Garfunkel Wild's Long Term Care Practice Group is comprised of individuals with deep experience in this segment of the health care industry, including former general counsels of national companies, who bring a seasoned and practical approach to the many challenges facing providers, suppliers, and investors. Our clients are engaged in skilled nursing, assisted living, home health, rehabilitation, continuing care retirement communities, behavioral health, infusion, and hospice and palliative care.
Our team regularly advises on and assists with:
Mergers, acquisitions and joint ventures
Transactional due diligence
Federal and state regulatory compliance
State licensure survey and enforcement matters, audits and investigations
Risk management
Digital health technology
HIPAA privacy and security
Entity formation and structuring
Third party payor negotiations (including Medicare Advantage and ISNPs)
Contract negotiations with vendors and other third parties
Medicare and Medicaid enrollment, compliance and reimbursement issues
CARES Act compliance
Labor and employment matters
Discharge planning and appeals
Resident rights
Guardianship proceedings
Treatment issues, including DNR and MOLST
Our team is available to provide immediate assistance in emergent situations, such as removing immediate jeopardy citations, responding to incidents, communications strategies, conducting incident investigations and addressing urgent treatment, transfer and discharge matters. We also conduct training for facilities and staff concerning new or existing legal requirements. Our team’s broad experience means that an answer to a pressing client question is usually only a phone call away. Garfunkel Wild attorneys are mindful of the many pressures facing industry participants and always strive for unsurpassed responsiveness and efficiency in the handling of matters trusted to us.
Garfunkel’s Compliance Webinar Series rolls on with an examination of the 2024 Work Plan published by the New York State Office of Medicaid Inspector General (OMIG).
The recently enacted New York State (NYS) budget for fiscal year 2025 significantly changed who can be a Fiscal Intermediary (FI) under the state’s Consumer Directed Personal Assistance Program (CDPAP). This change was made by amendment to Social Services Law (SSL) § 365-f by eliminating the CDPAP request for offers (RFO) process that was in place for designating FIs (RFO #20039).
On Tuesday, April 23, 2024, the Federal Trade Commission (FTC) promulgated a final rule banning most non-compete agreements, in any industry, and is set to become effective 120 days after its publication in the Federal Register (the “Final Rule”).
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted a favorable Advisory Opinion (24-02) permitting a non-profit organization (Non-Profit) to provide financial support to eligible patients with specific rare diseases through assistance programs (Programs) it operates.
Nursing homes being cited for Life Safety Code (LSC) deficiencies by the New York State Department of Health (DOH) are on the rise. The difficulty achieving substantial compliance or obtaining a waiver places nursing homes at risk for termination from Medicare and Medicaid, denial of payments, and monetary penalties.
The United States Department of Health and Human Services (HHS), Office of Inspector General (OIG) recently posted a new educational resource on its website about Single Audits. HHS is the largest grant-making agency in the Federal government, and OIG’s new resource is designed to help key stakeholders understand the scope of Single Audits, as well as improve the overall quality of such audits.
Governor Hochul’s 30-day Amendments to her proposed state fiscal year 2025 Executive Budget would significantly change New York State’s (NYS) Consumer Directed Personal Assistance Program (CDPAP) and what licensed home care services agencies (LHCSAs) can enroll or re-enroll in Medicaid.
On January 8, 2024, New Jersey passed a law that permits Clinical Social Workers, Professional Counselors, and Marriage and Family Therapists to bill NJ Medicaid/NJ FamilyCare directly for services rendered to Medicaid beneficiaries.
The New York State Office of the Medicaid Inspector General (OMIG) recently updated its Self-Disclosure Guidance and Frequently Asked Questions (collectively, “Updates”). These Updates give participating providers and entities additional insight into how to report overpayments involving unresponsive Medicaid Managed Care Organizations (MMCOs) or multiple entities, as well as those that are untimely, have adjusted or voided claims, or lost or damaged records.
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted a favorable Advisory Opinion (23-12) that allows a limited liability partnership (the Partnership) consisting of two classes of physician partners to make a one-time, voluntary redemption offer (offer) to individual partners when they reach age 67.
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted a favorable Advisory Opinion (23-15) permitting a consulting company’s (Consultant) proposal to offer gift cards to its current physician practice customers for referring potential new physician practice customers to Consultant. Notably, OIG determined that the proposed arrangement did not implicate the Anti-Kickback Statute (AKS).
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) released a new toolkit to help Medicare Advantage (MA) organizations replicate OIG audit methodologies to detect and correct inaccurate diagnosis codes in their own systems.
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) recently designated oversight of managed care as a “priority area”, and developed a coordinated strategic plan (the Plan) to better align its audits, evaluations, investigations, and enforcement of managed care.
The New York State Office of the Medicaid Inspector General (OMIG) released its 2024 work plan in furtherance of its mission to coordinate and conduct activities to prevent, detect and investigate medical assistance program fraud, waste and abuse, and to recover improperly expended Medicaid funds.
Continuing its year-end reporting blitz, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Semiannual Report (SAR) to Congress on December 1, 2023.
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted two favorable Advisory Opinions (23-09 and 23-10) to allow a licensed offeror of Medicare Supplemental Health Insurance (Medigap Plan) policies and a preferred health organization (PHO) (collectively, “the requestors”) to incentivize Medigap Plan policyholders to seek inpatient care from a hospital within the PHO’s network. Notably, OIG issued these favorable opinions even though the proposed incentives implicated the Anti-Kickback Statute (AKS) and the Beneficiary Inducement Civil Money Penalty (CMP), and there was no applicable exception or safe harbor.
On November 17, 2023, the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) published a final rule (“Final Rule”) imposing new ownership disclosure requirements on Medicare skilled nursing facilities and Medicaid nursing facilities (“nursing homes”). Due to concerns over the quality of patient care in facilities owned by certain types of nursing facility owners, including private equity companies and real estate investment trusts, CMS believes these new disclosure requirements will allow them to monitor and hold nursing homes accountable.
This week, the United States Department of Justice (DOJ) and the United States Department of Health and Human Services (HHS) fulfilled its annual statutory obligation by releasing its jointly-authored Health Care Fraud and Abuse Control Program (HCFAC) Report for Fiscal Year 2022.
The U.S. Court of Appeals for the Second Circuit decision held that while nursing homes have a general obligation to adequately care for their residents, there is no specific requirement that nursing homes use Medicaid or Medicare reimbursement payments in a certain way because such payments are reimbursements for services already provided to residents, and do not contain “forward-looking conditions” on how the funds must be used.
The OIG fulfilled its annual statutory obligation by releasing its Top Management and Performance Challenges (TMC) document. Providers should take note because the document provides important insight into the specific areas over which HHS (and the OIG) will remain focused.
On November 15, 2023, the DOH adopted new regulatory requirements for adult ACFs in an effort to expand resident rights in conformance with the CMS’s HCBS rule final rule. ACFs across the State are now required to allow residents to have visitors at any time, giving them unrestricted access to common areas.
On November 6, 2023, the OIG released its General Compliance Program Guidance, the first in a series of new, non-binding reference guides designed to share information with health care compliance professionals and other health care industry stakeholders
Join Garfunkel Wild’s Jeffry Adest, Emily Schwerd, and Jenny Brown as they discuss the OSV process, highlight the areas HRSA reviewers consider, and impart meaningful tips on how FQHCs can be in compliance.
In what appears to follow a multi-state trend to protect “temporary” workers, as part of the New York Budget for FY 2023-2024, a new law went into effect that requires any entity that provides temporary staff to health care entities to register with the Department of Health (DOH).
On June 5, 2023, the Centers for Medicare and Medicaid Services (“CMS”) published a much anticipated Final Rule surrounding vaccination and related requirements surrounding the COVID-19 Public Health Emergency.
Governor Phil Murphy signed an Executive Order lifting COVID-19 testing requirements for health care and congregate care settings. This Executive Order took effect April 3, 2023.
Governor Kathy Hochul re-instated provisions in the State Public Health Law (Sections 2895-b[3] and 2828[1]). The New York State Department of Health (DOH) later notified nursing home administrators that these two provisions are in “full effect” as of April 1, 2022.
Garfunkel Wild’s Debra Silverman and John Martin will present the webinar “Federal No Surprises Act – One month in. What have we learned? What questions remain?" on February 1, 2022, from 12:00 pm – 1:00 pm (EST).
Garfunkel Wild Of Counsel Eve Green Koopersmith will present at the Greater New York Health Care Facilities Association’s Webinar: LTC New Horizons…New Governor, October 7, 2021.
As the Delta variant of COVID-19 continues to spread, New York, New Jersey, and Connecticut have mandated that certain health care workers be vaccinated against COVID-19.
On June 11, 2021, Governor Cuomo signed Senate Bill S6767 into law. The amended law, which takes effect on October 21, 2021, will continue to greatly impact the ownership and operation of nursing homes in New York by imposing broad notice and contract disclosure requirements on nursing homes.
In a Dear Administrator Letter (“DAL”) dated May 28, 2021, the New York State Department of Health highlights the differing requirements long-term care (“LTC”) facilities must meet regarding COVID-19 vaccinations under recent federal and state regulations.
In an effort to prioritize and increase infection control in adult care facilities, SB 1784A and AB 5846 were introduced in the New York State Legislature.
In a memo, dated September 28, 2020, the Director of the Quality, Safety & Oversight Group in CMS’ Center for Clinical Standards and Quality clarified that facilities that activated their emergency plans due to the COVID-19 Public Health Emergency (PHE) are exempt from their next required full-scale community-based or individual, facility-based functional exercise.
On May 1, 2020, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule with comment period that establishes new COVID-19 reporting requirements for long term care (LTC) facilities.
Garfunkel Wild’s Eve Green Koopersmith and Doris L. Martin will present the webinar “Personal Advance Care Planning in a Pandemic: How can I get my health care proxy, living will and estate planning documents in order” on April 23, 2020.
Garfunkel Wild’s Eve Green Koopersmith will present the webinar “Nursing Facility Update: 1135 Waivers and NYS Executive Orders Explained Emergency Treatment Protection Act (Immunity) And Telehealth Expansion” on April 21, 2020.
CT Governor Signs Orders Regarding Waivers for Healthcare Providers Related to COVID-19, Restricting Surprise Bills for Out-of-Network Services and Uninsured COVID-19, and Extending Permits and Pre-Licensure for Health Care Professionals.
In an effort to ensure the availability and accessibility of health care items and services, the Centers for Medicare and Medicaid Services (CMS) has issued blanket waivers of sanctions under the federal physician self-referral law (also known as the Stark Law) in response to the COVID-19 pandemic (the “Stark Blanket Waivers”).
Garfunkel Wild Partner/Director Eve Green Koopersmith will present the webinar “New Rules, New Monitors and New Spotlight on Nursing Homes” on April 1, 2020.
New York State’s rapidly evolving response to COVID-19 has resulted in a number of new Executive Orders (“Orders”) from Governor Cuomo, as well as various regulatory waivers and guidance from the Centers for Medicare and Medicaid Services, the New York State Department of Health and other state agencies.
We have been heartened by many of our client healthcare facilities and providers developing and offering up unique and creative solutions to address the surge of healthcare needs from the evolving COVID-19 outbreak.
The number of confirmed cases of COVID-19 in the United States is increasing rapidly and health care providers need to be prepared. Federal, state and local government agencies recommend that health care providers take various steps during their preparation efforts, including...
Eve Green Koopersmith will present at the Greater New York Health Care Facilities Association’s (GNYHCFA) Seminar – Regulatory Updates – March 5, 2020.
The New York State Legislature has expanded the authority of Mental Hygiene Legal Service (“MHLS”) to provide legal assistance to certain residents of residential healthcare facilities.
On October 9, 2019, New York State Department of Health (DOH) announced that it will be implementing a new methodology for adjusting nursing home Medicaid reimbursement rates, commonly referred to as the “case mix adjustment.” The revised methodology will apply retroactively to July 1, 2019. Under DOH’s revised methodology, adjustments will continue to be made in January and July of each calendar year based on the (Medicaid–only) case mix data for the previous case mix period.
Garfunkel Wild Partner/Director Debra A. Silverman and will be joined by Garfunkel Health Advisors, Inc., President Alicia Shickle to present a complimentary webinar entitled “Resolving Payer Obstacles,” Thursday, August 8, 2019 from 12:00 PM – 1:00 PM EDT.
Garfunkel Wild Partner/Director Peter M. Hoffman will host a webinar entitled “Home Care Referrals, Marketing, and the Kickback Laws” on Tuesday, March 19, 2019.
For those providers and suppliers that are subject to survey in order to maintain their Medicare status (e.g., hospitals, ASCs, SNFs, home health agencies), CMS has published important revisions to its current survey guidelines.
