CONTINUING CARE AT HOME INTENSIVE LEGAL CHALLENGES WITH DEVELOPING CONTINUING CARE AT HOME Kimber L. Latsha, Esq. 2014 LeadingAge Annual Meeting and Exposition Nashville, TN October 19-22, 2014

CCRCs AND CCaH PROGRAMS – COMPARISON OF CONTRACTUAL OPTIONS Provide a continuum of care to older adults Various contract options available for Resident/Member “Life Care” model Modified model “Fee-for-Service” model Entrance/Membership Fee Refundable Options – 25% - 90/100% Nonrefundable and full amortization Health Insurance typically is required, including Medicare Supplemental Coverage

CONTRACTUAL OPTIONS FOR CCaH MEMBERS Typically Members pay a one-time enrollment fee and a monthly maintenance fee Several plan options with different levels of coverage and payment Home Care Only Plan – covers services provided while living at home Life Care Plan – covers services provided at home and, if necessary, in an assisted living facility or a nursing home

TYPICAL SERVICES OFFERED Provided directly or under contractual arrangements What is included in the Monthly Fee? Care Coordination Home Visits Annual Physical Access to Campus Activities Wellness Programs Transportation Companion/Live In Care Home Care or Home Health Care  Call/Notification of Change in Condition System Adult Day Care Meals Referral Services Assisted Living/Personal Care Nursing Home Care

REGULATORY COMPLIANCE AND IMPACT ON MEMBER CONTRACTS Registration as a CCRC under existing regulatory framework “Entrance fee” compliance requirements Mandatory contractual provisions Disclosure Statement requirements

CONTRACTS & DISCLOSURE STATEMENT WITH MEMBERS/CONSUMERS Disclose, Disclose, Disclose Eliminate any ambiguity Payments and covered benefits Termination Consider Alternatives To Full “Life Care” to Reduce Cost & Minimize Risk Caps on benefits Disclaimers for Emergency Care & Define Contractual Limitations on Care Coordinator Insurance and Indemnification

PROVIDER CONTRACTS & NETWORK Range of LTC Services from Care Coordination/Case Management IADL, ADLs through institutional nursing facility Focus on Wellness Programs Maintain health of members Friends at Home VigR™ Program Credentialing of providers and quality control Licensing Certification Other credentials Member choice Affiliate providers & in-network negotiated rates Contracts With Network Providers Screening/reputation Impose quality & credentialing standards Insurance & indemnification requirements Payment Termination

LEGAL ISSUES Selecting Structure of Entity Separate legal entity or operate as a division of existing CCRC Separate entity considerations Non-profit corporation LLC Acquisition of tax exemption Purpose of entity and connection to mission of charitable, non-profit system

INSURANCE ISSUES RELATED TO CCaH Liability Insurance Coverage Is the CCaH “business line” included within existing comprehensive liability coverage? Is it a different product requiring a rider? Are there additional premium costs?

QUESTIONS? Kimber L. Latsha, Esq. Latsha Davis & McKenna, P.C. 1700 Bent Creek Blvd., Suite 140 Mechanicsburg, PA 17050 717-620-2424 klatsha@ldylaw.com