The Approvalign® Process

The Approvalign® process is a multi-phase process that starts with identifying the states involved in a transaction and assigning a member of the Approvalign® team to each state and ends with the issuance of the licenses and/or licensure approvals needed to close a deal. The phases of the process involve, among other things, the following:

  • Securing written confirmation where no regulatory approvals are needed.
  • Completing health care (i.e., assisted living, skilled nursing and/or continuing care) licensure and ancillary license and permit (such as food permits, boiler permits, CLIA waivers, business licenses, salon permits, certificates of occupancy) application forms where regulatory approvals are needed.
  • Arranging for fire marshal and other inspections of the facilities.
  • Preparing and filing assumed business name filings.
  • Developing admission agreements and policies and procedures that comply with state law.
  • Working closely with the client and the regulators to address and resolve on a timely basis any questions and/or concerns that may arise.
  • Developing strategies where needed to minimize the need for required regulatory approvals and/or to close the transaction pending receipt of required regulatory approvals.
  • Conforming the legal documents involved in the transaction to accurately reflect the regulatory process/requirements of each state.
  • Coordinating local counsel legal opinions.
  • Submitting required documentation to secure Medicare and/or Medicaid tie in notices and/or new provider agreements.

The success of the Approvalign® process is built on relationships with the regulators, unwavering attention to detail and an in-depth knowledge of the long term care and senior housing industries.

The success of the Approvalign® process is also attributable to the fact that The Nathanson Group has developed its own database, known as Approvatrack®, which is used to facilitate the process of preparing the required licensure and ancillary permit applications.  Approvatrack® has improved the overall efficiency, both in terms of time and expense, of the CHOW application process by eliminating the need to prepare most applications manually and instead allowing them to be prepared electronically. Approvatrack® also provides a centralized place to monitor the status of in process and pending licensure and ancillary permit applications and is where the Master Packets (see below) are housed.

Staying Abreast of Regulatory Developments

In addition to the foregoing transaction specific steps, on an ongoing basis the members of the Approvalign® team update the “Master Packet” that we maintain for each State. Each Master Packet contains details that we believe will facilitate our ability to navigate the Approvalign® process in each State. Each Master Packet includes, but is not limited to, (i) the State’s current CHOW and/or Ancillary Permit rules and regulations, (ii) a complete set of Application materials, (iii) sample Notices, (iv) sample Application cover letters, (v) sample No CHOW confirmation letters, (vi) information on how we have addressed a particular State requirement in a prior transaction, (vii) information that will help us predict how the State will analyze a transaction from a CHOW/No CHOW perspective, (viii) the names and contact information for the reviewers with whom we have worked and (ix) notes on how a particular reviewer might prefer to see us handle an issue.