Because JJGuiliano and Associates recognizes that every engagement is different, and every Client has their own unique requirements when conducting the due diligence process. That is why we will customize our approach for each Client, rather than a “one size fits all” canned approach to services. Our team is experienced in dealing with lenders and transactions of all sizes and complexity both in the United States and Canada.
Our team blends with your team, creating a seamless approach for your clients
Provides a single point of contact person with Client for assignments
All contacts will be conducted as a Client team member under client logo
All correspondence can be done under the Client logo (if preferred)
Conduct reviews on-site or off-site based on Client direction
Maintaining Monitoring Database as requested by each client
Reports and worksheets will be tailored to fit Client current report formats, allowing ease of insertion of information into your credit and underwriting reports
Participation in Client Credit Committee meetings or Conference Calls as needed via phone
Can be available to contact and meet with State Survey Agency representatives and State Enforcement Officers
FEES AND FOLLOW UP ARRANGEMENTS
Fees for Facility reviews will be based on actual time. We offer competitive hourly fees, and provide volume discounts
Flexible billing arrangements with bills will itemized by client. Bills will be generated monthly, however billing totals can be provided on request for inclusion in your closing paperwork if needed
Facility review and monitoring schedule will be developed jointly with Client. Lower risk properties will be monitored less frequently, contributing to more efficient use of diligence fees for higher risk properties
Quick turnaround on assigned jobs to accommodate Client closing deadlines. Consultants available by phone after business hours as needed
SURVEY / REGULATORY REVIEW PROCESS (SAMPLE)
Due to the many challenges facing healthcare organizations, our approach to due diligence for healthcare include a review of the survey and regulatory issues surrounding the transaction. JJGuiliano and Associates stay current on all State and Federal Survey protocols and potential Regulatory Special Focus issues. Our scope may focus on some or all of the following key areas (as requested by lender).
DOCUMENT REVIEW PROCESS (Includes but not limited to)
Copy of most recent (last two years) 2567L with Plan of Correction (inc. State Licensure Deficiencies).
Federal Oscar reports 3 & 4 (as needed)
Copies of Aspen Enforcement Management Reports
State and CMS Cover letters with particular attention to:
Date of latest Annual Full Survey
Scope/Severity of Findings
Due dates for response
Recommendations for Remedies (CMP, DPNA, Termination)
Life/Safety Code findings (with Waivers if applicable)
2567B – Revisit findings & number of revisits noted
State Survey letter indicating Statement of Compliance
Complaint Investigations resulting in deficiencies since last Full Survey
Federal Validation Survey findings (if any)
Validation of State License and potential limits on licenses
Review of possible State/Federal Injunctions
Review and interpretation of court appointed Independent Review Clinical Monitoring reports
Review and Analysis of Facility/Corporate OIG Corporate Compliance Agreements and Plans
Facilities identified as Special Focus facility under the CMS Special Focus Facility Program.
CORPORATE COMPLIANCE DEVELOPMENT SERVICES
Provides (outside of the diligence obligation) Comprehensive Assessments of existing Corporate Compliance Plans and Programs
Certified to Benchmark the Role and Functions of the Corporate Compliance Officer and other Key Clinical and Support Operational titles
Certified to assist in the screening and selection of suitable Corporate Compliance Officer candidates and other Key Clinical and Operational Managers
Assists Providers with selection and delivery of suitable Staff Development and Training Programs (General and Specific)
Assists Providers with the development of Clinical and Regulatory Trend Analysis reports
Assists providers with the development of Auditing and Monitoring Protocols
Provides technical assistance to Long term Care Providers with the development of effective Incident Reporting Policies, Procedures and Incident Review protocols
Provides effective Incident Investigations Training and selections of suitable Internal Special Investigators.
Assists Provider Boards of Directors with Trend Analysis and other Risk Reporting data.
ADDITIONAL DUE DILIGENCE ACTIVITIES
Under the DRA, as of Jan. 1, 2007, entities receiving or making $5 million or more in payments under a state Medicaid plan will not be entitled to payment for services unless they establish written policies for employees, contractors and agents detailing: (1) the federal False Claims Act provisions; (2) the administrative remedies for false claims and statements; (3) any state laws relating to civil or criminal penalties for false claims and statements; and (4) the whistleblower protections under such laws.
Special examinations are required for these facilities. Facilites identified as Special Focus facility under the CMS Special Focus Facility Program and fully examined for perfromance.
Medicaid Integrity Contractors MIP requires CMS to use contractors for four specific functions: a) the review of actions of those seeking payment from State Medicaid plans; b) the audit of those claims; c) the identification of overpayments related to those claims; and d) the education of providers and others with respect to payment integrity and quality of care. Special examinations are required for these facilities.
Review of facility /facilities have been subject to Medicaid Integrity Contractor Audits) Special examinations are required for these facilities.
Meeting/Call with Administrator and Director of Nursing (as requested)
Maintain contacts with State & Federal Survey Agency Directors
SITE VISIT (IF APPLICABLE)
- Property Review
- Physical Plant/ NFPA Life/Safety Code interpretation
Administrative Interview - Clinical and Resident Observations
- Risk Assessment and Recommendations
- Other as directed by Lender
KEY INDICATORS OF VULNERABILITY
- Shortened provider agreement and Licensure requirements
- Administrative and staff turnover
- Administrator knowledge of facility and population
- Survey findings and Enforcement issues
- Response to inquires from State/ Federal Survey Agencies
- Successor liability issues
- Special Focus Facility designations
CORPORATE COMPLIANCE PERFORMANCE RANKINGS
- Recent and previous low or no deficiencies on full survey. Facility Rating and Ranking on CMS (5) Five Star Rating system
- Acceptable level of Substantial Compliance in past surveys and currently within survey “window”
- Currently Not in Substandard Compliance, findings of SQC, pending IDR, proposed/imposed CMP, DPNA or recommendation for termination, appointment of monitor, etc.
POST CLOSING MONITORING (AS DIRECTED)
- Monitor Survey Cycle Dates at the direction and approval of Client
- Review Surveys and Results
- Follow up contacts with State and Federal Survey Agencies
- Monitor Publications (newspapers, professional and Federal regulatory updates)
