admin, Author at Stotler Hayes Group https://stotlerhayes.com/author/admin/ A Law Firm Exclusively for Healthcare Providers Mon, 02 Jun 2025 12:54:31 +0000 en hourly 1 https://wordpress.org/?v=6.8.1 https://stotlerhayes.com/wp-content/uploads/2024/04/New-SHG-FLower-150x150.png admin, Author at Stotler Hayes Group https://stotlerhayes.com/author/admin/ 32 32 Common Medicaid Application Mistakes: Errors to Avoid During the Application Process https://stotlerhayes.com/common-medicaid-application-mistakes/?utm_source=rss&utm_medium=rss&utm_campaign=common-medicaid-application-mistakes Mon, 02 Jun 2025 12:22:59 +0000 https://stotlerhayes.com/?p=5146 The Medicaid application process can be complicated. However, there are several common mistakes made by filers that can make things even more difficult than they need to be, adding unnecessary obstacles. In this article, we will discuss some errors to avoid during the Medicaid application process. Common Mistake #1: Waiting to File One of the […]

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The Medicaid application process can be complicated. However, there are several common mistakes made by filers that can make things even more difficult than they need to be, adding unnecessary obstacles. In this article, we will discuss some errors to avoid during the Medicaid application process.

Common Mistake #1: Waiting to File

One of the most common errors in the Medicaid application process is waiting too long to file the application. This begs the question: When should an application for Medicaid benefits be filed? Generally, the answer is as soon as possible. In most states, it is advantageous to file the application by the end of the month to maximize retroactive coverage or the deduction of incurred medical expenses (IME) if your state does not provide retroactive coverage. Because the date the application is filed can be critical in establishing the effective date of coverage, it is imperative that you keep proof of submission, whether that is a fax confirmation sheet, screenprint of the electronic submission confirmation, or tracking information for an application submitted by mail.

A common reason for waiting to file the application is the misplaced belief that an application cannot be filed unless the filer has all the applicant’s financial information and documentation ready for submission with the application. While proof of eligibility will be required for approval for Medicaid benefits, all that is generally required to submit a Medicaid application is the applicant’s name, mailing address, and a signature on the application. You should submit an application even if you are not sure the applicant will qualify for or need Medicaid benefits.

Another common mistake is waiting on a third party to apply. If a facility waits for and relies upon a third party to file an application, the failure to timely file could result in loss of Medicaid coverage. In the case of a third party not taking prompt action, a facility should consider filing an application on behalf of its resident, either as an authorized representative or someone acting responsibly for an incapacitated resident. A responsible party may be a relative, friend, guardian, conservator or other individual who is in a position to know of the applicant’s circumstances. This includes a representative of the long-term care facility where the individual resides.

Common Mistake #2: Guessing

The applicant is incapacitated, and a family member or neighbor thinks they might be a veteran and gets VA benefits and maybe has a bank account at the local credit union, but they do not have any bank statements or award letters. Do you list that on the Medicaid application? No. Do not guess because you cannot un-ring the bell. If you are wrong, you may be forced to prove a negative, i.e., provide verification that something does not exist. If you do not know for sure, it is better to wait to see what the agency finds and for which it requests verification. On the other hand, if you know something does not exist, say so to try to avoid the long, generic laundry list of verification requests.

Common Mistake #3: Failing to Provide Notice of Incapacity

Another common mistake is failing to provide notice of an applicant’s incapacity along with the Medicaid application. In some states, this can lead to the exclusion of resources and an approval of Medicaid benefits pending the appointment of a legal agent, while in other states this might require the agency to hold the application open (securing the application date) until a legal agent is appointed and able to access and obtain verification of the applicant’s income and resources. The failure to provide notice of incapacity could result in a denial of Medicaid benefits for failure to provide requested verifications and a loss of months of Medicaid coverage that could have been preserved.

Common Mistake #4: Waiting to Gather Verifications

While it is a mistake to wait to file an application until financial verifications are obtained, it is also a mistake to wait until the agency issues a request for information or verification checklist to gather the documentation that will be requested. It is important for the filer to be proactive. Getting a release and authorization from the applicant can streamline the process and enable the filer to obtain verifications from third parties that are not readily available to the applicant.

Common Mistake #5: Failing to Ask for an Extension and to Respond to Every Request

Once a verification checklist or request for information is received, a common mistake is failing to timely respond to each request. First, it is important to calendar deadlines, including internal or self-imposed deadlines that will facilitate timely submission of the requested information. A common mistake is missing or ignoring a deadline because you do not yet have the information requested and failing to ask for an extension of time to submit the remaining verifications.

Second, it is important to always respond to every item requested. It is helpful to itemize each document or verification requested in your response. If something does not exist, then your response should say so. It is also important to submit information even if it is late. In some states, the submission of requested information within a certain amount of time after the denial could result in the reinstatement and approval of the denied application, thereby saving the original application date and maximizing the available coverage beyond what would be available under a newly submitted application.

Common Mistake #6: Failing to Request Assistance

Another common mistake is the failure to request assistance. Beginning with the Medicaid application and in all subsequent correspondence, the filer should always ask the agency for assistance with obtaining any requested verification information and documentation. Federal regulations require state Medicaid agencies to provide assistance with the application or renewal process, while a request for assistance in many states will trigger agency requirements to take steps to obtain any requested information and documentation on behalf of the applicant. The failure of the agency to provide assistance when requested could provide a meritorious ground to appeal a Medicaid denial.

Common Mistake #7: Failing to Monitor/Follow Up

After an application is submitted, a common mistake is the failure to monitor and follow up on the pending application. No news on a pending application is probably not good news. It is important to follow up at least monthly on the application’s status and be prepared to submit a new application to preserve coverage dates even if you have not received a denial of the pending application. You should also consider an inaction appeal if the agency has not timely processe the application.

Common Mistake #8: Failing to Communicate in Writing

In some states, agency representatives will communicate by telephone or even in person at a local office. A common mistake is reliance on these oral conversations. It is critical to communicate in writing. If you communicate with the agency by phone or in person, it is important to follow up with a written communications that confirms the substance of the conversation and to document the conversation in your file notes. This puts the onus on the agency to dispute any misunderstanding, and such contemporaneous written communication and notes can be a powerful tool for proving the substance of the conversation after time passes and memories fade.

The Medicaid application process is already difficult enough. The common mistakes above only complicate things further for filers. Avoiding these errors while applying for Medicaid will not guaranty a smooth and pain-free process, but it should help avert any self-inflicted obstacles to securing coverage.

If you have questions about the medicaid application process we encourage you to reach out to Stotler Hayes Group at 843.235.9871 or through our contact us form.

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Medicaid Application Process: Top Tips for Applying for Medicaid https://stotlerhayes.com/medicaid-application-process-top-tips-for-applying-for-medicaid/?utm_source=rss&utm_medium=rss&utm_campaign=medicaid-application-process-top-tips-for-applying-for-medicaid Mon, 28 Apr 2025 13:12:28 +0000 https://stotlerhayes.com/?p=5106 Applying for Medicaid benefits, particularly long-term care benefits, can be difficult and confusing. Yet, it is a necessary evil for many who rely on Medicaid to ensure that they can afford the room, board, care, and services they need to survive. While the Medicaid application process is certainly not easy, there are some ways to […]

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Applying for Medicaid benefits, particularly long-term care benefits, can be difficult and confusing. Yet, it is a necessary evil for many who rely on Medicaid to ensure that they can afford the room, board, care, and services they need to survive. While the Medicaid application process is certainly not easy, there are some ways to make it less painful. In this article, we will discuss some tips to make the Medicaid application process go as smoothly as possible.

Tip #1: Be Proactive

While the specific requirements for long-term care Medicaid benefits vary from state to state, you can be sure that the agency will request information and documentation regarding the applicant’s gross income and finances. Typically, the Medicaid agency will provide a very limited amount of time to provide the requested information and documentation. For example, in North Carolina, applicants typically have twelve days to submit this information, and, in Virginia, applicants typically only have ten days to provide the information.

Depending on the state, the Medicaid agency may request up to five years of records for financial resources, including bank accounts, retirement accounts, life insurance policies, vehicles, real properties, etc. Most of us probably do not maintain records for the last five years, and if we do, we may not remember exactly where we have them. If the Medicaid agency requests five years of documents, and you only have ten days to provide them, you may start to panic. Therefore, it is a good idea to start gathering these documents as soon as the need for Medicaid benefits arises.

The Medicaid agency will also always require medical documentation to establish that the applicant requires nursing home care. Rather than waiting for the agency to specifically request this documentation, go ahead and have the nursing home complete what is called a level of care assessment for the applicant. Depending on the state, this may be a full assessment by a nursing home medical provider or a written request for the assessment to be completed by the Medicaid agency.

In most states, an applicant’s request for assistance from the Medicaid agency will require that the agency take steps to obtain any requested information and documentation on behalf of the application. Consequently, it is important to always request that the Medicaid agency assist the applicant in all written communications with the agency, and to initially make this request when submitting the Medicaid application.

Tip #2: Always Submit the Application

You should always submit your Medicaid application even if you do not have all the information requested within the application. Depending on your state, you may be able to wait to submit your application until the last day of the month, but you should always confirm with the local Medicaid agency on which date you should submit the application to ensure you preserve the benefits coverage dates needed.

You should always submit an application even if you are unsure of whether you will qualify for Medicaid or if benefits will ultimately be needed. You can always choose to withdraw your application, but you may not be able to get the coverage you need without having submitted the application.

We often see situations in which a Medicaid applicant lacks capacity and is unable to submit a Medicaid application on their own. Federal Medicaid regulations ensure that, despite incapacity, any person seeking Medicaid benefits can have an application submitted on their behalf. Federal Medicaid regulations also require Medicaid agencies to accept verifications submitted by third parties on an applicant’s behalf, even if the third party is not the applicant’s Guardian, Power of Attorney, or relative. So, if the applicant lacks capacity and is unable to submit the application on their own behalf, do not let that stop you from submitting the application.

Prior to submitting the application, check the local Medicaid agency’s website to confirm the current contact information for the agency. This is to ensure that you submit the application correctly. Once the application is submitted, make sure to retain a copy of the submission confirmation in case the application is lost by the agency.

Tip #3: Notify the Medicaid Agency of an Applicant’s Incapacity

In many states, an applicant’s incapacitation or incompetency, terms that are used interchangeably by most Medicaid agencies, triggers specific regulations and procedures that the Medicaid agency must follow. For example, in North Carolina and Florida, once documentation supporting the applicant’s alleged incompetency is submitted to the Medicaid agency, the agency must typically exclude the applicant’s financial resources. This can lead to an approval of Medicaid pending Guardianship proceedings for the allegedly incompetent applicant.

In other states, such as Virginia, the Medicaid agency will typically keep the Medicaid application open while Guardianship proceedings are pending for the allegedly incompetent applicant rather than denying the Medicaid application for failure to provide the requested documents.

Therefore, it is always a good idea to notify the Medicaid agency of an applicant’s potential incapacity or incompetency as soon as possible. Notice to the Medicaid agency can be as simple as a note on the application itself or a written letter submitted to the agency at the time of application.

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Lien on Me – How an Attorney Can Help Secure Your Debt https://stotlerhayes.com/lien-on-me/?utm_source=rss&utm_medium=rss&utm_campaign=lien-on-me Fri, 14 Mar 2025 14:58:13 +0000 https://stotlerhayes.com/?p=5020 Too often creditors are faced with accounts that are seemingly uncollectable. If the debtor had money on hand to pay, presumably they would not have incurred the debt at all, right? Especially in the realm of medical debt, and long term care where bills can mount at rates of hundreds of dollars per day, large […]

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Too often creditors are faced with accounts that are seemingly uncollectable. If the debtor had money on hand to pay, presumably they would not have incurred the debt at all, right? Especially in the realm of medical debt, and long term care where bills can mount at rates of hundreds of dollars per day, large lump sums can be difficult for debtors to pay with their liquid assets. In these situations, creditors have to be creative to find ways to recover even if it means that payment may not be immediate.

Often the most valuable asset a debtor will own is real property. In these instances, creditors have an opportunity to secure their debt for payment in the future via a lien on that property. In this article, we will explore what a lien is, and how an attorney can help a creditor use a lien to secure payment on an otherwise unrecoverable account.

What is a lien?

Put simply, a lien is an interest that an outside party has in someone’s property. Liens are regularly seen attached to real property (i.e. the mortgage you take out to purchase a home). However, liens can be held on personal property as well (i.e. a loan you take out to purchase a car).

When is a lien a viable option for collection?

When it comes to collection, liens should be seen as an option of last resort. Liens are wonderful tools for when a debtor has no or insufficient liquid assets to pay a debt, and there is no other way for the creditor to be paid during the debtor’s lifetime.

However, a lien is only viable when a piece of property has sufficient equity value available to cover the debt owed. In order to determine if a piece of property is appropriate for recovery by a lien, an attorney can perform a title search and analysis to ensure that the debtor has good title to the property, that the debt remaining on any other liens or judgments that may be attached to the property, and that the debtor owns the property in such a way that will allow for the creditor to collect against the same. If the debtor owns the property jointly with another person, the equity value attributable to the debtor may be lessened, and securing a lien altogether may be more challenging or even impossible, depending on the type of joint ownership. The creditor’s attorney will be able to advise the creditor on all of these variables based upon the outcome of the title search.

How can a creditor obtain a lien?

Some creditors are granted the right to impose liens on debtors’ property by statute, such as mechanic’s liens in those states that recognize them. However, medical providers are not granted such statutory authority. Instead, creditors seeking to collect medical debt must take affirmative steps to obtain a lien, either with the debtor’s voluntary grant of a lien or involuntarily through court proceedings.

A voluntary lien takes the form of a mortgage or deed of trust on the real property, executed willingly by the debtor. These mortgages are often accompanied by a promissory note, in which an attorney can help the creditor set forth the terms for repayment such as when the mortgage will come due, if any monthly payments are required before the due date, the rate of interest that will accrue, and can even include specific language to give the creditor’s lien priority over other liens that may already exist on the debtor’s real property.

By contrast, an involuntary lien requires the creditor to bring a lawsuit against the debtor. In that litigation, the creditor must obtain a judgment for the debt owed. Then, the judgment can be attached to the debtor’s real property as a judgment lien. Again, an attorney can assist the creditor in crafting language for the judgment regarding imposition of interest, or even recovery of attorney’s fees, in addition to the principal amount due.

When does the lienholder receive payment?

The terms of payment on a lien are set in the documents that form the lien – the promissory note that accompanies a voluntary mortgage or deed of trust, or in the language of the judgment that forms the judgment lien. When a creditor is forced to seek recovery via a lien, typically the debtor is not in a position to be able to make installment payments. Therefore it is common for the lien to require payment of the full balance in a lump sum on a given date. This date is usually tied to the future sale of the property by the debtor, or the debtor’s death. However, an attorney can assist the creditor with determining if monthly installment payments would be viable based upon the debtor’s circumstances. In those instances, the lien will act much like a typical home loan where the debtor will make monthly installment payments, and the remaining principal balance due at the time of the sale of the property or the debtor’s death will then be due in a lump sum. If the debtor’s death is the event that triggers payment, then the creditor’s attorney can further assist with ensuring the creditor follows any state probate code requirements to assert a claim for payment against the debtor’s estate.

When creditors need to play the long game in instances where a debtor does not have sufficient liquid assets to pay immediately, a lien is a wonderful tool for creditors to use to secure future payment. By utilizing the advice and expertise of legal counsel, creditors can use voluntary or involuntary liens to maximize recovery of not only principal debt, but also interest and attorney’s fees. In this way, despite being a recovery option of last resort, liens are an integral part of a creditor’s collection toolbox.

Read more articles by Stotler Hayes Group here.

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Medicare Advantage Plans Onerous Prior Authorizations Requirements & Negative Impacts on Skilled Nursing Facilities https://stotlerhayes.com/medicare-advantage-plans-onerous-prior-authorizations-requirements/?utm_source=rss&utm_medium=rss&utm_campaign=medicare-advantage-plans-onerous-prior-authorizations-requirements Mon, 17 Feb 2025 17:37:00 +0000 https://stotlerhayes.com/?p=5121 Traditional Medicare (Parts A and B) and Medicare Advantage (Part C, including additional vision, dental, and hearing benefits) plans aim to provide comprehensive medical benefits to American Seniors and adults with disabilities. However, the two programs function very differently, especially in terms of their applicable administrative processes. One of the most significant differences, which profoundly […]

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Traditional Medicare (Parts A and B) and Medicare Advantage (Part C, including additional vision, dental, and hearing benefits) plans aim to provide comprehensive medical benefits to American Seniors and adults with disabilities. However, the two programs function very differently, especially in terms of their applicable administrative processes. One of the most significant differences, which profoundly impacts beneficiaries and healthcare providers, especially skilled nursing facilities (SNFs), is the use of prior authorizations (“PAs”) in Medicare Advantage plans, which is far more frequent than traditional Medicare.

  1. Higher Rate of Prior Authorizations in Medicare Advantage Versus Traditional Medicare Plans

Health insurance plans administratively use PAs to require pre-approval for various services, procedures, or medications. They often use PAs to manage costs and to ensure that treatments are medically necessary and appropriate.

Private insurance companies manage Medicare Advantage plans, and while they are regulated by the Centers for Medicare & Medicaid Services (CMS), they require PAs for many medical services, ranging from hospital stays, surgeries, prescription drugs, and rehabilitative care. Traditional Medicare plans, on the other hand, do not require PAs for most services. Indeed, as recently reported by McKnights, in 2023, approximately two PAs were required by private health insurance companies per Medicare Advantage Plan enrollee, while CMS required approximately .01 PAs per Traditional Medicare Plan beneficiary (only conducting a PA review for 1 out of every 100 beneficiaries). See McKnights Long-Term Care News, MA plans’ use of prior authorizations climbs again, despite heightened pressure to limit tactic (January 31, 2025), available at https://www.mcknights.com/news/ma-plans-use-of-prior-authorizations-climbs-again-despite-heightened-pressure-to-limit-tactic/?utm_source=marketing&utm_medium=email&utm_

campaign=NWLTR_MLT_DailyUpdate%20-%20013125&hmEmail=jsfrElZHed5K6BzfWhx

tufiAWyDGhZct&sha256email=6ba3b6226ef34542a614dfec541ea32610e397b9c7720599687b090b5e6591ed&elqTrack=True (last visited February 9, 2025).

The discrepancy between Traditional Medicare plans and Medicare Advantage plans’ required PAs – the latter of which rose to approximately 50 million in 2023 (up from 42 million in 2022) – exists, although Medicare beneficiaries enrolled in Medicare Advantage plans have the right to the same care as beneficiaries enrolled in Traditional Medicare plans. See McKnights, supra, citing a KFF analysis of the issue, released on January 28, 2025.

In May 2024, CMS issued new rules governing Medicare Advantage plans’ behavior in an effort to compel insurers to reduce their dependence on repeated PAs and streamline the PA process. These new rules did not have robust enforcement “teeth” to begin with, and their enforceability in any form rests with the Trump Administration’s review and final adoption. See McKnights, supra; see also, Medicare Rights Center, Final Rules on Medicare Advantage Prior Authorization Offer Improvements, but More Change is Needed (January 31, 2025), available at https://www.medicarerights.org/medicare-watch/2024/05/30/final-rules-on-medicare-advantage-prior-authorization-offer-improvements-but-more-change-is-needed (last visited February 10, 2025).

  1. The Negative Impacts of Prior Authorizations on Skilled Nursing Facilities

Skilled nursing facilities (SNFs) provide short-term, medically necessary care following hospitalization, often for rehabilitative services such as skilled nursing care, physical therapy, and other specialized medical treatments. For patients under Traditional Medicare, accessing SNF care is relatively uncomplicated. Ordinarily, only a three-day qualifying hospital stay and other non-onerous conditions must be met for beneficiaries to transition to an SNF. Traditional Medicare covers a portion of the SNF care for up to 100 days. No PA is required for Traditional Medicare beneficiaries to transition to a SNF.

By contrast, when an individual has a Medicare Advantage plan, approval of PAs is often required before the individual is admitted to skilled nursing facilities so that the plan can pay for a portion of the individual’s nursing home care.

The need for a PA can delay the timely admission of patients to SNFs. For example, network restrictions on specific authorized SNFs negatively impact SNFs that rely heavily on Medicare Advantage patients to support admissions. This can lead to a reduction in patient volume and financial uncertainty for the SNF. Admission delays caused by the timeframes for Medicare Advantage plans’ approval of PAs can also result in reduced revenue for SNFs.

A Senate subcommittee Report in the Fall of 2023 determined that the nation’s three largest Medicare Advantage plan insurers between 2019 and 2022 – United Healthcare, Humana, and CVS – intentionally denied PAs to boost the insurance companies’ profits, including United Healthcare, the PA denial rate of which for SNF stays increased 800% between 2019 and 2022. See McKnights, supra; see also, McKnights Long-Term Care News, Senate report hits top 3 Medicare Advantage insurers over ‘refusal’ of skilled nursing, other coverage (October 18, 2024), available at https://www.mcknights.com/news/senate-report-hits-top-3-medicare-advantage-insurers-over-refusal-of-of-skilled-nursing-other-coverage/ (last visited February 10, 2025).

Medicaid Advantage plans have also customarily required repeat PAs during an enrollee’s continuous stay at a SNF, despite a 2024 Rule by which CMS attempted to compel insurers to reduce their repeat PA requirements. See McKnights, supra. If a SNF does not timely submit the necessary paperwork on the repeat PA, this can lead to the denial of part of a continuous SNF stay that had been initially approved. See McKnights, supra. Moreover, if Medicare does not cover the SNF care due to a denied PA, the SNF cannot privately recover the balance.

  1. Recommendations for SNF Management of Medicare Advantage Plan PA Denials

SNFs would benefit from more appeals from Medicare Advantage plan PA denials. In 2023, “insurers fully or partially denied 3.2 million prior authorization requests, or about 6.4%[, and o]nly 11.7% of those denials were appealed.” See McKnights, supra, referencing KFF’s Analysis. Between 2019 and 2023, denied PA requests that were appealed were overturned at a rate of 81.7%. See McKnights, supra.

SNFs may also benefit from more lobbying efforts at the Federal level. While legislation to curtail Medicare Advantage plan denials of PAs has not yet been enacted, bipartisan support of a majority of members of Congress in both houses allegedly exists. See McKnights, supra.

  1. Conclusion

Medicare Advantage plans offer expanded benefits to enrollees. On the other hand, the increased use of PAs by the health insurance companies managing these plans negatively affects SNFs. Traditional Medicare plans require far fewer PAs and do not negatively impact SNFs. The intricacies of administrative and PA approval for Medicare Advantage enrollees can complicate care delivery, increase costs, and reduce SNF admissions and recoveries. It will be critical for SNFs to play an active role in finding and advocating for solutions that balance cost control with the timely provision of essential care for Medicare beneficiaries.

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CMS Cracks Down on Responsible Party Liability in LTC Admission Agreements https://stotlerhayes.com/cms-cracks-down-on-responsible-party-liability-in-ltc-admission-agreements/?utm_source=rss&utm_medium=rss&utm_campaign=cms-cracks-down-on-responsible-party-liability-in-ltc-admission-agreements Mon, 03 Feb 2025 17:00:00 +0000 https://stotlerhayes.com/?p=5117 A nursing facility that participates in the Medicaid or Medicare programs may not require a third party to guarantee payment for a resident’s admission or continued stay. However, facilities are allowed to require a resident representative who has legal access to a resident’s income or resources to sign a contract to provide payment to the […]

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A nursing facility that participates in the Medicaid or Medicare programs may not require a third party to guarantee payment for a resident’s admission or continued stay. However, facilities are allowed to require a resident representative who has legal access to a resident’s income or resources to sign a contract to provide payment to the facility from the resident’s income or resources, without incurring personal financial liability.

But what happens if the resident representative fails to use the resident’s income and assets to pay for the resident’s care? Or refuses to take the steps needed to get the resident approved for Medicaid? Can the resident representative be held personally responsible for the facility’s damages under the contract?

Some Courts have said yes, and some LTC admission contracts include language advising responsible parties they could be held personally liable if they fail to perform their obligations under the agreement.

But new surveyor guidelines from CMS say that effective March 24, 2025, no such language will be allowed in admission agreements.

In the Memorandum Summary, originally released November 18, 2024 and revised January 15, 2025, CMS details its interpretation of what constitutes a prohibited “third-party guarantee of payment” when it comes to contractual language. It says that the contract does not need to specifically reference a “guarantee” to be non-compliant; that “[a]ny language contained in an agreement that seeks to hold a third party personally responsible for paying the facility would violate this requirement.”

Does this include financial liability for a responsible party’s failure to perform their own obligations under the contract? According to CMS it does. The release includes examples of non-compliant contractual language, including but not limited to:

  • Language that holds both (1) the resident and (2) the representative or other individual jointly responsible for any sums due to the facility (however, language that holds the resident solely responsible without joining the representative is allowable).
  • Language that holds the representative or other third-party individual personally liable for breach of an obligation in the agreement, such as (1) failing to apply for Medicaid in a timely and complete manner or (2) allowing someone other than a signatory to the agreement to spend the resident’s resources that would be used to pay the nursing home.
  • Language that does not specifically mention a third-party guarantee but that implies the resident could be discharged if the representative does not voluntarily agree to personally pay to prevent the discharge.
  • Language that holds the representative or other individual personally liable for any amounts not paid to the facility in a timely manner because the representative or other individual did not provide accurate financial information or notify the facility of changes in the resident’s financial information.

These examples indicate that any language in an admission contract – including warnings, disclaimers, notices – that in any way suggests that a responsible party could be financially liable to the facility for any breach of the agreement could be considered a violation.

LTC providers should review their admission documents for any language that could run afoul of the new guidance.


42 CFR § 483.15 (a)(3).
2 November 18, 2024 Memorandum Summary, available at: https://www.cms.gov/files/document/revised-
long-term-care-ltc-surveyor-guidance-significant-revisions-enhance-quality-and-oversight-ltc.pdf.
3 January 15, 2025 Memorandum Summary, available at: https://www.cms.gov/files/document/qso-25-12-
nh.pdf.

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Status of Nursing Home Staffing Standards Announced by Biden Administration and Orders Announced by Trump Administration https://stotlerhayes.com/status-of-nursing-home-staffing-standards-announced-by-biden-administration-and-orders-announced-by-trump-administration/?utm_source=rss&utm_medium=rss&utm_campaign=status-of-nursing-home-staffing-standards-announced-by-biden-administration-and-orders-announced-by-trump-administration Wed, 29 Jan 2025 16:47:27 +0000 https://stotlerhayes.com/?p=5111 Attorneys General from 20 states asked a federal judge to grant a temporary injunction halting implementation of changes to new rules affecting minimum nursing home staffing requirements announced by the Centers for Medicare and Medicaid Services (“CMS”) on April 22, 2024. 1 In his opinion, issued on January 16, 2025, Judge Strand, United States District […]

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Attorneys General from 20 states asked a federal judge to grant a temporary injunction halting implementation of changes to new rules affecting minimum nursing home staffing requirements announced by the Centers for Medicare and Medicaid Services (“CMS”) on April 22, 2024. 1

In his opinion, issued on January 16, 2025, Judge Strand, United States District Judge for the Northern District of Iowa, indicated that the plaintiffs failed to demonstrate a preliminary injunction is necessary and further stated that as the 24/7 registered nurse requirements and minimum hours-per-day requirements don’t take effect until May 2026, the alleged harm on Plaintiffs was too speculative to constitute irreparable harm, a requirement to secure a temporary injunction.

However, the litigation is still pending as the court considers whether the action taken by CMS is arbitrary and capricious. Judge Strand noted that the plaintiffs’ efforts would be best directed to arguing the merits of the matter as opposed to seeking to halt the implementation of the rule, stating: “the interests of justice will be best served by proceeding quickly to the dispositive motions stage of this case, thus allowing the parties to address the merits directly, rather than through the lens of a motion for a preliminary injunction”.

President Trump has nominated Dr. Mehmet Oz to lead CMS. There is no date set yet for the Senate confirmation hearing for Dr. Oz. However, President Trump has appointed Dr. Dorothy Fink as Acting Secretary of the Department of Health and Human Services (“HHS”). On January 21, 2025, Acting Secretary Fink ordered an immediate pause on issuing documents, regulations, and public communications. A link to the Memorandum is here: https://www.documentcloud.org/documents/25502931-acting-hhs-secretary-communications-memo-1-21-25/ The communication freeze is in place until February 1, 2025. Acting Secretary Fink indicates that “[t]he President’s appointees intend to review documents and communications expeditiously and return to a more regular process as soon as possible”.

Separately ordered by President Trump is a regulatory freeze, including new proposals for regulations, until such time as a department or agency head appointed or designated by President Trump reviews and approves all new proposed regulations. The regulatory freeze is in place for 60 days from January 20, 2025 and will allow the new administration time to determine its regulatory priorities and scope of forthcoming changes to regulations already in place.

Additionally, CMS implements a new rule requiring an RN to be onsite 24 hours a day/seven days a week and that such RN must be available to provide direct resident care.

Health care providers, including nursing facilities, should anticipate action to be forthcoming from the Trump Administration and we will be monitoring all actions which will impact healthcare providers and skilled nursing facilities.


[1] Under the new rule, CMS is requiring all nursing homes that receive federal funding through Medicare and Medicaid to provide a minimum of 3.48 hours of total direct nursing care to residents, of which .55 hours must be provided by a Registered Nurse and 2.45 hours to be provided by nurse aids. CMS clarifies that facilities are able to use any combination of nursing staff (RN, LPN, LVN, or nurse aides) to account for the additional .48 hours needed to comply with the new standards.

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Stotler Hayes Group, LLC: Ranked #1 Best Midsize Law Firm for Formal Training https://stotlerhayes.com/stotler-hayes-group-llc-ranked-1-best-midsize-law-firm-for-formal-training/?utm_source=rss&utm_medium=rss&utm_campaign=stotler-hayes-group-llc-ranked-1-best-midsize-law-firm-for-formal-training Fri, 17 Jan 2025 15:55:22 +0000 https://stotlerhayes.com/?p=4833 At Stotler Hayes Group, LLC (“SHG”), excellence is not just a goal—it’s a commitment. This dedication has recently been recognized with the prestigious accolade of being ranked as the #1 Best Midsize Law Firm for Formal Training. This honor is a reflection of the firm’s unwavering investment in its people and its innovative approach to […]

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At Stotler Hayes Group, LLC (“SHG”), excellence is not just a goal—it’s a commitment. This dedication has recently been recognized with the prestigious accolade of being ranked as the #1 Best Midsize Law Firm for Formal Training. This honor is a reflection of the firm’s unwavering investment in its people and its innovative approach to professional development.

A Commitment to Training and Mentorship

Training and mentorship are at the heart of SHG’s philosophy. Unlike many organizations where new hires are left to navigate challenges on their own, Stotler Hayes takes a different approach. Senior Partner and Director of Training and Development Jackie Richardson captures this ethos perfectly:

“At Stotler Hayes, we reject the sink or swim model. Instead, we embrace the idea that working in the legal field is truly a ‘practice’ which requires mentoring, support, and lifelong learning in order to be successful. We earnestly value and are committed to providing thoughtfully tailored Informal and Formal Training, Development and Mentorship for our Team so to be recognized as being the ‘best’ in these areas is truly humbling.”

This philosophy drives the firm’s tailored training programs, which are designed to address the unique needs of each team member. By providing resources and support that go beyond traditional methods, Stotler Hayes ensures every individual has the opportunity to thrive and grow.

Thoughtful and Tailored Programs

The training programs at Stotler Hayes are anything but one-size-fits-all. The firm’s leadership takes pride in crafting bespoke development plans that reflect the strengths, aspirations, and areas for growth of their employees. This includes:

  • Formal Training Sessions: Comprehensive workshops and seminars designed to enhance technical legal skills, industry knowledge, and professional development.
  • Mentorship Opportunities: Pairing team members with experienced mentors who provide guidance, share insights, and offer support.
  • Continuous Learning Initiatives: Encouraging team members to engage in lifelong learning through certifications, advanced training, and industry conferences.
  • Informal Support Networks: Fostering a collaborative environment where employees can learn from each other and build meaningful connections.

Why This Recognition Matters

Being recognized as the best in formal training is more than an award—it’s a reflection of Stotler Hayes Group’s core values. The firm understands that providing exceptional service to healthcare providers requires a well-prepared, confident, and knowledgeable team. By investing in their people, the firm not only elevates its internal culture but also ensures it delivers unmatched value to its clients.

This ranking affirms that the firm’s emphasis on development and mentorship is setting a new standard for excellence in the legal industry.

Looking Ahead

As Stotler Hayes Group continues to grow and evolve, its commitment to training and mentorship remains steadfast. The firm’s leaders recognize that cultivating talent is an ongoing process, one that requires innovation, care, and a willingness to adapt to new challenges. The #1 ranking is not just a milestone but a motivator to continue leading the way in shaping the future of legal training.

The recognition of Stotler Hayes Group, LLC as the #1 Best Midsize Law Firm for Formal Training underscores its dedication to empowering its team and creating an environment of continuous growth. With a clear vision and a heartfelt commitment to mentorship, the firm is paving the way for a brighter, more supportive future in the legal profession.

To learn more about Stotler Hayes, visit stotlerhayes.com

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Stotler Hayes Group (“SHG”) Ranked #2 Best Midsize Law Firm to Work For by Vault https://stotlerhayes.com/stotler-hayes-group-shg-ranked-2-best-midsize-law-firm-to-work-for-by-vault/?utm_source=rss&utm_medium=rss&utm_campaign=stotler-hayes-group-shg-ranked-2-best-midsize-law-firm-to-work-for-by-vault Fri, 03 Jan 2025 13:31:26 +0000 https://stotlerhayes.com/?p=4794 FOR IMMEDIATE RELEASE Stotler Hayes Group (“SHG”) Ranked #2 Best Midsize Law Firm to Work For by Vault Pawleys Island, SC – 1/3/25 Stotler Hayes Group, LLC is proud to announce its ranking as #2 Best Midsize Law Firm to Work For and one of Vault’s “Top 150 Under 150”, recognizing the top 150 law […]

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FOR IMMEDIATE RELEASE

Stotler Hayes Group (“SHG”) Ranked #2 Best Midsize Law Firm to Work For by Vault

Pawleys Island, SC – 1/3/25

Stotler Hayes Group, LLC is proud to announce its ranking as #2 Best Midsize Law Firm to Work For and one of Vault’s “Top 150 Under 150”, recognizing the top 150 law firms in the country with fewer than 150 attorneys.

Top Rankings in Key Categories


SHG earned top scores across several key categories:

  • #1 – Formal Training
  • #1 – Hours
  • #1 – Informal Training, Mentoring, & Sponsorship
  • #2 – Wellness
  • #2 – Overall Ranking
  • #3 – Associate/Partner Relations
  • #5 – Firm Culture
  • #5 – Satisfaction
  • #7 – Transparency
  • #8 – Diversity

Holistic Approach to Success

These rankings showcase the firm’s strong commitment to personal growth and professional development while cultivating a vibrant and inclusive culture.  “This recognition by Vault is a testament to SHG’s holistic approach to success, blending professional growth with a dynamic, positive workplace culture.” Said Kelly Hayes, Managing Partner. “Our continued investment in training ensures each of our team members have the opportunity to grow to their full potential, and our culture encourages creativity and innovation at all levels.”

About Stotler Hayes Group, LLC
Stotler Hayes Group is a national law firm exclusively serving healthcare providers, with a focus on delivering novel solutions and powerful legal representation. With all attorneys fully remote, Stotler Hayes Group, LLC is committed to flexibility, collaboration, and excellence in every aspect of its practice.

Contact:
Brittney Inman
Marketing Director
Stotler Hayes Group, LLC
346.471.5836
Binman@stotlerhayes.com
stotlerhayes.com

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Congratulations to Neighbor to Neighbor for Winning our last day of SHG’s 10 Days of Giving! https://stotlerhayes.com/congratulations-to-neighbor-to-neighbor-for-winning-our-last-day-of-shgs-10-days-of-giving/?utm_source=rss&utm_medium=rss&utm_campaign=congratulations-to-neighbor-to-neighbor-for-winning-our-last-day-of-shgs-10-days-of-giving Thu, 12 Dec 2024 13:30:00 +0000 https://stotlerhayes.com/?p=4764 Congratulations to Neighbor to Neighbor for winning our last day of SHG’s 10 Days of Giving! As we close out this year’s event, we would like to thank everyone who participated in this event and we hope everyone will continue to celebrate “Giving Month”. #10daysofgiving #stotlerhayesgroup

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Congratulations to Neighbor to Neighbor for winning our last day of SHG’s 10 Days of Giving!

As we close out this year’s event, we would like to thank everyone who participated in this event and we hope everyone will continue to celebrate “Giving Month”.

#10daysofgiving #stotlerhayesgroup

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Congratulations to Aging Forward for Winning Day 9 of our 10 Days of Giving event! https://stotlerhayes.com/congratulations-to-aging-forward-for-winning-day-9-of-our-10-days-of-giving-event/?utm_source=rss&utm_medium=rss&utm_campaign=congratulations-to-aging-forward-for-winning-day-9-of-our-10-days-of-giving-event Wed, 11 Dec 2024 13:30:00 +0000 https://stotlerhayes.com/?p=4757 Congratulations to Aging Forward for winning Day 9 of our 10 Days of Giving event! Today is Day 10, the last day of voting, so keep casting your votes! Everyone is invited to participate in voting for one of the 9 remaining charities. The charities we have selected not only reflect our organizational values, but […]

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Congratulations to Aging Forward for winning Day 9 of our 10 Days of Giving event!

Today is Day 10, the last day of voting, so keep casting your votes! Everyone is invited to participate in voting for one of the 9 remaining charities.

The charities we have selected not only reflect our organizational values, but are also organizations that are important to the long-term care industry.

Daily voting will be available each day by clicking the link below and selecting your preferred charity. The charity with the majority of votes each day will receive $1,000.

Vote here >>> https://forms.gle/Kj14aASXNMAWPCyh9 Good luck to this year’s eligible charities!

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