1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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?

10. QUESTIONS?
Kimber L. Latsha, Esq. Latsha Davis & McKenna, P.C Bent Creek Blvd., Suite 140 Mechanicsburg, PA