Our Legal Services for the Health Care Industry
Because the health care industry is heavily regulated, providers need to respond promptly, effectively and efficiently to regulatory requirements and changes. Our attorneys and staff have extensive experience in regulatory matters. We’re committed to analyzing the rapidly-changing regulatory environment and keeping our clients advised on regulatory changes affecting their operations.
We frequently present lectures at educational seminars on statutory and regulatory changes sponsored by health care trade associations and professional groups. In addition, we participate in continuing education programs for health care professionals and attorneys on health law matters.
Our firm also conducts its own seminars which are approved for continuing education credits through the National Continuing Education Review Service of the National Association of Boards of Examiners for Nursing Home Administrators, as well as the Pennsylvania State Board of Accountancy and the Pennsylvania Continuing Legal Education Board.
Read on to learn more about our various health care law specialties, or contact us to discuss how we can help your organization. The experienced and knowledgeable Capozzi Adler team is here to assist you with our legal services for the dynamic and challenging health care industry.
Admission Agreements for Skilled Nursing Facilities
Because the overall effectiveness of your facility’s accounts receivable is founded upon the strength of your Admission Agreement forms, we’re here to consult with you on how to effectively modify yours to protect the financial interests of your facility. When properly executed by all parties, your Admissions Agreement is a valid contract that provides your nursing facility with certain rights as a creditor and claimant under state and federal laws.
Assisted Living Law
We serve as counsel for assisted living providers. In fact, we were formerly General Counsel for the Pennsylvania Assisted Living Association. At Capozzi Adler, we have worked closely with providers and government staff to develop new laws and regulations for assisted living in Pennsylvania.
Collections and Management of Accounts Receivable
Our firm’s specialized attorneys provide collections and debt recovery services to our health care and commercial clients. We work directly with our clients to develop collection strategies, provide advice as to specific aging accounts, and take the appropriate courses of action to liquidate accounts receivable and recover outstanding debt. We also conduct cost-benefit analyses to ensure collection efforts are cost-effective and timely.
In sum, our collections staff provides a legal service not found at general collection agencies. We’re experienced in creditors’ rights, civil litigation, debt collection laws, asset searches, and the diverse regulatory, contractual, and family-related issues common in health care and long-term care collections. Our attorneys are knowledgeable in the laws related to Medicaid, Medicare, Social Security, and other payer sources.
Community HealthChoices Contracting
Long-term care providers in the Commonwealth face continued reimbursement challenges under Community Health Choices Managed Care. Fortunately, Capozzi Adler is available to assist your facility with negotiating contracts with the CHC-MCOs.
Background on Managed Care in Pennsylvania:
During the continuity of the care period, which is a period of 18 months from implementation, DHS mandates that the CHC MCOs contract with all existing Medicaid certified nursing facility providers if those nursing facility providers are willing to do so and are willing to accept the Community HealthChoices rates for payment. During this transition period, the CHC MCOs have agreed to pay providers a “rate floor” for the first three years after implementation of CHC in the region, which consists of an average of the four quarterly Medicaid rates effective prior to the date of implementation in the region.
Now that all of the Commonwealth has entered into Community Health Choices Medicaid Managed Care effective January 1, 2020 in the “Other Region” and CHC has now entered “steady state” operations, the long term care provider community must turn its attention to what is next for Medicaid Managed Care. The “any willing provider” period expired for the Southwest Region on June 30th 2019, expired for the Southeast region on June 30th, 2020 and expires for the rest of the Commonwealth on June 30th, 2021. After the “any willing provider” period expires in each region providers will essentially be on their own as to whether they will be able to contract with one or all three of the CHC MCOs. Moreover, after the end
of the rate floor, providers will again be completely on their own with respect to negotiating their rates for Medicaid recipients, with essentially private entities that are the CHC MCOs. The rate floors will no longer exist.
Rate floors have not kept pace with increased acuity of patients/ residents being served by providers, or the increased costs of providing that care. Not only have the rate floors not kept pace with costs, but payment methods will need major adjustments to take into account the demonstrated increased cost of infection control compliance from the ongoing COVID-19 pandemic and the projected enhanced licensing and certification (including OSHA) requirements, as well as increased insurance and staffing costs, expected to follow from it.
If you have questions on Managed Care in Pennsylvania or if you would like assistance in negotiating your contracts, please contact Daniel Natirboff, Esquire at firstname.lastname@example.org or 717-233-4101.
Continuing Care Retirement Communities (CCRCs)
CCRCs, as hybrid providers of a continuum of services, face legal and regulatory issues not confronted by free-standing long-term care providers. Our attorneys can help a CCRC develop residency agreements and respond to the wide variety of legal challenges. We can also assist in resolving the regulatory and structural issues related to developing a CCRC.
At Capozzi Adler we understand the regulatory framework of the Insurance Department and are familiar with its regulators. We were Counsel for the CCRC in the successful and precedent-setting Chapel Pointe case. In that case, the Pennsylvania Supreme Court held that Chapel Pointe’s CCRC was exempt from the payment of all real estate taxes beginning in 2001.
Corporate Compliance Services
At Capozzi Adler, we’re a leader in health care compliance, particularly in the long-term care field. Our firm began implementing corporate compliance programs for our long-term care clients even before the Department of Health and Human Services’ Office of Inspector General issued its voluntary Compliance Guidance for nursing facilities. Today, our leading-edge, proactive approach remains intact. We continually seek the newest and best practices in health care compliance, and we assist our clients in implementing those practices in a careful, cost effective manner.
Guardianships for Residents of Nursing Facilities
Our firm has developed a statewide guardianship practice, and we work with clients to obtain guardianships to protect residents and assure continuity of their care. We’ve developed strong relationships with guardianship services organizations that serve as guardians for residents who have no relatives willing to accept the responsibility, or for residents who need an independent guardian.
We offer flat-fee pricing for uncontested guardianships. We also have experience in coordinating guardianship proceedings with Medicaid eligibility determinations to assure continuity of Medicaid payments.
Insurance Liability Defense
Capozzi Adler can act as insurance defense counsel in nursing facility liability and malpractice cases. We serve in that capacity for other types of liability cases as well, providing experienced, committed representation.
Medical Marijuana Practice Group
With the passing of Medical Marijuana Act on April 17, 2016, the Commonwealth of Pennsylvania has entered a new era of therapy and treatment for patients suffering from Serious Medical Conditions enumerated in the Act such as Cancer, Parkinson’s Disease, chronic pain not treatable by conventional pain therapies, seizures, Epilepsy, Autism and Neuropathies. We at Capozzi Adler, PC support this courageous and compassionate legislation and are proud to announce the services of our Cannabis Practice Group. We are uniquely prepared, based on our experience in serving Health Care Providers and navigating the complex statutory and regulatory issues that will come with Department of Health oversight and administration of the Pennsylvania Medical Marijuana Program, to assist potential grower/processors and dispensaries in obtaining licenses/permits and ongoing Compliance with the Act and future regulations. Our Firm will also bring a team approach integrating our other practice areas in all aspects of the Medical Marijuana business including:
- Labor and Employment issues
- Business Organization
- Regulatory compliance and external auditing
- Enforcement Issues
With the passing of the Medical Marijuana Act, Pennsylvania legalized medical marijuana, however it is still a federal crime to grow, sell and/or use marijuana as it remains a Schedule I controlled substance under applicable federal law. All content herein is not intended to provide legal advice to assist with violation of any state or federal law.
Medicare & Medicaid Appeals
Capozzi Adler, P.C. is the leading firm providing this type of health care legal service in the Commonwealth. We have a proven and well-documented litigation record of success in the resolution of Medicare and Medicaid reimbursement appeals. No other firm has represented more clients with more docketed appeals before the Department of Human Services Bureau of Hearings and Appeals (“BHA”). We have litigated more than 1,000 appeals to increase client’s Medicaid and Medicare reimbursement, including litigation before federal courts including the Third Circuit Court of Appeals, the Commonwealth Court, and the Supreme Court of Pennsylvania.
We have also litigated numerous administrative appeals and regulatory matters in other states. Over a three year period, our reimbursement department has obtained $7,941,000 in additional Medicaid reimbursement for our clients. While budgetary cuts at the state and federal levels have resulted in efforts to reduce reimbursement to healthcare providers, our goal is to “level the playing field” and obtain the reimbursement for care and services to which our clients are legally entitled.
Real Estate Tax Exemption and Assessment
Capozzi Adler has attorneys experienced in representing both nonprofit and for-profit providers in real estate tax assessment appeals. We help them obtain exemptions or reductions in their real estate tax assessments and will litigate issues through the appeal process when an amicable resolution is impossible. In addition, we help our nonprofit clients develop compliance guidelines for preserving their tax exempt status. We’re also experienced in obtaining exemptions from Federal and State sales and use taxes.
Sales and Acquisitions of Nursing Facilities
In numerous transactions, our firm has acted as special or corporate counsel, including those involving acquisitions of facilities in bankruptcy. We work to structure transactions to enhance Medicare/Medicaid reimbursement and to streamline the regulatory approval process. We also advise clients on how best to address Union collective bargaining agreements, including negotiating new agreements and eliminating exposure for the prior owner’s past employment practices. During the week of July 1, 2011, we successfully closed over $30 million in sales for our clients.
Special or General Counsel to Health Care Providers
At Capozzi Adler, P.C., we assist with the general and corporate issues every business, including health care providers, must confront. We’ve assisted with restructuring some of our clients to better position themselves for the risks and challenges of the changing health care system. By doing so, we’ve helped clients to pursue participation in joint ventures and to diminish the risk associated with expanding into new service areas.
We also provide special assistance to our clients by updating existing policies and practices, including employee manuals, and drafting admissions agreements and other contracts that meet program and licensure requirements. In addition, we provide assistance with obtaining timely collections and the resolution of disputes, and we help our clients with the development of home and community based service programs. To help clients respond to the ever-changing health care delivery system, we also assist them in their strategic planning efforts.
Survey and Enforcement
Capozzi Adler, P.C. offers broad experience in assisting providers through the compliance, survey, and enforcement process. Our attorneys are familiar with the requirements for participation in Federal and State health care programs. We assist our clients with obtaining and maintaining required licensures and certifications while meeting compliance standards for those programs. We have assisted providers in developing effective health care policies and in responding to both State and Federal regulators.
In addition, we have worked with our clients to successfully utilize the informal dispute resolution process. Recognizing sound business sense, we work to resolve some survey disputes amicably without relinquishing the merits of the provider’s position and while preserving the provider’s appeal rights.