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LONG-TERM ACUTE CARE HOSPITALS (LTCHs)

Jason specializes in legal issues affecting long-term acute care hospitals.  He served as General Counsel to the Acute Long Term Hospital Association (ALTHA), the leading LTCH trade association with over 300 member hospitals.  In this capacity, Jason advised ALTHA on legislative, rulemaking, and other legal matters affecting its membership.  Jason also counsels individual and chain LTCHs on virtually every type of legal matter impacting their business, including: legislation, regulation, compliance, reimbursement, litigation, development, transactions and other issues.  His relevant experience and capabilities include:

 

Legislation

 

  • Active involvement in every piece of federal LTCH legislation over the past 8 years
  • Helped shape legislative proposals, achieve consensus with other hospital trade associations, and work with Congressional staff and legislative counsel on LTCH bills that were enacted as part of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), the American Recovery and Reinvestment Act of 2009 (ARRA), and the Patient Protection and Affordable Care Act of 2010 (PPACA)
  • Regularly counsel LTCHs on the impact of these statutes on their business, including the LTCH facility and bed moratorium and MMSEA regulatory relief

 

Regulation

 

  • Prepare written comments to LTCH Medicare payment updates and other rulemakings on behalf of LTCH companies
  • Advise LTCHs on Medicare regulations and policies that impact LTCHs, including rules concerning: hospitals-within-hospitals, satellite facilities, remote locations, provider-based entities, and grandfathering

 

Compliance

 

  • Regularly advise LTCHs on average length of stay (ALOS) calculation and compliance matters, coordination with Medicare FI/MAC on ALOS testing
  • Assist LTCHs with compliance programs, legal reviews of compliance issues, internal audits, and legally privileged independent audits
  • Advise and assist with overpayment and other compliance disclosures to government agencies
  • Advise LTCHs on corporate integrity agreement compliance and disclosures 

 

Reimbursement

 

  • Regularly counsel LTCHs on the LTCH prospective payment system (LTCH PPS) and its payment adjustments, including the 25% Rule, high cost outliers, and short stay outliers
  • Advise LTCHs on outlier reconciliation
  • Assist LTCHs in obtaining written guidance from CMS and its components on regulatory issues
  • Work with LTCHs on proposed cost report adjustments and other reimbursement disputes to avoid the need for appeal

 

Litigation

 

  • Federal and state court challenges to LTCH regulations and reimbursement determinations
  • Represented hundreds of LTCHs in administrative appeals of Medicare reimbursement disputes on cost report determinations before the Provider Reimbursement Appeals Board and CMS Administrator, and on claims determinations before Administrative Law Judges and the Departmental Appeals Board
  • Significant success in representing dozens of LTCHs in appeals challenging WPS medical necessity audits
  • Represented LTCHs in Medicare decertification appeals to the Departmental Appeals Board where all appeals were resolved favorably

 

Development

 

  • Negotiated more than a dozen lease agreements and ancillary services agreements for new LTCH hospitals-within-hospitals and satellite facilities
  • Advise LTCHs on moratorium issues including new buildings, bed increases, relocations, satellite facilities, remote locations, certificates of need, and provider-based status
  • Assist LTCHs with obtaining advance determinations from CMS on moratorium exceptions

 

Transactions

 

  • Perform regulatory due diligence for buyers and sellers in LTCH transactions with an emphasis on LTCH-specific regulatory and compliance issues
  • Provide written opinions of relative risk associated with regulatory issues identified for target companies
  • Advise and assist LTCHs with government approvals and notifications in connection with licensure, certification, and accreditation requirements
* Long-term acute care hospitals may be referred to using the acronyms LTCHs, LTACs, or LTACHs.