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Long Term and Post-Acute Care Law and Compliance

Schedule

This program will be formatted as a traditional two and a half days in-person program - we are excited for attendees to connect and network in person.

More information on the schedule will be available soon. Session are designated in areas of focus: SNF – Skilled Nursing Facility; AL – Assisted Living; HH – Home Health and Hospice

AHLA is committed to providing a safe and healthy environment for program participants and staff. AHLA has adopted preventative measures to reduce the potential spread of the COVID-19 virus, including proof of vaccine or a negative PCR test, and is following guidance provided by the US Centers for Disease Control and local authorities. Attendees are also expected to do their part and abide by AHLA’s Duty of Care.

Wednesday Schedule

 

Thursday Schedule

 

Friday Schedule

         

Wednesday, March 1, 2023

7:30 am-4:30 pm

Registration and Check-In
Come to AHLA Registration area to print out your badge. We'll need your proof of vaccine or negative COVID-19 test on the Clear Health App.

 
8:00-9:00 am

Continental Breakfast
This event is included in the program registration fee. Attendees, faculty, and registered guest are welcome.

 
8:00 am-1:00 pm

Assisted Living In-House General Counsel Roundtable, sponsored by NCAL
Pre-registration is required: space is limited; open to Assisted Living In-House Counsel only. More information will be available soon. 

 
9:00-10:15 am Extended Concurrent Sessions


1. Beyond SNF: Intro to Post-Acute / Fundamentals of Medicare and Medicaid Reimbursement in Long Term Care (not repeated)
Christina Hultsch, Benesch Friedlander Coplan & Aronoff LLP, Columbus, OH

More Information

  • Structure and background of the Medicare Program: History, program administration, and operation
  • Medicare coverage: Statutes, manuals, LCDs, NCDs, ALJ decisions, legislative history, resources
  • Components of Medicare programs, Parts A–D: Eligibility criteria, provider types, current reimbursement system, quality incentives affecting reimbursement, and appeals process
  • Medicaid fundamentals: Overview of state programs, eligibility criteria, covered benefits, reimbursement and financing, recent reform, and developments

 


2. The Expanded Value-Based Purchasing Program in Home Health (HH) (not repeated)
Michael H. Cook, Liles Parker PLLC, Washington, DC
Melinda Gaboury, Chief Executive Officer, Healthcare Provider Solutions, Inc, Nashville, TN

More Information

In its final rule on home health under the Medicare program, HHS expanded its value-based purchasing model in home health from a demonstration model in 9 states to a nationwide program beginning with calendar year 2023. The session would discuss the VBP program and its current requirements.

  • The earlier demonstration project that generated the national program and its results
  • The program will operate under the expanded model
  • The program will affect Medicare reimbursement
  • The appeal process
  • Practical advice and resources

3. Case Law Update (SNF, AL, HH)
Michelle R. Adams, Lane Powell PC, Portland, OR
Kara G. Silverman, Arnall Golden Gregory LLP, Atlanta, GA

More Information

  • False Claims and other fraud and abuse litigation
  • Arbitration agreement litigation
  • Data breach and HIPAA enforcement actions
  • General litigation developments
 
10:45-11:45 am Concurrent Sessions​


4. Roundtable Workshop Discussion on How to Fix the Broken Survey Enforcement Appeal Process (SNF) (not repeated)
Joseph Bianculli, Health Care Lawyers PLC, Arlington VA
Alan C. Horowitz, Arnall, Golden & Gregory, Atlanta GA
Karl E. Steinberg, AMDA, the Post Acute Medical Society, Vista, CA

More Information

  • This is not a complaint session, but a serious effort by experienced counsel and Dr. Karl Steinberg, former President of the Society for Post-Acute Medicine, to address growing concerns with the fairness and efficacy of the Departmental Appeals
  • Board (DAB) process for review of nursing facility survey sanctions
  • The state of the DAB in 2023 – 47 ALJ Decisions in 2022, 1 of which was favorable to a facility on the merits; 2 Board Decisions, with scores pending (while CMS holds escrowed CMPs)
  • Kisor, GLC Mountain View and the Good Guidance Practices Rule–Translating the Administrative Procedure Act to the DAB in a way that respects CMS’ legitimate enforcement prerogatives while also weeding out ad hoc sanctions and poorly prepared cases
  • Structuring appeals to anticipate Court of Appeals review; highlighting the role of medical evidence and the Medical Director; The Heights of Tomball, ALJ Decision No. CR6147
  • Who will bell the cat?

5. Competency/Capacity Issues in Long Term Care, with Findings From an Empirical Study of Clinician Attitudes​ (SNF, AL)
Barbara S. Barrett, Chief Compliance Officer, Reliant Care Management Company, St. Louis, MO
David N. Hoffman, Assistant Professor, Columbia University, General Counsel, Claxton Hepburn Medical Center, Ogdensburg, NY

More Information

  • How should you address decisions of residents with cognitive impairments
  • What to do when a resident wants to leave AMA
  • Dealing with family members as guardians who agree or disagree with resident choices
  • These issues will be address in light of the findings in a recent empirical study on advance directives for people with decisional incapacity

6. In Case of Accusation, Break Glass: Practical Advice for Responding to a False Claims Act Investigation
David C. Beck, Law Offices of David Beck PLLC, Dallas, TX
Brad Robertson, Bradley Arant Boult Cummings LLP, Birmingham, AL

More Information

Few things are more disruptive and costly to a health care provider than responding to an action under the False Claims Act. Mr. Robertson and Mr. Beck will share practical tips and specific actions, strategies, and tactics clients have employed in defeating FCA cases or achieving reasonable settlements, from the perspectives of outside counsel, chief legal officer, and chief ethics and compliance officer. Topics covered will include:

  • Steps to take when a client gets a civil investigative demand or other signs arise of an FCA investigation
  • Reading the tea leaves–“reverse engineering” the government’s concerns from the CID and other clues
  • Preparing the organization, from the Board to the front line, for the lengthy roller coaster ride that is an FCA defense
  • Selection of defense counsel and how to get the most from the relationship between in-house and outside counsel
  • Tools and tips for evaluating FCA exposure
  • Planning and executing a comprehensive defense strategy, including how to evaluate potential for settlement
  • How and when to communicate about the FCA matter, both internally and with third parties
 
11:45 am-1:00 pm

Lunch on your own

 
1:00-2:00 pm Concurrent Sessions​

7. Health Care Transactions in a Distressed Environment (SNF, AL) (not repeated)
Krystal Mikkilineni, Dentons Davis Brown, Des Moines, IA
Ronald Winters, Gibbins Advisors, LLC, Nashville, TN

More Information

  • Regional and national demographic changes that impact demand
    • Changes in life expectancy
    • Changes in wealth of retirees
  • Alternative services / “products” to address significant senior living modalities (independent, assisted, memory care, LTACH)
    • State-driven initiatives to test or implement lower cost alternative services
    • Other reimbursement risks where applicable
    • Reliance on Medicare post-acute care revenue in economic model
  • Continued labor uncertainty
    • Reliance on immigration to staff certain positions with uncertain supply
    • Working capital pressure
    • Loss-weary vendors and upstream pressure from their liquidity sources
  • Insurance matters
    • Property and casualty insurance costs impacted by environmental and building/construction changes
    • Tort claim environment
  • Availability of capital from lenders and landlords
    • Recent credit loss experience
    • Impact of regulation on credit loss experience
    • Changes in number / sophistication of credit suppliers
  • Pressure for capital expenditures
    • For regulation
    • For competitiveness
  • Complexity of dealing with governmental parties
    • Uncertainty of future recoupments
    • Impacts on buyers and resulting values
  • Expense of bankruptcy which may be only avenue of restructuring depending on complexity of capitalization and vendor relations
  • Special complexity in areas of limited population density

8. SNF Legislative and Regulatory Update (SNF)
Crystal Bowens, Vice President of Regulatory and Clinical Services, American Health Care Association, Washington, DC
Jonathan Lips, Vice President, Legal Affairs, LeadingAge, Washington, DC

More Information

  • Key developments in Centers for Medicare & Medicaid Services regulation, survey and enforcement of skilled nursing facilities, including the anticipated CMS regulation establishing minimum staffing standards
  • Current status and likely future of regulatory matters specific to COVID-19, including waivers in place during the Public Health Emergency
  • 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 2023

9. Audits and Investigations of Provider Relief Fund Monies Distributed to Post-Acute and LTC Providers: The Saga Continues​ (SNF, AL, HH)
Mark E. Reagan, Hooper Lundy & Bookman PC, San Francisco, CA and Boston, MA
Bill Ulrich, President/CEO, Consolidated Billing Services, Spokane Valley, WA

More Information

  • Changes in reporting requirements
  • The current status of PRF audits of post-acute and LTC providers: Single/financial audits
  • HRSA collection process and activities
  • OIG activities and expected reports
  • Preparing for future audits, investigations , and appeals
 
 
2:30-4:30 pm General Session​

2:30-2:45 pm
Welcome and Introduction

Thomas Shorter, AHLA President
Barbara Duffy, Planning Committee Chair


2:45-3:45 pm
10. The Future Is Here: How Ageing Services and Seniors Housing Providers are Employing Robotics, AgeTech and Other Innovation To Serve Our Seniors

Scott Code, Vice President, LeadingAge, Center for Aging Services Technology, Washington, DC
Dusanka Delovska-Trajkova, Chief Information Officer, Ingleside, Rockville, MD
Marc Gaber, Chief Technology and Information Officer, Transforming Age, Des Moines, IA


3:45-4:30 pm
11.
Keynote Address: An Update from the Office for Civil Rights (OCR)
Melanie Fontes Rainer, Director of the Office for Civil Rights, US Department of Health and Human Services, Washington, DC

More Information

  • A 2023 outlook and HHS OCR priorities
  • Status update on pending regulations and future guidance  
  • Current HIPAA privacy, security, and breach notification issues and enforcement trends 
  • Nondiscrimination in health programs and activities (Section 1557, Language Access, Section 504)
 
4:30-5:30 pm

Networking Reception, sponsored by Dorsey & Whitney LLP
This event is included in the program registration. Attendees, faculty, and registered guest are welcome.

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Thursday, March 2, 2023

7:00 am-5:30 pm

Registration and Check-In
If you have not checked in, come to AHLA Registration area to print out your badge. We'll need your proof of vaccine or negative COVID-19 test on the Clear Health App.

 
7:00-8:00 am

Continental Breakfast
This event is included in the program registration. Attendees, faculty, and registered guest are welcome.

 
8:00-9:15 am Extended Concurrent Sessions

12. Assisted Living and Senior Housing Legislative and Regulatory Update (AL)
LaShuan Bethea, Executive Dire​ct​or, National Center for Assisted Living, Washington, DC
Glenn D. Fox, Executive Vice President and General Counsel, ACTS Retirement-Life Communities Inc, Fort Washington, PA
Drew Graham, Hall Booth Smith PC, New York, NY

More Information

  • Updated legislative and regulatory requirements in the senior living space, including potential new staffing requirements
  • Recent changes in the Medicare conditions of participation for skilled nursing facilities impact on state regulatory policy governing senior living providers
  • A continued revamping of existing assisted living regulations in various states
  • Regulatory changes and impact to overall cost of risk

13. Long Term Care Surveys: A Look Back and a Look Forward, with An Analysis of a Recent Facility Closing (SNF)
Marian Hayden, Cull and Hayden PSC, Frankfort, KY
Larry Johnson, Director Iowa Department of Inspection & Appeals, Iowa Department of Inspections & Appeals, Des Moines, IA
Janine Lehman, Director of Legal Nurse Consulting, Proactive Medical Review, Evansville, IN

More Information

  • 2022 State Survey Agency Results, 2023 Performance Measurement Standards for State Survey Agencies, nationwide trends of survey findings and activities, and look at survey changes
  • The current “Top 10” deficiencies cited as of December 2022 and best practice recommendations for how to prevent them
  • Analysis of an involuntary closure. Factors driving the regulators’ decision. Opportunities to reverse course. Action steps when decertification is inevitable
  • A look at the Survey priorities for the upcoming year and upcoming changes in the LTC survey process

14. Has the Standard of Care for Post-Acute and Long Term Care Changed in the Wake of COVID-19? (SNF, AL, HH)
Fay Hardison Bembry, Nurse Practitioner, Paradigm Healthcare Services, Johnson City, TN
Martin Delahunty III, Director of Legal Affairs, CommuniCare Health, Cleveland, OH
John Huff, Jackson Kelly PLLC, Charleston, WV
Douglas S. Mitchell, Founding Owner/CEO, Adfinitas Health, Hanover, MD

More Information

  • Standards of Care for Post-Acute and Long Term Care (Skilled Nursing) Facilities
  • COVID-19 governmental and quasi-governmental regulations, restrictions and guidance and impacts on staffing
  • Impacts of PPE on staffing and delivery of care
  • Quarantine: Close contacts and infections and impacts on isolation of residents/patients and limitations on staffing
  • Balancing protections for staff with delivery of care and services to residents and impacts on level, frequency and duration of care
  • Whether SOC should be flexible in light of this operating environment and these external factors?

3. Case Law Update (SNF, AL, HH) (repeat)
Michelle R. Adams, Lane Powell PC, Portland, OR
Kara G. Silverman, Arnall Golden Gregory LLP, Atlanta, GA

More Information

  • False Claims and other fraud and abuse litigation
  • Arbitration agreement litigation
  • Data breach and HIPAA enforcement actions
  • General litigation developments
 
9:45-10:45 am Concurrent Sessions

15. Home Health Legislative and Regulatory Update (HH)
William A. Dombi, President and CEO, National Association for Home Care & Hospice, Washington, DC

More Information

  • The 2023 Medicare home health payment rule updates
  • Nationwide expanded Medicare Home Health Value Based Purchasing Demonstration
  • Hospice quality of care survey and sanction reforms
  • Hospice claims oversight
  • Hospice business practices under review
  • 2024 MedPAC recommendations on home health and hospice reforms
  • Status of home care expansions in Medicare
  • Impact of PHE end on home health and hospice waivers by CMS

16. Legal Ethics and Professionalism Hot Topics
Lynn M. Barrett, Wachler & Associates PC, Windermere, FL

More Information

  • Potential pitfalls in the use of social media and texting
  • Emails and the potential waiver of privilege
  • The use of non-lawyers
  • Certain potential changes to the ABA's Model Rules and the impact such changes may have on health care attorneys

17. Health Care Strategy: Data and Cyber Considerations​ (SNF, AL, HH)
Alisa Chestler, Baker Donelson Bearman Caldwell & Berkowitz PC, Nashville, TN
John DiMaggio, CEO, Blue Orange Compliance, Columbus, OH
David Gibbons, Compliance Officer, CommuniCare Health, Charleston, WV

More Information

  • Data Strategy
    • Need to remember that data is a valuable asset at risk/ Not just about “compliance” or “HIPAA compliance”
    • Data Mapping
    • Data Retention and Destruction, medical records and email issues
    • EMR/EHR Agreements and other Tech Agreements
  • Health Technology
    • EMR/EHR Agreements and other Tech Agreements
    • Health Tracking Litigation and Guidance
  • State of industry and HC for Cyber
    • Cyber insurance market/underwiring
    • Recent cases
  • HIPAA Waterline
    • Basic HIPAA security items
    • OCR investigation popular items
  • Civil Negligence line – similar to HIPAA
  • Recognized security practices (HITECH 2021)

18. Managing Risk and Disruption: New Liability Issues for Long Term Care and Transitions in Care in Post Acute Settings​
Caroline J. Berdzik, Goldberg Segalla, LLP, Princeton, NJ
Minton P. Mayer, Quintairos Prieto Boyer and Wood, PA, Memphis, TN
Beverly B. Wittekind, General Counsel, The Ensign Group Inc, San Juan Capistrano, CA

More Information

  • Care rendered outside the SNF or by non-SNF providers, does it compliment or disrupt the care continuum?
    • Wound care consultants, physicians and the importance of written orders, and compliant documentation
    • Hospice care and who is responsible for effective pain management, oxygen, skin integrity, and end of life care
    • Dialysis care, emergency room wait times, and impact on skin integrity
  • Agency staffing, wage inflation, social inflation, and the great resignation, what is the short term impact on care and risk?
    • This program will also expound upon liability Issues inherent in care transitions for the elderly and infirm
  • Analyzing recent cases dealing with liability issues in care transitions and how these situations can be avoided for long term care health care providers
    • Documentation issues
    • Effective communications with stakeholders

 
10:45-11:15 am

Coffee and Networking Break
Exhibits Open–Meet the Exhibitors

 
11:15 am-12:15 pm Concurrent Sessions

19. AseraCare’s Aftermath and Other Trending False Claims Act Defenses Related to Government Investigations and Litigation against Long Term and Post-Acute Care Providers​ (not repeated)
Bryan Nowicki, Husch Blackwell LLP, Madison, WI
Robert S. Salcido, Akin Gump Strauss Hauer & Feld LLP, Washington, DC

More Information

  • AseraCare and Subsequent Case Law:
    • Care Alternatives (cert. denied): The 3rd Circuit allows a jury to determine which of two reasonable medical determinations is “more” correct
    • Curo Health: A federal District Court finds that outliving a terminal prognosis corroborates a claim that a certification of terminal illness is fraudulent
    • Bethany Hospice (cert. pending): A whistleblower seeks review of an 11th Circuit decision concerning the quantum of evidence of actual claims that is necessary
    • CMS and OIG Audits: How have CMS and the OIG addressed the AseraCare case in their provider audits?
  • In FCA litigation, learn other defenses that maximize the likelihood that defendant will prevail on the FCA’s falsity, knowledge and materiality elements
  • In FCA / AKS litigation and investigations, learn new defenses related to fair market value and the requirement that plaintiff link remuneration to claims that defense counsel needs to understand
  • In FCA / Stark law litigation and investigations, learn the type of activity the government targets such as when providers measure revenue associated with downstream referrals and when physician compensation does not match productivity and defenses related to reasonable interpretation of ambiguous rules
  • In COVID-19 and pandemic relief related fraud litigation and investigations, learn the latest enforcement tends and defenses
  • FCA Amendments: Proposed statutory changes that limit provider defenses

20. Navigating Relationships Between Ancillary Providers and Long-Term Care Facilities (SNF, AL, HH)​
Ragini Acharya, Husch Blackwell LLP, Denver, CO
Anna F. Munoz, Senior Director, Legal Operations, Licensing & Risk, Brookdale, Milwaukee, WI

More Information

  • The types of relationships between ancillary providers and long-term care facilities
  • Considerations for contractual agreements, such as third party access agreements, partnership/joint venture arrangements, and space leases
  • Impact for licensure or other government approvals
  • Case studies and review of best practices to avoid violations of fraud and abuse laws

21. Population Health (HH, AL)
Joseph Greenman, Associate General Counsel, Moda Health, Portland, OR
Christopher C. Puri, Bradley Arant Boult Cummings LLP, Nashville, TN
Kirstin B. Sumner, VP Legal Operations, Brookdale Senior Living, Milwaukee, WI
Hank Watson, Chief Development Officer, American Health Plans, Franklin, TN

More Information

This session will introduce attendees to the concept of population health and how the management of groups of residents and patients is likely to affect providers along the LTC continuum, and identify legal issues in moving towards risk based managed care programs. A panel of experts will discuss:

  • How do you define “population health” from both the provider and payer perspective
  • Why providers should care about how population health will affect delivery of long term care
  • What challenges and opportunities exist for providers?
  • Two experts involved in population health management will explain what this looks like on the ground within Medicaid Managed Care, Medicare Advantage and Medicare FFS arrangements

5. Competency/Capacity Issues in Long Term Care, with Findings From an Empirical Study of Clinician Attitudes (SNF, AL) (repeat)
Barbara S. Barrett, Chief Compliance Officer, Reliant Care Management Company, St. Louis, MO
David N. Hoffman, Assistant Professor, Columbia University, General Counsel, Claxton Hepburn Medical Center, Ogdensburg, NY

More Information

  • How should you address decisions of residents with cognitive impairments.
  • What to do when a resident wants to leave AMA.
  • Dealing with family members as guardians who agree or disagree with resident choices.
  • These issues will be address in light of the findings in a recent empirical study on advance directives for people with decisional incapacity.
 
12:15-1:30 pm

Networking and Presentation Lunch, sponsored by Initial Vll Consulting LLC

The Power of Perception: Balancing Legal and PR Strategies
Beth Martino, Senior Vice President, Public Affairs, American Health Care Association, Washington, DC

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

More Information

  • How to use communication research and industry perception information to benefit your long term care organization
  • Learn how to integrate legal and communications strategy and create an ongoing dialogue with the PR team
  • Tips for working together with your PR team to successfully address a crisis
 
 
1:45-2:45 pm Concurrent Sessions

22. Confronting and Resolving Difficult Problems Associated with Involuntary Discharges from Assisted Living and Nursing Facilities​ (SNF, AL)
Randall R. Fearnow, Quarles & Brady LLP, Chicago, IL
Robert J. Lightfoot, Reinhart Boerner Van Deuren SC, Madison, WI

More Information

  • Situations which often result in efforts by SNF and AL providers to discharge residents involuntarily
  • The special problem of the difficult resident or family member
  • Valid and invalid bases for involuntary discharge, including the resident's failure to pay for services
  • Avoiding legal and ethical risks associated with nursing and assisted living facility collection efforts
  • Compliance with notice and procedural requirements for involuntary discharges
  • What to do when a resident or family member refuses to vacate the premises

23. Developing Effective Staff Screening Procedures in Long Term Care and Immigration Options for Addressing Shortages​ (SNF, AL)
Richelle D. Marting, Attorney with Marting Law LLC, Olathe, KS
Dustin J. O'Quinn, Lane Powell PC, Seattle, WA

More Information

  • Applicable federal, and common state law requirements and restrictions governing employment of individuals with certain convictions or administrative findings and consequences for hiring prohibited or excluded individuals
  • OIG LEIE database and additional screening sources, and limitations to effective searches
  • The challenge with effective searches in the context of staffing shortages and staffing agencies
  • Strategies to expand effective staff screenings to third party vendors
  • Work-authorized visas available to long term care employees
  • Visa application processes and timelines for foreign students and graduates inside and outside the United States

9. Audits and Investigations of Provider Relief Fund monies distributed to Post-Acute and LTC providers; The Saga Continues (repeat)
Mark E. Reagan, Hooper Lundy & Bookman PC, San Francisco, CA and Boston, MA
Bill Ulrich, President/CEO, Consolidated Billing Services, Spokane Valley, WA

More Information

  • Changes in reporting requirements
  • The current status of PRF audits of post-acute and LTC providers: Single/financial audits
  • HRSA collection process and activities
  • OIG activities and expected reports
  • Preparing for future audits, investigations , and appeals

15. Home Health Legislative and Regulatory Update (HH) (repeat)
William A. Dombi, President and CEO, National Association for Home Care & Hospice, Washington, DC

More Information

  • The 2023 Medicare home health payment rule updates
  • Nationwide expanded Medicare Home Health Value Based Purchasing Demonstration
  • Hospice quality of care survey and sanction reforms
  • Hospice claims oversight
  • Hospice business practices under review
  • 2024 MedPAC recommendations on home health and hospice reforms
  • Status of home care expansions in Medicare
  • Impact of PHE end on home health and hospice waivers by CMS
 
3:15-4:15 pm Concurrent Sessions

24. Patient Safety Organizations - Aging Services Missed Opportunity to Improve Quality and Protect Quality Assurance Information (SNF, AL, HH) (not repeated)
Joel I. Fishbein, Litchfield Cavo LLP, Philadelphia, PA
Victor Lane Rose, Executive Director, Aging and Ambulatory Care, ECRI, Plymouth Meeting, PA

More Information

  • The Patient Safety and Quality Improvement Act
  • The requirements for establishing a new, or joining an existing PSO in compliance with the PSQIA
  • The patient safety and quality improvement benefits of PSOs
  • The ways in which being part of a PSQIA compliant PSO protect quality improvement and patient safety information
  • Perform a cost/benefit analysis to help determine if being part of a PSO is right for your aging services organization

25. Private Equity Ownership: How to Prepare for the Government’s New Focus in Long Term Care Enforcement(SNF, AL, HH)
Thomas H. Barnard, Baker Donelson Bearman Caldwell & Berkowitz, Baltimore, MD
Bridgette Uhlemann, VP/Corporate Counsel, Director of Legal and Compliance, Life Care Services, Des Moines, IA

More Information

  • The federal government’s focus on private equity’s role in the ownership of LTC facilities and the risks that private owners face
  • Risks these transactions pose and how to mitigate risk and exposure. At the state level, disclosure rules and filings continue to raise challenges for facilities
  • An increasing number of nursing and long term care facilities are involved in transactions with or owned by private equity (PE) firms. Public statements by the President and other agencies have revealed a growing distrust of PE involvement
  • The government has expressed concern over the lack of transparency regarding ownership, as well as a perceived focus away from patient care to a profit-first mentality
  • The financial challenges of long term care related operations, staffing costs, and other challenges make the availability of support from private equity essential to sustain many facilities
  • Critical to this transition to new types of ownership are issues related to the transactions themselves, issues learned during due diligence, and strategies for clarifying control or ownership

26. Understanding And Mitigating Litigation And Regulatory Risks In Assisted Living​​ (AL)
Tomek Koszylko, Counsel, Vi Living, Chicago, IL
Payam A. Saljoughian, Hanson Bridgett LLP, San Francisco, CA

More Information

  • The most common claims reported in assisted living
  • Fact patterns that expose assisted living providers to claims
  • Common areas of regulatory risk in assisted living
  • Current trends impacting the assisted living industry
  • Practices implemented by providers to address risk factors

21. Population Health (HH, AL) (repeat)
Joseph Greenman, Associate General Counsel, Moda Health, Portland, OR
Christopher C. Puri, Bradley Arant Boult Cummings LLP, Nashville, TN
Kirstin B. Sumner, VP Legal Operations, Brookdale Senior Living, Milwaukee, WI
Hank Watson, Chief Development Officer, American Health Plans, Franklin, TN

More Information

This session will introduce attendees to the concept of population health and how the management of groups of residents and patients is likely to affect providers along the LTC continuum, and identify legal issues in moving towards risk based managed care programs. A panel of experts will discuss:

  • How do you define “population health” from both the provider and payer perspective
  • Why providers should care about how population health will affect delivery of long term care
  • What challenges and opportunities exist for providers?
  • Two experts involved in population health management will explain what this looks like on the ground within Medicaid Managed Care, Medicare Advantage and Medicare FFS arrangements
 
4:45-5:45 pm Concurrent Sessions

27. Abuse and Neglect – Sexual Consent and Updated Guidance (SNF, AL) (not repeated)
Sean J. Fahey, Hall Render Killian Heath & Lyman PC, Indianapolis, IN
Shelly Maffia, Director of Regulatory Services, Proactive Medical Review & Consulting, Evansville, IN

More Information

Session will capture key changes to abuse and neglect in the new surveyor guidance, as well as regulatory requirements for abuse and neglect prevention and reporting for long term care, with an emphasis on determining capacity to consent to sexual activity. Session will also review recent issues in abuse and neglect DAB decisions and best practices for responding to abuse and neglect allegations.

  • New surveyor guidance on abuse and neglect prevention and reporting for nursing homes
  • CMS guidance on how to determine if a resident has the capacity and ability to consent to sexual activity
  • Recent issues in abuse and neglect in DAB decisions
  • Pertinent actions to take in response to abuse and neglect allegations

6. In Case of Accusation, Break Glass: Practical Advice for Responding to a False Claims Act Investigation​ (repeat)
David C. Beck, Law Offices of David Beck PLLC, Dallas, TX
Brad Robertson, Bradley Arant Boult Cummings LLP, Birmingham, AL

More Information

Few things are more disruptive and costly to a health care provider than responding to an action under the False Claims Act. Mr. Robertson and Mr. Beck will share practical tips and specific actions, strategies, and tactics clients have employed in defeating FCA cases or achieving reasonable settlements, from the perspectives of outside counsel, chief legal officer, and chief ethics and compliance officer. Topics covered will include:

  • Steps to take when a client gets a civil investigative demand or other signs arise of an FCA investigation
  • Reading the tea leaves–“reverse engineering” the government’s concerns from the CID and other clues
  • Preparing the organization, from the Board to the front line, for the lengthy roller coaster ride that is an FCA defense
  • Selection of defense counsel and how to get the most from the relationship between in-house and outside counsel
  • Tools and tips for evaluating FCA exposure
  • Planning and executing a comprehensive defense strategy, including how to evaluate potential for settlement
  • How and when to communicate about the FCA matter, both internally and with third parties

8. SNF Legislative and Regulatory Update (repeat)
Crystal Bowens, Vice President of Regulatory and Clinical Services, American Health Care Association, Washington, DC
Jonathan Lips, Vice President, Legal Affairs, LeadingAge, Washington, DC

More Information

  • Key developments in Centers for Medicare & Medicaid Services regulation, survey and enforcement of skilled nursing facilities, including the anticipated CMS regulation establishing minimum staffing standards
  • Current status and likely future of regulatory matters specific to COVID-19, including waivers in place during the Public Health Emergency
  • 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 2023
 
5:45-6:45 pm

Networking Reception, Sponsored by The Completed Life Initiative
This event is included in the program registration. Attendees, faculty, and registered guests are welcome.

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Friday, March 3, 2023

7:00 am-1:15 pm

Registration and Check-In
If you have not checked in, come to AHLA Registration area to print out your badge. We'll need your proof of vaccine or negative COVID-19 test on the Clear Health App.

 
7:00-8:00 am

Continental Breakfast
This event is included in the program registration. Attendees, faculty, and registered guests are welcome.

 
7:30-9:15 am

Interactive Session: General Counsel Roundtable Discussion (SNF)
This session is for in-house counsel ONLY; pre-registration required. 

Annaliese Impink, Executive Vice President Chief Compliance Officer, SavaSeniorCare Administrative and Consulting LLC, Atlanta, GA
Beverly B. Wittekind, General Counsel, The Ensign Group Inc, San Juan Capistrano, CA

More Information

  • Life After COVIDNew Robust Regulations
    • New Robust Regulations
    • TNA waiver - where are we now?
    • Staffing - what is the impact?
    • PHE - what about Medicaid Eligibility?
    • Push for Up-to-Date Vaccinations - how are we doing?
  • Compliance and Arbitration Conditions of Participation
    • How have the Survey Teams handled this and what can we do to prepare?
  • Medical Malpractice in the Era of the PREP Act.
  • What is new in the Survey and Enforcement Environment?
8:00-9:15 am Extended Concurrent Sessions

12. Assisted Living / Senior Housing Legislative and Regulatory Update (repeat)
LaShuan Bethea, Executive Dire​ct​or, National Center for Assisted Living, Washington, DC
Glenn D. Fox, Executive Vice President and General Counsel, ACTS Retirement-Life Communities Inc, Fort Washington, PA
​Drew Graham, Hall Booth Smith PC, New York, NY

More Information

  • Updated legislative and regulatory requirements in the senior living space, including potential new staffing requirements
  • Recent changes in the Medicare conditions of participation for skilled nursing facilities impact on state regulatory policy governing senior living providers
  • A continued revamping of existing assisted living regulations in various states
  • Regulatory changes and impact to overall cost of risk

13. Long Term Care Surveys: A Look Back and a Look Forward, with An Analysis of a Recent Facility Closing (SNF) (repeat)
Marian Hayden, Cull and Hayden PSC, Frankfort, KY
Larry Johnson, Director Iowa Department of Inspection & Appeals, Iowa Department of Inspections & Appeals, Des Moines, IA
Janine Lehman, Director of Legal Nurse Consulting, Proactive Medical Review, Evansville, IN

More Information

  • 2022 State Survey Agency Results, 2023 Performance Measurement Standards for State Survey Agencies, nationwide trends of survey findings and activities, and look at survey changes
  • The current “Top 10” deficiencies cited as of December 2022 and best practice recommendations for how to prevent them
  • Analysis of an involuntary closure. Factors driving the regulators’ decision. Opportunities to reverse course. Action steps when decertification is inevitable
  • A look at the Survey priorities for the upcoming year and upcoming changes in the LTC survey process

14. Has the Standard of Care for Post-Acute and Long Term Care Changed in the Wake of COVID-19? (repeat)
Fay Hardison Bembry, Nurse Practitioner, Paradigm Healthcare Services, Johnson City, TN
Martin Delahunty III, Director of Legal Affairs, CommuniCare Health, Cleveland, OH
John Huff, Jackson Kelly PLLC, Charleston, WV
Douglas S. Mitchell, Founding Owner/CEO, Adfinitas Health, Hanover, MD

More Information

  • Standards of Care for Post-Acute and Long Term Care (Skilled Nursing) Facilities
  • COVID-19 governmental and quasi-governmental regulations, restrictions and guidance and impacts on staffing
  • Impacts of PPE on staffing and delivery of care
  • Quarantine: Close contacts and infections and impacts on isolation of residents/patients and limitations on staffing
  • Balancing protections for staff with delivery of care and services to residents and impacts on level, frequency and duration of care
  • Whether SOC should be flexible in light of this operating environment and these external factors?
 
9:15-9:45 am

Coffee and Networking Break
Exhibits Open–Meet the Exhibitors

 
9:45-10:45 am Concurrent Sessions

28. The Key Word is “Effective” – Transitioning Compliance and Ethics Programs from the Page to the Caregiving Provider (SNF) (not repeated)
Annaliese Impink, Executive Vice President Chief Compliance Officer, SavaSeniorCare Administrative and Consulting LLC, Atlanta, GA
Daniel Merriman, Senior Compliance/Public Policy Analyst, Life Care Services, Des Moines, IA
Paula G. Sanders, Post & Schell PC, Harrisburg, PA

More Information

The session provides up to date guidance on the requirements of skilled nursing facilities to maintain an effective corporate compliance and ethics program. It will examine federal guidance on compliance and ethics programs and how effectiveness has evolved through precedent. It will reflect, beyond the basics, the perspective from internal compliance professionals and outside counsel. This session will also dive into the complexities of developing an effective compliance and ethics program on campuses with a combination of senior services settings and levels of care also containing skilled nursing. It will focus on:

  • An updated review of Federal requirements and guidance for Compliance and Ethics programs and 2022 published Centers for Medicare and Medicaid Services surveyor guidance
  • Tips and lessons learned from communities regarding what makes a compliance program effective within a community
  • Actual experience and case studies from Corporate Integrity Agreements and other investigations and best practices learned
  • The compliance structures within complexities of a multi-level campus, such as life plan (CCRC) communities
  • Managing contracted vendors and other related third parties bound by the compliance and ethics program

16. Legal Ethics and Professionalism Hot Topics (repeat)
Lynn M. Barrett, Wachler & Associates PC, Windermere, FL

More Information

  • Potential pitfalls in the use of social media and texting
  • Emails and the potential waiver of privilege
  • The use of non-lawyers
  • Certain potential changes to the ABA's Model Rules and the impact such changes may have on health care attorneys

17. Health Care Strategy: Data and Cyber Considerations​ (SNF, AL, HH) (repeat)
Alisa Chestler, Baker Donelson Bearman Caldwell & Berkowitz PC, Nashville, TN
John DiMaggio, CEO, Blue Orange Compliance, Columbus, OH
David Gibbons, Compliance Officer, CommuniCare Health, Charleston, WV

More Information

  • Data Strategy
    • Need to remember that data is a valuable asset at risk/ Not just about “compliance” or “HIPAA compliance”
    • Data Mapping
    • Data Retention and Destruction, medical records and email issues
    • EMR/EHR Agreements and other Tech Agreements
  • Health Technology
    • EMR/EHR Agreements and other Tech Agreements
    • Health Tracking Litigation and Guidance
  • State of industry and HC for Cyber
    • Cyber insurance market/underwiring
    • Recent cases
  • HIPAA Waterline
    • Basic HIPAA security items
    • OCR investigation popular items
  • Civil Negligence line – similar to HIPAA
  • Recognized security practices (HITECH 2021)
 
11:00 am-12:00 pm Concurrent Sessions

18. Managing Risk and Disruption: New Liability Issues for Long Term Care and Transitions in Care in Post Acute Settings​ (repeat)
Caroline J. Berdzik, Goldberg Segalla, LLP, Princeton, NJ
Minton P. Mayer, Quintairos Prieto Boyer and Wood, PA, Memphis, TN
Beverly B. Wittekind, General Counsel, The Ensign Group Inc, San Juan Capistrano, CA

More Information

  • Care rendered outside the SNF or by non-SNF providers, does it compliment or disrupt the care continuum?
    • Wound care consultants, physicians and the importance of written orders, and compliant documentation
    • Hospice care and who is responsible for effective pain management, oxygen, skin integrity, and end of life care
    • Dialysis care, emergency room wait times, and impact on skin integrity
  • Agency staffing, wage inflation, social inflation, and the great resignation, what is the short term impact on care and risk?
    • This program will also expound upon liability Issues inherent in care transitions for the elderly and infirm
  • Analyzing recent cases dealing with liability issues in care transitions and how these situations can be avoided for long term care health care providers
    • Documentation issues
    • Effective communications with stakeholders

20. Navigating Relationships Between Ancillary Providers and Long-Term Care Facilities (SNF, AL, HH)​ (repeat)
Ragini Acharya, Husch Blackwell LLP, Denver, CO
Anna F. Munoz, Senior Director, Legal Operations, Licensing & Risk, Brookdale, Milwaukee, WI

More Information

  • The types of relationships between ancillary providers and long-term care facilities
  • Considerations for contractual agreements, such as third party access agreements, partnership/joint venture arrangements, and space leases
  • Impact for licensure or other government approvals
  • Case studies and review of best practices to avoid violations of fraud and abuse laws

23. Developing Effective Staff Screening Procedures in Long Term Care and Immigration Options for Addressing Shortages​ (SNF, AL) (repeat)
Richelle D. Marting, Attorney with Marting Law LLC, Olathe, KS
Dustin J. O'Quinn, Lane Powell PC, Seattle, WA

More Information

  • Applicable federal, and common state law requirements and restrictions governing employment of individuals with certain convictions or administrative findings and consequences for hiring prohibited or excluded individuals
  • OIG LEIE database and additional screening sources, and limitations to effective searches
  • The challenge with effective searches in the context of staffing shortages and staffing agencies
  • Strategies to expand effective staff screenings to third party vendors
  • Work-authorized visas available to long term care employees
  • Visa application processes and timelines for foreign students and graduates inside and outside the United States
 
12:15-1:15 pm Concurrent Sessions

22. Confronting and Resolving Difficult Problems Associated with Involuntary Discharges from Assisted Living and Nursing Facilities​ (SNF, AL) (repeat)
Randall R. Fearnow, Quarles & Brady LLP, Chicago, IL
Robert J. Lightfoot, Reinhart Boerner Van Deuren SC, Madison, WI

More Information

  • Situations which often result in efforts by SNF and AL providers to discharge residents involuntarily
  • The special problem of the difficult resident or family member
  • Valid and invalid bases for involuntary discharge, including the resident's failure to pay for services
  • Avoiding legal and ethical risks associated with nursing and assisted living facility collection efforts
  • Compliance with notice and procedural requirements for involuntary discharges
  • What to do when a resident or family member refuses to vacate the premises

25. Private Equity Ownership: How to Prepare for the Government’s New Focus in Long Term Care Enforcement (SNF, AL) (repeat)
Thomas H. Barnard, Baker Donelson Bearman Caldwell & Berkowitz, Baltimore, MD
Bridgette Uhlemann, VP/Corporate Counsel, Director of Legal and Compliance, Life Care Services, Des Moines, IA

More Information

  • The federal government’s focus on private equity’s role in the ownership of LTC facilities and the risks that private owners face
  • Risks these transactions pose and how to mitigate risk and exposure. At the state level, disclosure rules and filings continue to raise challenges for facilities
  • An increasing number of nursing and long term care facilities are involved in transactions with or owned by private equity (PE) firms. Public statements by the President and other agencies have revealed a growing distrust of PE involvement
  • The government has expressed concern over the lack of transparency regarding ownership, as well as a perceived focus away from patient care to a profit-first mentality
  • The financial challenges of long term care related operations, staffing costs, and other challenges make the availability of support from private equity essential to sustain many facilities
  • Critical to this transition to new types of ownership are issues related to the transactions themselves, issues learned during due diligence, and strategies for clarifying control or ownership

26. Understanding And Mitigating Litigation And Regulatory Risks In Assisted Living​ (AL) (repeat)
Tomek Koszylko, Counsel, Vi Living, Chicago, IL
Payam A. Saljoughian, Hanson Bridgett LLP, San Francisco, CA

More Information

  • The most common claims reported in assisted living
  • Fact patterns that expose assisted living providers to claims
  • Common areas of regulatory risk in assisted living
  • Current trends impacting the assisted living industry
  • Practices implemented by providers to address risk factors

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In-Person Program Format

How It Works

  • We will offer in-depth breakout sessions where speakers and attendees can interact and collaborate with each other in-person.
  • We consider the health and safety of all those onsite at in-person programs our top priority. AHLA will follow guidance and requirements issued by the CDC as well as by state and local government.. 
  • All attendees, who register for the in-person program, will be required to commit to our Duty of Care agreeing to follow the protocols we establish and monitor their own health for the health and safety of all. 
  • We have adopted a new onsite registration system by providing seamless check-in, onsite badge printing, and safety supplies to all attendees to use while in attendance.
  • Built-in extended time between sessions for moving from room to room, networking with colleagues, and personal break time.  
  • Socially distanced seating arrangements in breakout rooms, regular cleaning in and around meeting spaces, and appropriate signage/floor decals to reinforce spatial distancing and other safety reminders.
  • All program sessions will be recorded. Video of the presentations, along with the materials will be available to all attendees who register to apply for additional On Demand Continuing Education Credits. Those that cannot attend in-person can purchase the eProgram and apply for Continuing Education Credits. More information on our ePrograms.
  • For questions or more information, please email [email protected]
Program Accessibility and Special Needs

AHLA is committed to ensuring equitable access to our educational content. We are continually improving the user experience for everyone and offering accessibility accommodations for our in-person programs.

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Safety Protocols

AHLA considers the health and safety of all those onsite at in-person programs our top priority. During these challenging times, AHLA is committed to providing a safe and healthy environment for all of our in-person programs participants and staff. 

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Thank You to Our Long Term and Post-Acute Care Law and Compliance Sponsors

The Completed Life LogoDorsey & Whitney LogoInitial VII Consulting LogoNtracts LogoProactive Logo

If your organization is interested in sponsoring AHLA's Long Term and Post-Acute Care Law and Compliance program, please contact Valerie Eshleman.