Long-Term and Post-Acute Care Providers
If you are a long-term care or post-acute provider, we have significant experience in every facet of the law to help you. We guide clients through acquisitions, joint ventures, and other affiliations, including transactions involving complex certificate of need (CON), licensing, and other regulatory issues. We also can provide you with guidance if you are closing a facilities and must transfer their residents to other locations.
Advised one of the nation’s largest senior CCRC through a bankruptcy sale
“We’re starting a new chapter in the Henry Ford Village story, and we’re pleased to do so having achieved a stronger financial foundation and maintained the best interests for the full HFV community,” said Bruce Blalock, HFV’s Executive Director.
HFV is one of the nation’s largest independently operated nonprofit Continuing Care Retirement Communities (CCRC), and accomplished entry of a sale order approving the sale for substantially all of HFV’s assets for $76.3 million. The sale order was entered by the United States Bankruptcy Court in the Eastern District of Michigan on May 25, 2021, and the Dykema team carefully shepherded HFV through its reorganization.
Dykema is recognized for its track record of success serving the full spectrum of long-term care and post-acute provider clients. This includes:
- Nursing homes
- Homes for the aged
- Adult foster care facilities
- Unlicensed assisted living facilities
- Continuing care retirement communities (CCRCs)
- Senior housing
- Post-acute rehabilitation services
- PACE providers
- Home health agencies
- Hospices
We help clients with Michigan CON applications for acquisition, replacement, and relocation of acute care and psychiatric hospital beds, nursing home beds (including CON approvals for special population beds for Alzheimer residents, hospice use or special religious needs), nursing home “green house,” and new model design projects, and Facility Innovative Design Supplement program issues under the Michigan Medicaid program.
CON programs aim to control health care costs by restricting duplicative services and determining whether new capital expenditures meet a community need, but can be complicated to navigate from an individual system perspective, with its own assessment of capital needs.
Our deep experience working with MDHHS CON Section provides us the expertise to efficiently complete complex transactions requiring CON approval.
We have experience in working with clients through all stages of the nursing home development cycle, from initial startup or acquisition, and expansion to ultimate sale or winding down.
When it comes time to acquire or sell a facility, we can assist small and large chain skilled nursing facilities and nursing homes with the various change of ownership (CHOW) filings:
- CON approval
- Facility licensure and ancillary licensure issues (e.g., foodservice, medical waste, etc.)
- Medicare Certification: CMS 855A, filings, CMS regional office approvals, Medicare tie-in notices
- State Medicaid enrollment and certification, licensure issues, and risk assessment
- CLIA certification
We have completed hundreds of CHOW filings with the LARA BCHS and MDHHS CON Section and MDHHS Sections for Medicaid Policy, and Planning and Long Term Care Reimbursement and Rate, providing us valuable insight into the CHOW process in Michigan.
As providers retool to successfully take on this decade’s challenges, Dykema stands ready to assist with obtaining and retaining state licensure, including options to operate legally as an unlicensed facility and structuring joint ventures between and among hospices, home health agencies, nursing homes, and senior living facilities.
We regularly work with LARA Bureau of Community and Health Services to ensure efficient licensure of communities and have particular experience with Michigan Home for the Aged and Adult Foster Care licensing and exemption matters.
We have an experienced public finance and commercial finance team who can assist with tax exempt bond financings, private equity financings, and HUD financings. We regularly prepare licensing opinions on behalf of our clients.
We represent long-term care clients with respect to:
- Medicare certification for skilled nursing facilities (SNFs), SNF operational and compliance issues, including assistance with development of SNF compliance programs and materials consistent with applicable OIG guidance and anti-fraud provisions of the Deficit Reduction Act (DRA)
- Survey and long term care enforcement support, including informal appeals (IDR and IIDR), preparing plans of correction, and full administrative hearings
- Assisted living licensure issues, including regulation of non-licensed assisted living facilities, development of assisted living contracts, including food service contracts, personal care services agreements and private duty nursing service agreements, home for the aged licensure, and licensure of facilities as adult foster care facilities
- Contractual arrangements
- Nursing home and SNF management contracts and operational agreements, including management agreements for county medical care facilities, representation of REITs regarding nursing home and SNF properties and management issues, including regulatory matters related to foreclosure and termination of leases for nursing home and SNF operators and lessees.
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