ALF and ILF Preferred Provider Agreements
Managers at assisted living facilities (ALFs) and independent retirement communities (ILFs) are often committed to keeping residents in their facilities for as long as possible. There are, of course, costs associated with filling vacancies. In addition, if residences remain empty for any length of time, the profitability of these types of entities can be severely adversely affected.
Consequently, to the extent that agencies can assist residents to remain in their homes, ALFs and ILFs may be extremely interested in establishing on-going relationships with private duty agencies, home health agencies, hospices and home medical equipment companies. ALF's and retirement communities can be valuable referral sources for companies, both in terms of the volume of patients and the types of patients referred. Referrals from ALFs and ILFs can also be relatively cost-effective. With enough volume, providers can realize significant savings in staff members’ travel time and costs.
Management at ALFs and retirement communities often want to make referrals to a single or a few providers. The perception among managers of these types of facilities, whether true or not, seems to be that providers are more likely to assist them in meeting the goal of limiting resident turnover if they have preferred provider relationships with them. Providers may wish, therefore, to approach ALFs and ILFs to see if they are interested in these types of arrangements.
If they are, management of ALFs and ILFs may be interested in signing a Preferred Provider Agreement in order to cement relationships with providers. Providers that enter into Preferred Provider Agreements with ALFs and ILFs must be sure to take into account requirements for licensure of ALFs regarding patients’ right to choose providers that may vary from state to state. In addition, home care providers should also consider the following, in combination with Preferred Provider Agreements, in order to strengthen relationships with ALFs and ILFs:
Assign a coordinator/liaison to each ALF or ILF. There is no substitute for a regular “presence” at ALFs and ILFs on at least a part-time basis so that management and residents can rely more readily on the assistance of home care providers through access and developing relationships.
Lease space for the coordinator/liaison to occupy on a regular basis. A standardized Lease can be used for multiple relationships. In addition, Medicare certified providers must take into account requirements of the Medicare Program regarding branches, satellites/drop sites and multiple locations.
Providers should offer a full range of screenings and educational events for and about common chronic illnesses or community awareness activities. ALF’s and ILFs often ask providers to conduct educational events and basic screenings for common chronic conditions. Managers of ALFs and ILFs like to include the availability of these programs in their marketing efforts. Generally, providers may offer these activities if they walk a relatively fine line between engaging in community awareness activities and providing free skilled services to residents that exceed $15.00 in value at a time or $75.00 in the aggregate per year. At a minimum, such activities must be conducted consistent with a detailed policy and procedure that governs the provision of such services, so that providers do not violate the anti-kickback statute.
Establishing relationships with ALF’s and ILFs may result in numerous referrals to post-acute providers. Such relationships should be based on standard documents and comprehensive policies, as described above, in order to ensure compliance. Legal representation is essential for the development and implementation of these documents due to the complexity of the issues involved.
Elizabeth E. Hogue, Esq.