacts in collateral spaces, especially personal injury defense? Our panel of experienced practitioners reviews these recent developments, and offers a few peeks into their crystal balls

Brian Danaher, Vice President and Deputy General Counsel, Benchmark Senior Living
Brian Rath, Buchanan Ingersoll & Rooney PC

Unlike nursing homes, assisted living facilities are granted far more leeway in the discharge of residents, at least in theory. This session will examine the general principles and challenges involved in an assisted living discharge. In addition, the presentation will discuss the various state-specific discharge requirements and practices and how a multi-state assisted living providers can address the various rules.

• Prepare for discharge starting at admission
• Making the decision to discharge
• The discharge notice
• Discharge planning
• Litigating a discharge

William A. Dombi, President, National Association for Home Care
Andrew B. Wachler, Wachler & Associates PC

• The key risk areas for home health agencies, hospice providers and SNFs
• The latest developments in the Medicare and Medicaid appeal landscape
• Discuss and compare the Medicare and Medicaid appeals processes as well effective strategies for defending claim denials in each process
• An overview of the attendant risks and potential collateral consequences beyond the audit findings
• Forecast the future developments for these provider types

Katie Wehri, National Association for Home Care & Hospice

• The 2025 Medicare Home Health Payment Rate Update final rule provisions and cumulative provider impact
• New! Home health admission to service policy condition of participation
• Updates on the Medicare Home Health Value Based Purchasing Demonstration and Review Choice Demonstration
• Hospice program integrity initiatives and payment updates
• New! Hospice Outcomes & Patient Evaluation (HOPE) tool
• Telemedicine prescribing and DEA updates

LaShuan Bethea, Executive Dire​ct​or, National Center for Assisted Living
Neville M. Bilimoria, Duane Morris LLP
Daniel Merriman, Senior Compliance/Public Policy Analyst, Life Care Services

• Updated legislative and regulatory requirements in assisted living and memory care, including transparency and ownership disclosures
• Recent developments in the Press and Congressional Activity regarding assisted living facilities
• A continued revamping of existing assisted living regulations in various states
• Regulatory and litigation changes, other "hot topics" and trends affecting assisted living facilities

Jonathon Lips, Vice President, Legal Affairs, LeadingAge

• Notable trends in CMS survey and enforcement activity
• Key developments in CMS regulation of skilled nursing facilities, including the implementation status of rules concerning minimum staffing requirements, disclosure of ownership and management information, and Medicare appeals rights for changes in patient status
• Initiatives from other federal agencies with impact on skilled nursing facilities, including the HHS Office of Inspector General and the Department of Labor
• Outlook for Congressional activity on selected issues affecting the sector in 2025

Michelle McGovern, General Counsel, A Place for Mom
Sarah Swank, General Counsel, On Belay Health Solutions

• Structuring value base program opportunities and the role of long term care, including ACOs, Medicare Advantage, Shared Savings and preferred provider relationships
• Summary of Value Based Payment compliance requirements and risks, including enforcement actions and new OIG guidance
• Provider referral risks and incentive compensation arrangements
• Building an effective compliance program to address VBP risks
• Regulatory reporting requirements and managing the reporting process

Barbara Barrett, Attorney, Chief Compliance Officer, Reliant Care Management Company
Elizabeth LaFoe Frederick, Husch Blackwell
Suzanne Sheldon-Krieger, Senior Counsel, Legal Services, BJC HealthCare

The panel of presenters includes an attorney with experience advising facilities on involuntary discharges and handling related litigation, in house counsel for an organization that manages skilled nursing facilities specializing in behavioral residents, and counsel for a large hospital system, which is sometimes used as a discharge placement. The presenters will offer differing perspectives and practice tips based on their in-depth experience with these difficult situations and the different laws and procedures that apply to them. The session will include:

• A broad overview of the involuntary discharge process from skilled nursing facilities and the appeals process available to residents and their representatives
• The federal legal requirements and guidance for facilities on the discharge process and provide an overview of how appeals of these discharges may play out, depending on the state laws and processes in place

Jody Erdfarb, Wiggin and Dana LLP

This presentation will discuss how home health agency and/or hospice enforcement case “evolves,” with insight from both the government and provider perspectives. Participants will gain an understanding of:

• The survey process, including recent regulatory changes and the imposition of civil monetary penalties and other alternative sanctions
• The Statement of Deficiencies, including applicable statutory authority and regulations; frequently-cited tags; difference between deficiency type; discussion of SOM guidance
• The Informal Dispute Resolution and Independent Informal Dispute Resolution processes
• The administrative appeal process from different viewpoints, including cost-benefit analysis of appealing; appeal process; settlement negotiations; and applicable burdens of proof
• How the nursing home process is similar and different, with some updates on nursing home surveys

Kathleen Snyder, Husch Blackwell LLP

• AI implementation
• AI governance
• Innovative Agetech products for the long-term care and post-acute settings

This is not included in the registration fee; there is an additional fee of $65; limited attendance and pre-registration is required. Continuing Education Credits are not available.

Jennifer R. Sourk, General Counsel, Midwest Health

An open forum for attendees to share individual challenges, insights, and strategies in the current legal landscape in long-term care.

• Introduction
• Industry experiences and legal challenges
• Current events and legislative developments
• Regulatory trends and compliance
• Risk management and mitigation strategies

This session is for General Counsel only; space is limited; pre-registration required.

Steven E. Gordon, Retired, Civil Rights Enforcement Coordinator, Assistant United States Attorney, Eastern District of Virginia

• When Congress passed the Americans with Disabilities Act (ADA), it recognized that discrimination against individuals with disabilities persists in critical areas, including health services
• Through the ADA, Congress established a national mandate for the elimination of discrimination against individuals with disabilities by providing strong and enforceable standards
• The ADA requirements apply to a variety of healthcare providers, including long-term care and post-acute care providers. Further, the ADA applies to all services that covered entities provide, including in-person medical services, telephone consultations with family members and websites
• The United States Attorneys’ Offices across the nation in partnership with DOJ's Civil Rights Division have been enforcing the ADA in healthcare settings
• Cases have included enforcement actions against long-term care and post acute care providers for failing to provide appropriate auxiliary aids and services for individuals with communication disabilities, such as being deaf and hearing loss, ensuring physical access to medical care for people with mobility disabilities and ensuring equal access to healthcare provider's websites
• The ADA legal principles applicable in health care settings, common issues that arise in these cases, recent DOJ enforcement efforts, including an exploration of actual cases against long-term and post-acute care providers

Katey Hinz, Husch Blackwell
Sydney Pahren, Vorys

Our presentation will provide recent case law updates on the following topics:

• DAB/ALJ case law update, including federal decisions regarding DAB decisions
• False Claims Act and fraud and abuse litigation
• A high-level overview of arbitration agreement litigation for states
• HIPAA, Data Breach, and Privacy litigation and enforcement
• Other litigation updates, including the Fair Housing Act and Chevron deference (will do a light overview with the understanding that there will likely be other presentations solely on Loper Bright)
• Cases to watch that have not yet been decided but should be of interest to long term care providers and advisors

Thomas H. Barnard, Baker Donelson
Peter Marino, Chief Legal Officer, CommuniCare Health Services

The "Worthless Service" case has become the catch-all tool for HHS-OIG and DOJ to use the False Claims Act to address patient care concerns at Long Term care facilities. This theory is a creative and expansive use of a fraud statute, and toes the line on mixing standard of care second guessing with allegations of false claims. These types of cases have many unique aspects that are difference that traditional FCA cases, but are the most common theory for cases at SNFs and other resident care. A detailed break down of these cases from an experienced FCA litigator, and inside-advice from a general counsel of a major LTC network will help prepare attendees for these types of cases.

Taylor Tennison, Corporate Counsel, Addus HomeCare
Roy Wyman, Bass Berry

• HIPAA Pre-emption—exploring how the laws interact and why state privacy laws can apply to HIPAA covered entities, business associates and hybrids (do we want to be covered by HIPAA?)
• Know thy data: The importance of data mapping, including beyond the EMR
• How expanding technologies can increase risk
• Privacy compliance that actually reduces privacy—addressing rules that generate counter-productive responses
• Dealing with multiple laws: One policy to rule them all?
• From here to there: Guidance on how to create, and modify, a compliance program to address new and changing laws

Jennifer Gallop, Krokidas & Bluestein LLP
Jennifer L. Hilliard, Arnall Golden Gregory

The focus of this session is on Medicare Advantage contracting, although content will have some applicability to Managed Medicaid and managed care contracting generally. In this session you will learn how to:

• Evaluate the Medicare Advantage landscape and options for provider contracting
• Ready and best position your organization for negotiations
• Understand the regulatory underpinnings of Medicare Advantage participation that drive the majority of contracting issues
• Review key contacting considerations and provisions
• Examine individual issues which may drive participation and/or impact operations in the assisted living and skilled nursing environments

Lynn M. Barrett, Barrett Law, PA

This session will explore recent ethics issues and decisions affecting lawyers, including those relating to:

• A lawyer's use of and potential reliance on artificial intelligence
• A lawyer's duty to assess the facts and circumstances of a client representation
• Conflicts of interest
• Multi-jurisdictional practices; and more!

Best practices and practical tips will also be discussed

Bruce Anders, Chief Legal Officer, Pacific Retirement
Dee Pekruhn, Director of Life Plan Communities Policy, LeadingAge National

Two influential forces drive legislative activity for continuing care retirement communities (CCRCs:) states' statutory language and consumer legislative activity. Working closely with state partners, members, and business partners, LeadingAge proactively tracks the statutory language and consumer advocacy efforts in order to protect and promote CCRCs and the older adults they serve. This session will review the newly-released comparative resources that LeadingAge has created during a thorough review of states' statutes, and will explore current and recent-past consumer legislative activities. The panel will explore the possible implications of these activities on CCRCs, and will propose shared strategic preparations that can help secure the CCRC model for the future.

Rachel Hold-Weiss, Benesch, Friedlander, Coplan and Aronoff LLP
Katherine A. Proctor, Chief Strategy Officer and General Counsel, Omnia Healthcare Group

Hospices and nursing homes have different requirements for compliance with federal and state requirements for their operations, and the differing requirements do not always fit together nicely and smoothly. Hospice services provided in assisted living facilities pose different challenges. This session will address the benefits and potential pitfalls when hospices contract with nursing homes and when hospice provides services in assisted living facilities. We will provide tips and tricks to help hospices and nursing homes and assisted living facilities to work together in a compliant manner that ultimately benefits all parties.

Valerie Montague, Nixon Peabody LLP
Ben Woit, Senior Vice President, General Counsel, Legal Services, Benedictine Health System

• Who (who are you/how are you regulated?), what (what data do you hold?), when (when did you evaluate the status of data privacy and security), where (where is your data stored and transmitted), and how (how are you protecting your organization)?
• Making your security risk analysis worth it: Creating a “living” risk management plan
• Addressing your weakest links: Personnel and vendors
• Document, then document some more: Preparing or locating compliance documentation in advance of an incident
• Practice makes perfect: Don’t leave your incident response plan on a shelf

Katie Cownie, Dorsey & Whitney
Krystal Mikkilineni, Dentons Davis Brown
Ronald Winters, Gibbins Advisors, LLC

The panel will discuss recent and anticipated challenges faced by skilled nursing facilities and their stakeholders and potential available strategies available to each with separate focus on Propcos, Opcos, and Owner-operated facilities. The panel will review one or more illustrative case studies.

• Propcos–review of available landlord options and con
• Opcos–available strategies for struggling Opcos
• Owner-operators
• Other parties

Beth Moskow-Schnoll, Ballard Spahr LLP
Michelle Romeo, Clinical Reimbursement Nurse Consultant, Western PA Consultants, LLC

In December 2023, after a 5-week trial in federal district court, we were able to obtain a full acquittal for Michelle Romeo, my co-presenter, on charges of criminal health care fraud and conspiracy involving several nursing homes in western Pennsylvania. In this presentation, she and I will discuss the following topics:

• The indictment against Michelle and others, including fraud involving minimum data sets.
• Government errors in its prosecution, including, among other issues: Too much and not enough data, ignoring important data in residents' medical files, poor investigation (including engaging in confirmation bias), reliance on questionable witnesses, and a failure to understand CMS' RAI Manual and related regulations
• Michelle's role with the nursing homes, her response to the indictment, what it was like going through the trial and lessons learned
• How having Michelle, an expert in the applicable regulations, become part of the defense team, contributed to our success at trial

Katey Hinz, Husch Blackwell
Sydney Pahren, Vorys

Our presentation will provide recent case law updates on the following topics:

• DAB/ALJ case law update, including federal decisions regarding DAB decisions
• False Claims Act and fraud and abuse litigation
• A high-level overview of arbitration agreement litigation for states
• HIPAA, Data Breach, and Privacy litigation and enforcement
• Other litigation updates, including the Fair Housing Act and Chevron deference (will do a light overview with the understanding that there will likely be other presentations solely on Loper Bright)
• Cases to watch that have not yet been decided but should be of interest to long term care providers and advisors

Pamela S. Kaufmann, Hanson Bridgett LLP
Aaron Tax, Managing Director of Government Affairs and Policy Advocacy, Sage USA

• Data identifying the need to protect LGBTQ+ and HIV+ individuals in long-term care
• Survey state and local laws that protect these groups’ rights in this setting
• Terminology used in these laws
• Identify best practices for implementing these laws, including education of staff.
• Consider the future of LGBT rights legislation

Ashley Harrison Shudan, Stotler Hayes Group, LLC

• Laying the Groundwork with Proactive Admissions
  • Move beyond “heads in beds” by creating a strong foundation for Medicaid collections from the start of the resident’s journey
• Streamlining the Medicaid Application Process
  • Implement best practices for managing Medicaid applications and suggested policies and tools to effectively monitor pending accounts, minimize delays, and reduce bad debt
• Navigating Complex Eligibility Challenges
  • Address advanced issues, including penalty periods, terminations, appeals, and discharge proceedings, with practical strategies for resolution
• Overcoming Barriers
  • Tackle challenges such as incapacitated residents and uncooperative family members with proven approaches to improve outcomes
• Bridging the Gaps in Medicaid Coverage
  • Explore options like IME/OME/PEME and private collection strategies to address Medicaid shortfalls and optimize reimbursements

Rachel Hold-Weiss, Benesch, Friedlander, Coplan and Aronoff LLP
Katherine A. Proctor, Chief Strategy Officer and General Counsel, Omnia Healthcare Group

Hospices and nursing homes have different requirements for compliance with federal and state requirements for their operations, and the differing requirements do not always fit together nicely and smoothly. Hospice services provided in assisted living facilities pose different challenges. This session will address the benefits and potential pitfalls when hospices contract with nursing homes and when hospice provides services in assisted living facilities. We will provide tips and tricks to help hospices and nursing homes and assisted living facilities to work together in a compliant manner that ultimately benefits all parties.

Frank Carsonie, Benesch, Friedlander, Coplan and Aronoff LLP
Kelly Leahy, Dinsmore & Shohl LLP

This program will examine alternatives to traditional business models in senior living that offer providers the opportunity for survival and strategic growth.  The presenters will provide an overview of the industry’s circumstances fostering innovation, alternative models such as special membership interests, support services organizations and unique affiliations, and legal issues to be navigated when implementing new models

Jonathon Lips, Vice President, Legal Affairs, LeadingAge

• Notable trends in CMS survey and enforcement activity
• Key developments in CMS regulation of skilled nursing facilities, including the implementation status of rules concerning minimum staffing requirements, disclosure of ownership and management information, and Medicare appeals rights for changes in patient status
• Initiatives from other federal agencies with impact on skilled nursing facilities, including the HHS Office of Inspector General and the Department of Labor
• Outlook for Congressional activity on selected issues affecting the sector in 2025

Jennifer Gallop, Krokidas & Bluestein LLP
Jennifer L. Hilliard, Arnall Golden Gregory

The focus of this session is on Medicare Advantage contracting, although content will have some applicability to Managed Medicaid and managed care contracting generally. In this session you will learn how to:

• Evaluate the Medicare Advantage landscape and options for provider contracting
• Ready and best position your organization for negotiations
• Understand the regulatory underpinnings of Medicare Advantage participation that drive the majority of contracting issues
• Review key contacting considerations and provisions
• Examine individual issues which may drive participation and/or impact operations in the assisted living and skilled nursing environments

Christopher C. Puri, Bradley Arant Boult Cummings LLP
Paula Sanders, Post & Schell PC

This session will explain new requirements imposed for Medicare enrollment and revalidation imposed by CMS’s October 1, 2024, changes to the CMS-855A form. The speakers will outline new requirements that all skilled nursing facilities (SNFs) disclose more detailed ownership information (both operations and real estate), as well as “additional disclosable parties”. This newly reported data will be collected through a new “SNF Attachment” that will now be part of the CMS-855A. The speakers will also discuss various sub-regulatory questions and answers that CMS has provide since the rollout of the new requirements. The presentation will also analyze various risks the public disclosure of this information may pose to providers. At the conclusion of the session, participants will achieve the following objectives:

• Understand new CMS reporting requirements for SNF CHOWs, CHOPs, revalidations, reactivations, and changes of information
• Gain insights into the mandatory off-cycle SNF revalidation process and implications for non-compliance
• Understand CMS’s possible policy motivations for the changes and the publishing of all data on its public website, and the various risks from that public disclosure

Barbara Barrett, Attorney, Chief Compliance Officer, Reliant Care Management Company
Elizabeth LaFoe Frederick, Husch Blackwell
Suzanne Sheldon-Krieger, Senior Counsel, Legal Services, BJC HealthCare

The panel of presenters includes an attorney with experience advising facilities on involuntary discharges and handling related litigation, in house counsel for an organization that manages skilled nursing facilities specializing in behavioral residents, and counsel for a large hospital system, which is sometimes used as a discharge placement. The presenters will offer differing perspectives and practice tips based on their in-depth experience with these difficult situations and the different laws and procedures that apply to them. The session will include:

• A broad overview of the involuntary discharge process from skilled nursing facilities and the appeals process available to residents and their representatives
• The federal legal requirements and guidance for facilities on the discharge process and provide an overview of how appeals of these discharges may play out, depending on the state laws and processes in place

Jody Erdfarb, Wiggin and Dana LLP

This presentation will discuss how home health agency and/or hospice enforcement case “evolves,” with insight from both the government and provider perspectives. Participants will gain an understanding of:

• The survey process, including recent regulatory changes and the imposition of civil monetary penalties and other alternative sanctions
• The Statement of Deficiencies, including applicable statutory authority and regulations; frequently-cited tags; difference between deficiency type; discussion of SOM guidance
• The Informal Dispute Resolution and Independent Informal Dispute Resolution processes
• The administrative appeal process from different viewpoints, including cost-benefit analysis of appealing; appeal process; settlement negotiations; and applicable burdens of proof
• How the nursing home process is similar and different, with some updates on nursing home surveys