According to president-elect Donald Trump, Americans have suffered under the weight of a massive economic burden brought about by the Affordable Care Act (ACA). Apparently the Affordable Care Act was passed into law without much foresight, resulting in out-of-control costs, non-functional websites, higher premiums, less competition in the insurance industry and a greater rationing of care. As a…

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Moving to another state is a big undertaking for any family, but it can be particularly complicated when a family member has a disability. The secrets to a successful transition are advance planning and a backup plan in case of problems. Here are a few specifics to keep in mind.

Know what to expect with public benefits

If your family member with a disability is receiving Social Security Disability Insurance (SSDI) benefits, there should be no disruption in payments, as long as you inform the Social Security Administration as early as possible of your change of address. Supplemental Security Income (SSI) benefits should not be disrupted either, but the amount could change. In 2016, the federal maximum SSI benefit for an individual is $733 per month. However, some states add an optional state supplement or make food stamps or other benefits available to SSI beneficiaries, so those benefits may vary by state.

Plan in advance for health care needs

Health care is a primary concern, and in this area much can change when moving to another state. In addition to finding new doctors, therapists and other service providers, you should be prepared for changes in coverage. Private health insurance policies may have different coverage or premiums in another state. If you signed up for health insurance through the Affordable Care Act state exchanges, you can take advantage of a 60-day special enrollment period, but be sure to check the eligibility requirements ahead of time. Medicare benefits should not be affected by an interstate move, but Medicaid will need to be reapproved in the new state, and the services and support available through Medicaid varies from state to state.

Special education and other services

While students with disabilities are guaranteed a free and appropriate public education by the federal Individuals with Disabilities Education Act (IDEA), a special needs student’s Individualized Education Program (IEP) will need to be renegotiated. Other services, such as day care, social programs and in-home services vary greatly from state to state. ABLE Act legislation has not yet been enacted in all 50 states, and special needs trusts should be reviewed by an attorney to ensure that they are up to date and there are no problems created by the move.

Moving to a new state is a big project, but creating a checklist and engaging in advance planning will help you have an organized approach. Even with a detailed plan, it is a good idea to have a backup plan, and an emergency fund, in case of pitfalls along the way.

Learn more about our special needs planning and special education advocacy services at www.littmankrooks.com or www.specialneedsnewyork.com.

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According to experts, approximately 45 percent of people retire sooner than they planned. It is smart to have a contingency plan for early retirement.

It may not be feasible to secure a job that pays well, particularly for those in industries that largely depend on contractors. Even though it is illegal for employers to practice age discrimination, several older workers have difficulty finding work. If you are forced to retire early, your best option may be to find new work, even if it is not in your chosen field, and even if the compensation does not approach the amount you are accustomed to earning. Alternatively, you may find it more reasonable to reduce your expenses. Or you may decide to do both.

Another cost-effective measure is to avoid using your Social Security early, even if that means withdrawing funds from your retirement savings. If you claim social security at age 62, your monthly benefit will be 25 percent less than it would have been if you had delayed your retirement until you attained the full retirement age of 66 or 67. And if you wait to retire until you are age 70, you will receive another 32 percent.

Some options to consider if you must retire early are to accept a position that pays a lower salary, work part-time or become a consultant, reduce expenses, apply for unemployment benefits, seek health insurance on the Affordable Care Act exchange, have your college-age children decrease their expenses and consult a financial adviser.

You may also wish to conduct research of Social Security to make certain that you are collecting the maximum possible amount, continue to network professionally and pursue hobbies that make you happy.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

According to experts, approximately 45 percent of people retire sooner than they planned. It is smart to have a contingency plan for early retirement.

It may not be feasible to secure a job that pays well, particularly for those in industries that largely depend on contractors. Even though it is illegal for employers to practice age discrimination, several older workers have difficulty finding work. If you are forced to retire early, your best option may be to find new work, even if it is not in your chosen field, and even if the compensation does not approach the amount you are accustomed to earning. Alternatively, you may find it more reasonable to reduce your expenses. Or you may decide to do both.

Another cost-effective measure is to avoid using your Social Security early, even if that means withdrawing funds from your retirement savings. If you claim social security at age 62, your monthly benefit will be 25 percent less than it would have been if you had delayed your retirement until you attained the full retirement age of 66 or 67. And if you wait to retire until you are age 70, you will receive another 32 percent.

Some options to consider if you must retire early are to accept a position that pays a lower salary, work part-time or become a consultant, reduce expenses, apply for unemployment benefits, seek health insurance on the Affordable Care Act exchange, have your college-age children decrease their expenses and consult a financial adviser.

You may also wish to conduct research of Social Security to make certain that you are collecting the maximum possible amount, continue to network professionally and pursue hobbies that make you happy.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

by Thomas D. Begley, Jr., CELA

Settlement Protection Trusts can be very useful tools in the settlement of a personal injury case. A Settlement Protection Trust is very flexible. However, it cannot be used where an individual is receiving means-tested public benefits. A Settlement Protection Trust is essentially a Support Trust designed to provide for the health, education, maintenance and support of the trust beneficiary.

A budget is prepared and the trustee can often simply write a monthly check to the beneficiary, so that the beneficiary can pay all of his or her monthly bills. In other cases, the beneficiary will simply obtain a credit card and send the credit card bills to the trustee for payment, so long as the expenditures are within the agreed-upon budget. The budget should be designed so that the money will last as long as the plaintiff lives, if that is possible.

When to Use a Settlement Protection Trust

Minor or Incapacitated Person—Plaintiff Not Receiving Means-Tested Public Benefits

In these situations, a Settlement Protection Trust is ideal. If there is a minor or incapacitated person, the monies can be deposited into the Settlement Protection Trust rather than the probate court.

In cases involving a minor or incapacitated person, the establishment of the Settlement Protection Trust must be approved by the court.

Competent Adult Not Receiving Means-Tested Public Benefits

Where a competent adult is not receiving public benefits, both New Jersey and Pennsylvania allow distributions to be made from income and principal without court approval. The beneficiary enjoys the advantages of the Settlement Protection Trust, and the trust serves to protect the settlement from being squandered by the injured plaintiff or being coveted by family members and friends.

Large Settlement—Client Receiving Means-Tested Public Benefits

In many large settlements, the client may be receiving SSI and Medicaid. In some cases, the Medicaid benefit may be modest and, therefore, unnecessary. In other cases, the Medicaid benefit may be significant, but can be replaced by insurance under the Affordable Care Act or a combination of Medicare and private insurance. In these cases, it is often beneficial to consider giving up the public benefits in exchange for greater flexibility in administration and avoiding the Medicaid payback.

Fifty years ago, Medicare and Medicaid became the latest and greatest entitlement signed into law. Lyndon B. Johnson did the honors July 30, 1965, with past Democrat president Harry S Truman sitting next to him.

The new law was part of Johnson’s “Great Society” plan, which was a continuation of Franklin Roosevelt’s “New Deal.” It was meant to be another safety net for seniors and other Americans who would need medical care later in life.

It is a significant milestone to have a government program remain operational 50 years later. But with such longevity, the question is then begged, as times have changed:

What will become of this program over the next 50 years?

That discussion has been a hot topic among conservatives and Republicans in regards to saving not only Medicare and Medicaid, but also to Social Security. While those programs were signed into law by Democrat presidents, Republicans have seemed to be the ones fighting to see that the government “upholds its promises to the nation’s seniors.”

With all the talk over the last several years, backed up by various studies and analyses about the programs, there have been suggestions that Medicare and Medicaid may be completely broke as early as 2025 if nothing is done to reform the structure of the system. But there are others who say that sustainability has already been addressed with the Affordable Care Act – though it reportedly took $700 billion from Medicare to pay for the bill.

In some ways, it is serendipitous that these programs have managed to be around for 50 years in the first place. But can the government continue to fulfill promises moving forward as the population ages and there are fewer workers paying into the system but more former workers taking out of the system?

What should be done, if anything has been a source of much debate? And the New York Times, in “celebrating” 50 years of Medicare, opened up its debate and opinion pages to several perspectives about Medicare and its future. While it seems there is general agreement that Medicare will look different in the next 50 years than it was in the last 50 years, there is strong debate as to how the program will change. From discussions about structural reform or developing a single-payer healthcare system (“Medicaid for all,” as it has been deemed), to cutting benefits, raising taxes and having benefits means-tested – there are plenty of options and plenty of areas of discussion and disagreement.

Whichever way you come down, there is one thing that is certain – you can’t be certain about it, so you need to be prepared for alternatives. Before you are near the age of being qualified for Medicare or Medicaid, it would be a good idea to include this topic in your discussion about estate planning with a local certified elder law attorney. He or she can sit down with you and discuss not only your general estate plan to get all your affairs in order, but can also help you understand Medicaid, its uncertain figure and how you can create some certainty for yourself and your family.

When you don’t know how much longer you’ll live, you can’t count on something unreliable. You need a rock to lean on, and your estate plan can be that rock – whether it includes Medicare or not.

The post The Future of Medicare and Medicaid 50 Years from Now appeared first on The Elder Care Firm.

Fifty years ago, Medicare and Medicaid became the latest and greatest entitlement signed into law. Lyndon B. Johnson did the honors July 30, 1965, with past Democrat president Harry S Truman sitting next to him.

The new law was part of Johnson’s “Great Society” plan, which was a continuation of Franklin Roosevelt’s “New Deal.” It was meant to be another safety net for seniors and other Americans who would need medical care later in life.

It is a significant milestone to have a government program remain operational 50 years later. But with such longevity, the question is then begged, as times have changed:

What will become of this program over the next 50 years?

That discussion has been a hot topic among conservatives and Republicans in regards to saving not only Medicare and Medicaid, but also to Social Security. While those programs were signed into law by Democrat presidents, Republicans have seemed to be the ones fighting to see that the government “upholds its promises to the nation’s seniors.”

With all the talk over the last several years, backed up by various studies and analyses about the programs, there have been suggestions that Medicare and Medicaid may be completely broke as early as 2025 if nothing is done to reform the structure of the system. But there are others who say that sustainability has already been addressed with the Affordable Care Act – though it reportedly took $700 billion from Medicare to pay for the bill.

In some ways, it is serendipitous that these programs have managed to be around for 50 years in the first place. But can the government continue to fulfill promises moving forward as the population ages and there are fewer workers paying into the system but more former workers taking out of the system?

What should be done, if anything has been a source of much debate? And the New York Times, in “celebrating” 50 years of Medicare, opened up its debate and opinion pages to several perspectives about Medicare and its future. While it seems there is general agreement that Medicare will look different in the next 50 years than it was in the last 50 years, there is strong debate as to how the program will change. From discussions about structural reform or developing a single-payer healthcare system (“Medicaid for all,” as it has been deemed), to cutting benefits, raising taxes and having benefits means-tested – there are plenty of options and plenty of areas of discussion and disagreement.

Whichever way you come down, there is one thing that is certain – you can’t be certain about it, so you need to be prepared for alternatives. Before you are near the age of being qualified for Medicare or Medicaid, it would be a good idea to include this topic in your discussion about estate planning with a local certified elder law attorney. He or she can sit down with you and discuss not only your general estate plan to get all your affairs in order, but can also help you understand Medicaid, its uncertain figure and how you can create some certainty for yourself and your family.

When you don’t know how much longer you’ll live, you can’t count on something unreliable. You need a rock to lean on, and your estate plan can be that rock – whether it includes Medicare or not.

The post The Future of Medicare and Medicaid 50 Years from Now appeared first on The Elder Care Firm.

Durable Powers of Attorney

There is a need in all of us to nurture our parents as they become older. We make decisions regarding where they will live – whether in their own home, with you or in an elder care facility. After making this decision, however, you find there are other preparations to arrange. You may now find yourself in charge of such financial and medical matters as overseeing their insurance and day-to-day concerns like paying the bills. This is where durable powers of attorney can change things and pave the way for both you and your parent to have smoother transitions on all necessary legal matters.

Durable Power of Attorney in Michigan

A durable power of attorney enables your elderly parent (called the “principal” in the power of attorney document) to appoint an “agent,” (you), to handle specific health, legal and financial responsibilities. This document is especially important in regards to their healthcare. With the need for proper medical assistance becoming such an important issue, being able to step in and make decisions regarding your parent’s care, and their benefits under the Affordable Care Act, is vital. For instance, under this act, seniors with Medicare benefits will never have them reduced or eliminated and, will always be able to choose his or her own doctor. This is why it is essential to know what their rights are and set up the legal means to take over, if necessary, and make decisions for them before they become forgetful, terminally ill or have difficulty handling these tasks. By doing this now, while your parent is capable of deciding to seek assistance:

• First:  the transfer of responsibilities occurs immediately.
• Second: if they do unfortunately, become incapacitated or incompetent, this will allow you to make many important financial decisions, pay bills and make important healthcare decisions on their behalf.
• Third: this provides an opportunity to do crucial Medicaid planning. What this means is that if your parent should need long-term care in the future, which is expensive, this can deplete their life savings before they are even allowed to become eligible for benefits such as Medicaid or Medical Assistance. Through this planning, you can help your parent protect the assets they have; including their home.

Not All Durable Powers of Attorney are Equal

One of the big issues Michigan families run into is that not all durable powers of attorney are created equal.  Quite often when a durable power of attorney is reviewed it is prepared from an estate planning perspective, not an elder law one.  Meaning there are limitations that won’t allow you to properly plan for VA Benefits or Medicaid because the power of attorney was drafted by someone who is not a Certified Elder Law Attorney.

Durable Power of Attorney for Your Parents

We understand that emotions involved while caring for your elderly parent can seem almost as overwhelming as the financial obligations themselves. As your loved ones age, together, we can plan a caregiving strategy. By choosing The Elder Care Firm, a practice that is dedicated to helping Michigan seniors, veterans and their families plan for and cope with the many issues that come with growing older, this will help smooth transitions and give you a better view of the scope of your responsibilities. To learn more about the durable power of attorney and speak with a lawyer who can help, please contact us today for more information.

The post Durable Powers of Attorney Can Help Smooth Transitions for Elder Care in 2015 appeared first on Estate Planning Lawyers | Elder Law Attorneys | Brighton | Novi | Livonia Elder Law Attorneys.

THE IMPORTANCE OF A FINANCIAL ANALYSIS TO DETERMINE IF A SPECIAL NEEDS TRUST IS REQUIRED IN A PERSONAL INJURY CASE

by Thomas D. Begley, Jr., CELA

When a plaintiff receiving public benefits achieves a personal injury settlement, the plaintiff essentially has four choices:  (1) use a special needs trust (SNT) only; (2) use the SNT, but also buy ACA private health care; (3) do not use an SNT and buy ACA private insurance; or (4) do not use an SNT and attempt to become eligible for Medicaid-funded insurance through programs such as New Jersey Family Care.

Analysis of the Four Options with Respect to Special Needs Trusts

Let’s examine the advantages of each option.

1. Using an SNT only.  The advantage is that the plaintiff will continue to receive SSI, Medicaid, and other means-tested public benefits.  The disadvantages are that distributions from the trust must be for the sole benefit of the individual and that there is a Medicaid payback on the death of the trust beneficiary.

1. Use the SNT but also buy ACA private health care.  The advantage here is that the plaintiff’s SSI and Medicaid are protected.  The ACA insurance will result in a reduction or elimination of the Medicaid payback. Also, purchase of the ACA insurance may result in better health care and more access to health care providers than Traditional Medicaid.  The disadvantage is that the trust must pay the premiums for the ACA insurance, so this is a consideration in smaller trusts but definitely a good strategy for larger trusts.

1. Not use an SNT and buy ACA private insurance.  The advantage is that there is greater flexibility with respect to accessing the recovery.  The disadvantages are that the personal injury victim may squander the money and ACA insurance only covers what typical private medical insurance covers (i.e., hospitals and physicians), but does not cover what Medicaid Waiver programs cover, such as home- and community-based services or placement in group homes, assisted living facilities, or nursing homes.

1. Not use an SNT but rely on programs such as New Jersey Family Care.  The advantage is that there is greater access to the litigation proceeds.  The disadvantage is the money may be squandered, not everyone is eligible for New Jersey Family Care, and New Jersey Family Care does not cover hospital and physician costs.

Importance of SSI

If a personal injury victim is receiving means-tested public benefits such as SSI, Medicaid, Medicaid Waiver benefits, etc., it is often assumed that the plaintiff will require an SNT to preserve those benefits.  In the past, that conclusion was almost always true.  However, with the passage of the Affordable Care Act effective January 1, 2014, individuals with pre-existing conditions are now able to obtain private medical insurance and may not need to rely on Medicaid as much as prior to the ACA.  However, the analysis does not stop there.

Currently in New Jersey an SSI recipient is entitled to approximately $750 per month.  SSI comes with a COLA.  The value of the SSI payment over a lifetime is usually hundreds of thousands of dollars.

Who Will Hold the Money

In most cases, it makes financial sense to utilize an SNT if the plaintiff also receives SSI, unless the net settlement to the plaintiff exceeds roughly $3,000,000.  The SNT preserves SSI, which is often the individual’s only access to income.  In addition, if the plaintiff is incapacitated and is receiving means-tested public benefits, the litigation recovery must be placed in some kind of court-supervised entity, typically a guardianship or the Surrogate’s office.  It is always less expensive and easier to access funds held in an SNT than those held by a guardianship account or the Surrogate’s Court.  Funds held in a guardianship account or Surrogate’s Court are considered to be available for public benefits purposes and would cause a loss of both SSI and Medicaid.

Protecting the Plaintiff from Himself and Predators

Even if the plaintiff has legal capacity, frequently they do not have the sophistication to properly manage wealth.  An SNT allows the plaintiff to preserve eligibility for benefits, usually without court supervision in New Jersey, and to have a trustee with a fiduciary obligation to utilize the funds for the plaintiff’s sole benefit under a prudent investment strategy.  The trust also offers protection from financial predators including strangers, members of the opposite sex, and even family members looking to take advantage.  Under these circumstances, the SNT will provide the best option to safeguard and protect the person with a disability.

Budgeting

According to an analysis by Scott MacDonald, CSNA, Affordable Care Act’s Financial Effect on Settlement Planning, an individual receiving a net settlement of $1,000,000 that is placed into an SNT will receive an attainable annual total budget of $33,484.  If instead the plaintiff took the settlement and purchased private health care, even under the ACA, the annual budget would be reduced to $15,494.  If you add in the loss of the SSI COLA estimated at 2.5% over time, the plaintiff would be taking a 52% annual pay cut by not utilizing an SNT.  Using a similar analysis with a $100,000 net settlement, the SNT could provide $12,610 toward an annual budget, but if the beneficiary took the funds directly and lost SSI, the annual spending amount would be $3,614, a 71% reduction for life.  Under MacDonald’s analysis unless the plaintiff is netting at least $3,000,000, he will always be better off with an SNT.

A major concern is that such claims blindside tens of thousands of older Californians who are receiving “expanded Medi-Cal” under President Obama’s Affordable Care Act. They are shocked to learn that their estate, most typically consisting of their residence, will be essentially attacked upon their passing.

Michael Gilfix points out in the article that assets could be protected from such Medi-Cal recovery claims. “There are certain ways to transfer a home out of an estate, although this can raise tax issues,” Michael Gilfix is quoted in the article.

Clients of Gilfix & La Poll understand that the residence can be protected and that many potential tax traps can be avoided with careful planning.

Learn more by contacting Gilfix & La Poll Associates LLP at http://www.gilfix.com/contact-us/.

One proposal involves new limits on medical malpractice lawsuits.

Representative Steve Scalise, Republican of Louisiana, is one of several Republicans pushing for the proposed legislation, which would repeal the Affordable Care Act, place new restrictions on medical malpractice suits and provide more access to health savings accounts.

However, some Republicans oppose the concept of a big healthcare bill that would make sweeping changes. Instead, they propose a targeted approach with smaller bills that would make limited changes within Obamacare.

The Affordable Care Act sets minimum standards for health insurance coverage. It requires most Americans to purchase health insurance and provides subsidies for low-income people to get coverage. Opponents have criticized the legislation as government interference in the marketplace.

Many states have passed legislation limiting the amount of non-economic damages, such as those for pain and suffering, that can be recovered in lawsuits over medical malpractice. In other states, including Illinois, such limits have been ruled unconstitutional. At the federal level, the Supreme Court has ruled that punitive damages in any lawsuit may not exceed compensatory damages by a ratio of more than nine to one.

Paul Greenberg is a medical malpractice lawyer in Chicago and malpractice attorney with Briskman Briskman & Greenberg. To learn more call 1.877.595.4878 or visit http://www.briskmanandbriskman.com/.

Five key factors have the potential to affect insurance premiums: dog or large animal ownership; occupation and lifestyle; history of past insurance claims; credit score; and smoking habits. While some of these factors may seem surprising at first, they make sense when one understands the reasoning behind them.

Dog insurance claims cost millions of dollars every year. For example, California insurers paid out $480 million for dog bite claims in 2011 alone. Claims like these fall under the umbrella of renter’s or homeowner’s insurance, so if you want coverage, an insurer will want to know what breed of dog or other large animal you have. Some dogs may be excluded depending on their breeds, or a surcharge may be added if your dog has displayed dangerous behavior in the past. If your pet causes too many claims, your premiums may increase significantly, or your future insurance coverage may be declined.

Have a high-risk career as a construction worker, rodeo cowboy or diver? Your premiums for life insurance will be higher. Insurers will want to know if policyholders who travel outside the country participate in extreme sports like ballooning or skydiving. Some sports activities can also raise insurance rates, though policies differ at each insurance company. Always shop around for the best prices and coverage.

Some states have rules and regulations dictating that insurance companies can increase your premiums once you have filed any claim. By company logic, if you file once, you are likely to file again. All claims are on record. However, some insurance companies do have claim forgiveness.

Some insurance companies will check credit scores when calculating premiums for life, property or casualty insurance. Insurers claim that credit scores show how responsible you are; bad credit indicates that you may not be responsible. This practice is legal in some states. These checks are not permitted for health insurance premiums. Get several quotes from different insurers if you are concerned about your credit rating affecting your life insurance rates.

Even though the Affordable Care Act ensures that no one may be denied coverage or charged higher rates for pre-existing conditions, insurance companies may add up to a 50 percent surcharge for smokers. Some states allow the highest possible rate; others have smaller surcharges. If you want to reduce your premiums, enroll in a class to stop smoking. Life insurers rate smokers at a higher risk for life-altering medical conditions.

One major change has already been put into place — Preventive Care. Medicare started covering this type of serv… http://p.ost.im/8FhNN4

A recent article on the Washington Times Communities website suggests that the Affordable Care Act (ACA), or Obamacare, may lower this barrier to divorce if it succeeds in making health care more affordable.

A study by the University of Michigan in 2012 found that each year, some 115,000 American women lose their health insurance after they get divorced. Many of them are not employed outside the home, work part-time, or work for companies that do not offer insurance. Some are eligible for COBRA benefits, but of those, many cannot afford the premiums while living alone.

Concerns over health insurance are especially prevalent among couples divorcing after age 50, cases sometimes called “gray divorces.” If individuals are too young to qualify for Medicare, they may find themselves priced out of insurance markets. An unknown number of couples remain married until age 65 for this very reason.

Individuals with pre-existing conditions who are covered under their spouse’s plan also face strong incentives to remain legally married.

Beginning January 1 2014, the ACA could change this dynamic for many people. Presumably, some number of people will be able to afford health insurance on their own where previously they could not. If the program is a success, and large numbers of couples find themselves in this situation, the divorce rate could rise sharply, especially among the unemployed or underemployed, seniors and those with pre-existing conditions.

The ACA could also bring about changes in spousal support. The cost of health insurance affects the need for spousal support, with one party often having to pay enough for adequate coverage. Any change in the overall insurance market could affect how much support is awarded in some cases.

Accounting for these changes will likely be highly contentious in several ways. Opposing parties might disagree over whether spousal support should provide for excellent (“platinum”) insurance, or only basic (“bronze”) plans. If the spouse receiving support is eligible for a federal insurance subsidy, the other party may argue that that should lower the support awarded. Likewise, the expansion of Medicaid in some states will make more individuals eligible—another possible argument for lower support.

Among those couples who find themselves better able to afford health insurance under the Affordable Care Act, some who might otherwise have remained married may opt for divorce. The specific effects of such a change will take time to recognize and understand.

Kristi J. McCart is a Tampa divorce lawyer and Brandon child custody attorney with the Osenton Law Offices, P.A. To learn more, visit http://www.brandonlawoffice.com/

If a beneficiary’s health or prescriptions for medication have changed in the past year, then it might be a good idea to compare plans. It also may be that the plan itself is what has changed: many plans have increased premiums or copayments or changed the pricing tiers for prescription medication. If an insurer moves drugs from one pricing tier to another, that can have a significant effect on one’s out-of-pocket costs.

Some insurers have up to five different tiers of prescription drug pricing, and if a medication moves from a preferred to a non-preferred or specialty drug, the patient may have to pay up to 25 percent of the cost out-of-pocket. Price differences between generic and name-brand drugs are common, but some plans also have different tiers for preferred generic and non-preferred generic drugs.

One recent change in Part D is the growth of preferred pharmacy plans. Some insurers offer low premiums and low copayments if one uses a particular chain of pharmacies. The savings can be substantial when one uses the preferred pharmacy.

One can compare plans on Medicare.gov’s Plan Finder. Entering one’s zip code and medications and clicking on “prescription drug plans” brings up the plans available to the individual. The star ratings are useful in choosing a plan, because they incorporate actual members’ reported satisfaction with the plan.

Open enrollment is also an opportunity to choose a Medicare Advantage plan, if desired. To cover hospital care (Part A) and outpatient care (Part B), Medicare offers a choice between single-payer traditional Medicare or a network plan (Part C or Medicare Advantage), in which the federal government pays for a private insurer that the patient can choose. The majority of Medicare beneficiaries choose traditional Medicare, but if one chooses Medicare Advantage, now is when one can shop around among different plans.

One potential source of confusion that Medicare beneficiaries will want to avoid is that this is also the open enrollment period for the new health insurance exchanges under the Affordable Care Act. However, the two are completely separate. The health insurance exchanges are for people who do not have health insurance, and Medicare beneficiaries do have health insurance, through Medicare. The online location to compare Medicare plans is Medicare.gov, not Healthcare.gov.

The Hale Law Firm believe the right solution to your estate planning, elder law, or probate needs can be identified in a free initial consultation with one of our attorneys and counselors at law. To learn more or to contact a Dallas estate planning attorney, visit http://www.thehalelawfirm.com/ or call 972.351.0000

By Chris Berry

Monday, President Obama vented his frustrations with the failures of the government’s health care Web site, but said the technical problems were not indicative of a broader failure of the Affordable Care Act.

“We did not wage this long and contentious battle just around a Web site. That’s not what this was about,” Mr. Obama told supporters during 25-minute remarks in the Rose Garden.

HealthCare.gov failed to provide the easy opportunity to sign up for health insurance that White House officials promised. Despite its deficiencies President Obama insisted that critics support the law.

“It’s time for folks to stop rooting for its failure, because hard-working, middle-class families are rooting for its success,” he said.

A number of people have been unable to sign on to the site or create account, and the technical advisers involved say it could be weeks or months before the issues are resolved.

The President made no excuses for the problems, but did not say whether anyone in the government would be terminated as a result. Certain Republicans have answered by requesting the termination of Kathleen Sebelius, the secretary of health and human services.

Mr. Obama offered other ways to sign up for insurance, including expanded call centers and in-person “navigators” who are at hospitals and health care centers through the U.S. Additionally, people can download a form to be filled out and mailed in, he said.

The President urged people to disassociate the Web site’s problems from the purpose of the law, which was to find a way to provide affordable health insurance to millions of uninsured Americans, he said.

“The product is good. The health insurance that is being provided is good. It’s high quality and it’s affordable,” Mr. Obama said. “We know that the demand is there. People are rushing to see what’s there.”

Read more: http://www.nytimes.com/2013/10/22/us/politics/obama-pushes-health-law-but-concedes-web-site-problems.html?hp&_r=0

Christopher J. Berry is an elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.theeldercarefirm.com/ or call 248.481.4000

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Medicaid expansion battle in Michigan results in passage.

Tuesday, Republican governor Rick Snyder swayed just enough conservative senators in the State Legislature to accept the expansion, which was a part of President Obama’s health care law.

Despite falling one vote short initially, Mr. Snyder’s preferred bill was salvaged after months of lobbying. The vote in the Republican-controlled Senate was 20 to 18, with only 8 Republicans in favor. The Michigan House will need to once more vote and approve the Senate version before Snyder can sign the bill.

(Related: Medicaid Expansion Will Save the State Money, Snyder Says)

“The Affordable Care Act has probably been one of the most divisive issues that our country has faced in the last few years, and many people do have strong opinions both for and against,” Mr. Snyder said after the vote. “I just ask that all Michiganders step back and look to say this isn’t about the Affordable Care Act. This is about one element that we control here in Michigan that we can make a difference in here in people’s lives.”

In 2012 the Supreme Court gave the states the option opt out of Medicaid expansion, resulting in a struggle in the states along partisan lines. Gov. Snyder wasn’t the only Republican governor who found himself opposing his own party’s legislative caucuses in state capitals like Lansing, that are a Republican majority.

Arizona Gov. Jan Brewer, like Snyder, experienced great opposition from some lawmakers, but expansion was eventually approved. However, despite Gov. Rick Scott’s best effort legislators in Florida have resisted expansion, and the same goes for Gov. John R. Kasich’s push for expansion in Ohio.

(Related: Medicare Does Not Pay for Long-Term Care)

The debate grew heated on the floor of the Michigan Senate Tuesday, though lawmakers said the discussions had been even more intense behind closed doors. Advocates praised the measure for its fiscal sensibility, considering the promise of federal money, and imperative for thousands of low-income residents without insurance.

Currently, Medicaid covers more than 1.8 million people in Michigan, officials said, and the expansion would grant coverage to more than 400,000 more. Those making up to 133 percent of the federal poverty level — or about $15,500 a year for a single person — would now be covered.

“It’s a benefit to every person in the state of Michigan,” said State Senator Gretchen Whitmer, the Democratic leader, said on the floor. “It’s good public policy, and it makes good fiscal sense.”

Republican Senator Roger Kahn told his colleagues, “This is not Obamacare or the Affordable Care Act.” On the contrary, the measure will reform the costs of medicine across the state and serve as “a national model” for other states.

Opponents claimed that Medicaid expansion would imply tacit approval of Obama’s health care law. They said it would encourage big government and irresponsibly promise Michigan’s spending for years ahead.

(Related: Long-Term-Care Insurance Dilemma)

Senator Patrick J. Colbeck, another Republican who opposes expansion, said, “We’re spending money we do not have,” adding, “And we’re forcing decisions right now onto our youth.”

“We firmly believe that a vote to support Medicaid expansion is a vote to support the president’s health care law,” said opponent Annie Patnaude, deputy state director of Americans for Prosperity-Michigan..

Read more: http://www.nytimes.com/2013/08/28/us/medicaid-expansion-battle-in-michigan-ends-in-passage.html?nl=todaysheadlines&emc=edit_th_20130828&_r=1&

Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.theeldercarefirm.com/ or call 248.481.4000

Meanwhile, resources for healthcare have never been more easily available. A number of free or extremely affordable preventive health tests and screenings are now being provided to seniors under the Affordable Care Act. In some cases, these services may require a small co-pay, but many do not, and all are offered without any insurance deductible for seniors.

For example, doctors who participate in Medicare are now offering a free annual wellness exam. Use this opportunity to work with your primary care physician on a 12-month wellness plan. If you have just enrolled in Medicare, you will receive a “Welcome to Medicare” exam at no cost, as well. Physicians are using it as a preventative baseline check to help plan out an ongoing wellness approach with their new patients. Other services provided for free under the Affordable Care Act include smoking cessation services, bone mass measurements, flu shots, Hepatitis B shots, abdominal aortic aneurysm screenings, and medical nutrition therapy services.

Take advantage of these opportunities to keep up with your heath maintenance. That means getting an annual flu shot and staying current on all immunizations. Go in for regular dental cleanings and medical checkups. Keep an eye on your blood pressure and cholesterol levels; the levels may seem like a small part of your overall health, but healthy blood pressure and cholesterol numbers mean a lowered risk for stroke and heart disease.

The Affordable Care Act does not address the cost of long-term care, nor does Medicare pay for skilled nursing facilities ($5,000 – $10,000). To cover such costs, Medi-Cal is the only governmental source of assistance.

What else can seniors do to take charge of their health and enjoy their later years? Numerous studies have shown that keeping an active interest in intellectual pursuits slows the development of dementia or other types of cognitive decline. Take up a new hobby or learn a new skill. Work on puzzles, brain teasers, crossword puzzles. Take music lessons, or learn a new language. Even things as simple as taking an interesting class at a community center or brushing up on math can make a huge difference in brain activity.

Be sure to get regular exercise. It may be walking every day, or biking on the weekends, or taking an exercise class at the gym most mornings. Focus both on leisure activities which are enjoyable and physical activities which get you moving; you do not have to put too much of a strain on your body. Get outside, get active and have fun.

For Medi-Cal planning assistance, talk with a knowledgeable attorney who can guide you through the maze.

Pioneers of Elder Law – For over 30 years, Gilfix & La Poll Associates LLP has innovated creative legal solutions to help you manage and plan the future of your estate.
To contact an estate planning lawyer visit http://www.gilfix.com/ or call 800.244.9424.

Obamacare fails to address the growing coverage gap.

Despite the 2,200 page, $2.5 trillion effort known as the Affordable Care Act and the 20,000 pages of Obamacare regulations, there is a growing coverage gap that Obamacare fails to address. As a result, millions of Americans have been driven into poverty and the trend will continue.

It is uncommon for Americans to have long-term care insurance. This means they will have to dig into their own pockets if they end up in a nursing home or need home health care due to stroke, Alzheimer’s disease or other long term disabilities. Long-term care is the most significant out-of-pocket medical cost for the elderly and a leading cause of personal bankruptcy. Nursing homes typically cost more than $90,000 per year and home health care can run close to $10,000 per month.

Medicare only provides minimal coverage for nursing homes or home care like short-term recovery from acute illnesses and hospitalizations. Dementia and other long-term disabilities can result in costs for $200-$400 per day over the course of several years.

Two-thirds of working households approaching retirement have failed to save one year’s income. The most feasible option to cover a family member with a long-term disability is to exhaust family income and assets to qualify for nursing home care through state Medicaid programs. While the allowed assets that the family can keep varies by state, it is generally close to $1,500 in monthly income.

Even in the 30 states that expand Medicaid coverage under Obamacare in 2014, a two-person family would still require monthly income less than $1,800 to qualify for Medicaid. The Obamacare bill included a voluntary “CLASS program” for long-term care that would have provided a mere $50 per day of benefits, barely 10 percent to 25 percent of what is needed.

Sen. Kent Conrad, the Democratic chair of the Senate Budget Committee called the CLASS program  ”a Ponzi scheme of the first order.”

Read more: http://www.ocregister.com/articles/term-518990-care-long.html

Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000

Obamacare fails to address the growing coverage gap.

Despite the 2,200 page, $2.5 trillion effort known as the Affordable Care Act and the 20,000 pages of Obamacare regulations, there is a growing coverage gap that Obamacare fails to address. As a result, millions of Americans have been driven into poverty and the trend will continue.

It is uncommon for Americans to have long-term care insurance. This means they will have to dig into their own pockets if they end up in a nursing home or need home health care due to stroke, Alzheimer’s disease or other long term disabilities. Long-term care is the most significant out-of-pocket medical cost for the elderly and a leading cause of personal bankruptcy. Nursing homes typically cost more than $90,000 per year and home health care can run close to $10,000 per month.

Medicare only provides minimal coverage for nursing homes or home care like short-term recovery from acute illnesses and hospitalizations. Dementia and other long-term disabilities can result in costs for $200-$400 per day over the course of several years.

Two-thirds of working households approaching retirement have failed to save one year’s income. The most feasible option to cover a family member with a long-term disability is to exhaust family income and assets to qualify for nursing home care through state Medicaid programs. While the allowed assets that the family can keep varies by state, it is generally close to $1,500 in monthly income.

Even in the 30 states that expand Medicaid coverage under Obamacare in 2014, a two-person family would still require monthly income less than $1,800 to qualify for Medicaid. The Obamacare bill included a voluntary “CLASS program” for long-term care that would have provided a mere $50 per day of benefits, barely 10 percent to 25 percent of what is needed.

Sen. Kent Conrad, the Democratic chair of the Senate Budget Committee called the CLASS program  ”a Ponzi scheme of the first order.”

Read more: http://www.ocregister.com/articles/term-518990-care-long.html

Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.theeldercarefirm.com/ or call 248.481.4000

Snyder demanded Senate Republicans to “take a vote, not a vacation” and urged residents to “bug the living daylights” out of them.

After his recent blast of the Senate Republicans for their failure to vote on Medicaid expansion and reform plan before summer break, Michigan Gov. Rick Snyder is on the road to advocate for the benefits of the proposal.

Snyder’s office announced “A Conversation With the Governor,” a series of informal discussion with a variety of audiences throughout the state. The Republican governor is expected to begin the series in Grand Rapids, where he will discuss the “Healthy Michigan” initiative with Spectrum Health System employees and other stakeholders.

(Related: Long-Term-Care Insurance Dilemma)

“The Healthy Michigan plan is vital to the health of our families and the economic success of our state. Unfortunately, Michigan now faces a sense of urgency to approve the plan in the light of the Senate’s failure to vote before taking a summer vacation,” Snyder said.

“I look forward to sharing information about the plan with health care providers, employers and all Michiganders so that we can work together to move it forward. Healthy Michigan is a good step for our state. It will help build healthier families and a stronger Michigan.”

For months, Snyder has lobbied lawmakers to expand Medicaid eligibility to 133 percent of the poverty level using funding promised by the federal government under the Affordable Care Act, aka Obamacare.

(Related: Considering The Move To A Nursing Home: First Steps)

Despite their initial dismissal of the governor’s proposal, House Republicans ended up working with Snyder to develop an expansion plan that includes a number of state-level reforms.

After approving the measure in a 76-31 bipartisan vote, Senate Majority Leader Randy Richardville failed to call an up-or-down vote in that chamber before lawmakers left town for summer break, planting serious seeds of doubt regarding the fate of the expansion proposal.

(Related: 7 Risk Factors for Alzheimer’s, Dementia, and Cognitive Decline)

Then, in an afternoon press conference, Snyder demanded Senate Republicans to “take a vote, not a vacation” and urged residents to “bug the living daylights” out of them.

Read more: http://www.mlive.com/politics/index.ssf/2013/06/michigan_gov_rick_snyder_plans_1.html?utm_source=twitterfeed&utm_medium=twitter&utm_campaign=Feed%3A+michigan-news+%28Michigan+News%2C+Updates%2C+Photos%2C+Videos+and+Opinions+-+MLive.com%29

Christopher J. Berry is an elder law lawyer in Michigan Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000

While the latest scam is actually a classic one – stealing personal information to perpetuate identity theft – the details have been updated in light of the recent news about healthcare changes. A senior may receive a telephone call from someone who states that he or she is updating personal and contact information for a state or federal program such as Medicare or Medicaid, or for a private health insurance company. Some callers may reference new health care laws under the Affordable Care Act. The caller may ask for some or all of the following; mailing address, bank account routing numbers, social security numbers and/or date of birth.

None of this information should be given to someone you do not know or to someone over the phone whom you did not contact. If you receive one of these calls, simply hang up the phone.

If you have been the victim of one of these calls and have given out personal information, know that you are not alone. Law enforcement agencies across the U.S. are reporting that many people have also given out their information. Your first order of business should be to check your bank statement to see if anyone has drawn money from your account, and have a credit report run to ensure no one has taken out credit cards in your name.

Christopher J. Berry is an elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000

Because some states have declined to expand their Medicaid program under the Affordable Care Act, more than a quarter-million veterans who don’t have health insurance will miss out on Medicaid coverage.

Under the new federal health law, expanding Medicaid eligibility is a key component which aims to offer coverage to the majority of uninsured Americans. In January, uninsured adults with incomes at or below 138 percent of the federal poverty level ($15,415 for an individual and $32,527 for a family of four) will become eligible for Medicaid benefits in those states that expand their programs.

(Related: Rural Areas Could Suffer In States That Opt Against Medicaid Expansion)

It is a common misconception that the nation’s 12.5 million non-elderly veterans receive health benefits through the Department of Veterans Affairs (VA). But only two-thirds of those veterans are eligible for VA health care while only one-third are enrolled.

There are roughly 1.3 million uninsured veterans nationwide.

In a recent report, it was was estimated by the Urban Institute that if every state embraced the new Medicaid rules, as many as 535,000 uninsured veterans and 174,000 veteran’s spouses would become eligible for Medicaid coverage.

(Related: Palliative Care Need Grows, Specialists Dwindle)

Unfortunately, last june the U.S. Supreme Court ruled that states were not required to expand their Medicaid programs. As a result, 23 states have declined to expand Medicaid, while another six have yet to make a final decision. There are close to 258,600 uninsured veterans in the 23 states that have rejected the expansion who would have been eligible for Medicaid, according to a Urban Institute report.

And with Obamacare taking effect in 2014, like most other Americans, the uninsured veterans will be required to get it by January or risk paying a penalty under the Affordable Care Act. However, some of the uninsured who fail to qualify for Medicaid coverage might be eligible for federal subsidies that will be made available under the law. Uninsured Americans–veterans and non-veterans–will be able to use those subsidies to purchase private insurance on the state health care exchanges, set to launch in January.

There is a growing fear that Medicaid expansion and the array of health insurance choices available to veterans would result in worse care. The federal government created a separate VA health care system in the belief that veterans would get better care from doctors and nurses versed in the unique health conditions facing them, including post-traumatic stress in addition to other mental illnesses and physical injuries. But the Department of Veterans Affairs only expects 66,000 uninsured veterans to enroll in the VA system to meet the insurance requirement under the new health law.

(Related: Where Does Michigan Stand on Medicaid Expansion?)

Income limits for VA benefits are significantly less stringent than they are for Medicaid. A veteran with no dependents and an annual income of as much as $30,978 is eligible. But conditions other than income–like the length of time since combat, service medals, and service-related injuries or illnesses– also affect eligibility for VA health benefits.

Furthermore,, “there may be a variety of factors why a veteran would choose (Medicaid) or the (VA), such as proximity to VA facilities or their knowledge of the fact that VA care is available to them,” according to Jennifer Haley, who co-authored the Urban Institute report.

Read more: http://www.themonitor.com/news/local/article_035861f0-c972-11e2-8d60-001a4bcf6878.html

Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000

Learn more about Health Reform and the Implications for Women’s Access to Coverage and Care.

In this issue brief you will discover how the Affordable Care Act is expected to affect access to care and affordability of health coverage for women.

Also, it explains the provisions in the health reform law related to preventive screen services, reproductive health, maternity care and women on Medicare.

Included in the brief are national and state-level estimates of the percentage of uninsured women ages 18-64 who are like to qualify for federal help under the law and a summary of key coverage and benefits provisions in the health reform law that affect women.

Issue Brief (.pdf)

Christopher J. Berry is an elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000

Rural areas could suffer in states that opt against Medicaid expansion.

The goal of Medicaid expansion under the Affordable Care Act is supposed to cover more of the working poor and balance out cuts that were made to already-struggling hospitals. However, Republican-led states have been opting out or holding out, while outlying areas in states like Tennessee may be the most severely impacted.

(Related: DOMA Increases Medicare Costs For Same-Sex Married Couples)

Partners for Healing in Tullahoma, Tenn., offers care exclusively to the uninsured workers — and there’s a number of them in the town of 18,000 — with a number of studies indicating that rural Americans are more likely to have low-wage jobs, and no insurance.

Kentucky Democrat Governor Steve Beshear announced that he will expand Medicaid coverage and nearly cut the state’s uninsured population in half. The expansion will extend coverage to adults earning up to 133 percent of the federal poverty line, providing public health assistance to more than 300,000 people.

(Related: Google’s Plan for ‘Digital Afterlife’)

Those pushing for Medicaid expansion credited GOP lawmakers for putting forth a House bill for discussion. Senate Republicans met behind closed doors to discuss the plan but failed to reach a consensus.

(Related: How Much Will Medicaid Cost in the Future and Why: Federal Projections)

A health advocacy group has developed a compromise proposal in hopes of ending the debate in California of how to expand Medi-Cal. Health Access California proposes a time frame and percentages for the state and countries to share $1.4 billion in savings when Medi-Cal coverage is expanded next year. State and county officials have been playing tug-a-war with how the windfall should be divided.

Read more: http://www.kaiserhealthnews.org/Daily-Reports/2013/May/10/medicaid-expansion.aspx

Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000

Covering more than 60 million individuals, Medicaid is the nation’s primary health insurance program for low-income and high-need Americans.

(Related: GOP Gov. Rick Snyder Supports Michigan Medicaid Expansion)

Major federal funding is allocated by the Affordable Care Act’s expansion of Medicaid to a national eligibility floor of 138% of the federal poverty level (FPL).  The Supreme Court upheld the ACA but limited the federal government’s ability to enforce the Medicaid expansion to low-income adults, effectively making implementation of the Medicaid expansion a state choice.

(Related: Legal and Financial Resources for People with Alzheimer’s Disease)

The report below examines the latest Congressional Budget Office (CBO) projections for federal Medicaid spending over the 2013-2023 period. CBO’s budget projections, also referred to as “baseline” projections, reflect CBO’s best judgement about how the economy along with other factors will affect federal revenues and spending under the existing laws.

(Related: The Doctor’s New Prescription: An Elder Attorney)

It is important to understand the CBO baseline estimates because they are the basis to evaluate the federal cost and coverage implications of proposed federal policy changes. Federal budget and federal deficit reduction have ignited an active debate and discussion. The fiscal effect of any federal policy changes will be measured against the CBO baseline.

Report 

Hospitals Face Pressure to Avert Re-admissions
By JORDAN RAU

After years of gently prodding hospitals to make sure discharged patients do not need to return,the federal government is now using its financial muscle to discourage re-admissions.THE NEW OLD AGE New Efforts to Close Hospitals’ Revolving Doors Spurred by new financial penalties that Medicare started imposing on places with too many re-admissions, hospitals are doing more outreach to make sure patients are following their discharge program. Medicare last month began levying financial penalties against 2,217 hospitals it says have had too many re-admissions. Of those hospitals, 307 will receive the maximum punishment, a 1 percent reduction in Medicare’s regular payments for every patient over the next year, federal records show.  One of those is Barnes-Jewish Hospital in St. Louis, which will lose$2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.” The crackdown on re-admissions is at the vanguard of the Affordable Care Act’s effort to eliminate unnecessary care and curb Medicare’s growing  spending, which reached $556 billion this year. Hospital inpatient costs make up a quarter of that spending and are projected to grow by more than 4 percent annually in coming years, according to the Congressional Budget Office.  The readmission penalties will recoup about $300 million this year. But the goal is to pressure hospitals to pay attention to what happens to their patients after they walk out the door. The penalties have captured the attention of hospitals, and many are trying to improve their supervision of discharged patients’ recoveries. “I’ve been doing this for over two decades and talking to hospital leaders about re-admissions, and I used to get polite but blank stares,” said Dr. Eric Coleman, a professor at the University of Colorado Anschutz Medical Campus who has devised widely adopted methods to reduce hospitalizations. “Now they’repaying attention.” With nearly one in five Medicare patients returning to the hospital within a month — about two million people a year — re-admissions cost the government more than $17 billion annually. Hospitals’ traditional reluctance to tackle re-admissions is rooted in Medicare’s payment system. Medicare generally pays hospitals a set fee for a patient’s stay, so the shorter the visit, the more revenue a hospital can keep. Hospitals also get paid when patients return. Until the new penalties kicked in, hospitals had no incentive to make sure patients didn’t wind upcoming back. The maximum penalty is set to double next October and then reach 3 percent of reimbursements in October 2015. Medicare also is expanding the list of conditions it will assess in setting punishments. Right now it only evaluates re-admissions of heart attack, heart failure and pneumonia patients, counting every rebound, even ones not related to the original reason for hospitalization. The penalties are based on readmission rates in the past and applied to future payments for all Medicare patients. Researchers say that while some re-admissions are unavoidable, many are caused by the short shrift hospitals have given patients on their way out.Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services, said the penalties had helped galvanize hospitals’ efforts to avoid re-admissions. “We’ve seen a small but significant reduction,” he said. “That tells me we’ve focused the industry on improvement.”  Medicare’s tough love is not going over well everywhere. Academic medical centers are complaining that the penalties do not take into account the extra challenges posed by extremely sick and low-income patients. For these people, getting medicine and follow-up care can be a struggle. At Barnes-Jewish Hospital, Dr. Lynch said physicians from all over the Midwest referred their sickest heart patients to his facility for transplants and other major interventions. But those patients can skew his hospital’s re-admissions numbers, he said: “The weaker your heart, the more advanced your emphysema, the more likely you are to be re-admitted to the hospital.” Dr. Lynch said Barnes-Jewish set up follow-up appointments for patients who didn’t have their own doctors. But about half of the patients never showed up, he said, even after the hospital made reminder phone calls and arranged for free rides. Sending nurses to see patients at home did not significantly reduce readmission rates either, he said. “Many of us have been working on this for other reasons than a penalty for many years, and we’ve found it’s very hard to move,” Dr. Lynch said. He said the penalties were unfair to hospitals with the double burden of caring for very sick and very poor patients. “For us, it’s not a re-admissions penalty,” he said. “It’s a mission penalty.” Various studies, including one commissioned by Medicare, have found thatthe hospitals with the most poor and African-American patients tended to have higher re-admission rates than hospitals with more affluent and Caucasian patients. But the studies also determined that some safety-net hospitals performed better than average, showing that hospitals can overcome the challenges posed by the kinds of patients they treat. In some ways, the debate parallels the one on education — specifically, whether educators should be held accountable for lower rates of progress among children from poor families. “Just blaming the patients or saying‘it’s destiny’ or ‘we can’t do any better’ is a premature conclusion and is likely to be wrong,” said Dr. Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, which prepared the study for Medicare. “I’ve got to believe we can do much,much better.” Some researchers fear the Medicare penalties are so steep, they will distract hospitals from other pressing issues, like reducing infections and surgical mistakes and ensuring patients’ needs are met promptly. “It should not be our top priority,” said Dr. Ashish Jha, a professor at the Harvard School of Public Health who has studied re-admissions. “If you think of all the things in the Affordable Care Act, this is the one that has the biggest penalties, and that’s just crazy.” With pressure to avert re-admissions rising, some hospitals have been suspected of sending patients home within 24 hours, so they can bill for the services but not have the stay-counted as an admission. But most hospitals are scrambling to reduce the number of repeat patients, with mixed success. A few days after Eda Laurion was discharged from the Banner Del E. Webb Medical Center near Phoenix after treatment for her congestive heart failure in August,a nurse showed up at her house. “She helped explained the medicines I’m taking, the side effects,what they do for you,” said Ms. Laurion, 91, of Sun City West. Still, re-admissions can’t always be prevented. The nurse, Sue Koner, sent Ms. Laurion back to the hospital after two weeks for dangerously low sodium caused by an un-diagnosed kidney problem. However, Ms. Laurion avoided re-hospitalization in October when Ms. Koner deduced that her hallucinations were a reaction to an antibiotic. Overseeing former patients is expensive and time-consuming, so many hospitals are relying on financing from community health organizations and foundations. Ms. Koner works for Sun Health, a foundation-supported nonprofit. Since Sun Health started its program in November 2011, only nine of 213 patients have been readmitted. Dr. Krumholz said hospitals should think of re-admissions as a challenge to overcome. “One day, we’ll look back,”he said, “and we’ll be incredulous that one out of every five patients ended up back in the hospital.”

The Ten Most Common Nursing Home Violations
By Long Term Care Solutions
Pro Publica analyzed 262,500 deficiencies with its u Nursing Home Inspect tool, which includes deficiencies identified by government regulators and the U.S. Centers for Medicare and Medicaid Services over the past three years.  Since releasing this information on its website this summer,has added details of historical violations found in nursing homes. The agency now releases narrative reports of these problems from a home’s last three inspection cycles — or about three years.  Here is their list of the 10 regulations most commonly violated by nursing homes:
•    Facility is Free of Accident Hazards: 17,331     •    Facility Establishes Infection Control Program: 14,186     •    Provide Necessary Care for Highest Practicable Well-Being: 13,401     •    Store/Prepare/ Distribute Food Under Sanitary Conditions: 11,746     •    Develop Comprehensive Care Plans: 9,070     •    Services Provided Meet Professional Standards: 8,986     •    Clinical Records Meet Professional Standards: 7,962     •    Not Employ Persons Guilty of Abuse: 7,288     •    Drug Regimen is Free from Unnecessary Drugs: 7,040     •    Dignity: 6,605

OIG Issues Compendium of Unimplemented Recommendations
from Dixon Health Care Solutions, Inc.

The Office of Inspector General issued is Compendium of Unimplemented Recommendations. It summarizes significant monetary and non monetary recommendations that, when implemented,will result in cost savings and / or improvements in program efficiency and effectiveness. This includes two unimplemented issues for home health agencies, three unimplemented issues for hospices, and an unimplemented issue for Recovery Audit Contractors. For more information please utilize the following link:

https://oig.hhs.gov/reports-and-publications/compendium/files/compendium2012.pdf

Avoiding Sexual Harassment by Residents
by Ted Boehm

A recent lawsuit filed by the U.S. Equal Employment Opportunity Commission (“EEOC”)against a healthcare facility in Virginia highlights a legal liability to which nursing homes and other long-term care facilities are particularly vulnerable: harassment of employees by residents.The lawsuit in question was filed under Title VII of the Civil Rights Act and it alleged that a female receptionist was subjected to a “sexually hostile work environment” on the basis of harassment by a resident. The lawsuit further alleged that the employee made numerous complaints to her supervisor about the harassment yet the employer failed to take proper corrective action.
Harassment Problems Specific to the Resident Care Arena
Sexual harassment is a difficult issue in any employment setting, but perhaps nowhere more sothan in the resident care arena. A number of different nursing home employees have regular,physical contact with non-employees – primarily the residents for whom they care (and the familymembers of those residents). Under Title VII, nursing home employees are protected fromharassment by residents just as they are from co-workers and supervisors. Hospitals, nursinghomes, assisted living facilities and other patient-care entities are responsible for providing aworkplace free of sexual harassment, regardless of whether the harassment is perpetrated by aco-worker or by a paying resident. Most nursing home employers have experienced episodes inwhich a resident acts out in an inappropriate manner. Often, the inappropriate behavior is due tothe resident having a deteriorated mental condition such as dementia or Alzheimer’s. As a resultof this condition, residents may not understand that their actions are inappropriate. However, thismental condition does not act to shield nursing home employers from liability.
How Employers Can Minimize the Risk of Harassment
Where sexual harassment has been alleged, a court will likely first look to whether the employerknew or should have known about the harassment and whether the employer did anything tocorrect the offending conduct. Of course a nursing home employer is somewhat constrained inhow it can respond to complaints of sexual harassment by residents. For example, a residentcannot be transferred unless the transfer complies with the Bill of Rights for Residents ofLong-Term Care Facilities. However, this constraint does not mean an employer should donothing. While it may not be possible to completely prevent harassment in the long-term caresetting due to the mental conditions of residents, employers can take steps to address andminimize the risk. First, employers should maintain a policy that addresses harassment byresidents or other third parties. The policy should specifically address how employees can reportthe harassment when it occurs. Maintaining a “reporting” policy is critical for another reasonbecause it provides employers with important legal defenses in situations involving allegedharassment by a supervisor. Second, employers should regularly train its employees on how toreact when they are harassed by a resident. Because the duties of a nursing home employee oftenrequire him or her to work in close contact with residents, there is an increased potential forharassment. If employees are trained to react properly and promptly, the unwelcome conduct maybe stopped before it becomes “severe or pervasive” – the standard used by courts in analyzingsexual harassment claims. Third, employers must respond to complaints appropriately. While theresponse will depend on the circumstances of the complaint, there are several “best practices”that employers should consider. For example, employers could make staffing adjustments so thatthe employee does not care for the resident by his or herself. Other options include assigning theresident to another employee’s care or discussing with the employee whether he or she wants totransfer to another part of the facility.
Respond to Complaints – But Do Not Retaliate
While it is critical for an employer to respond meaningfully to a complaint, it is just as importantthat the response does nothing to permit an employee to argue that he or she was retaliatedagainst for making the complaint. Retaliation claims have increased within all industries in recentyears and the long-term care industry is no exception. An employer should not take any actionthat is “materially adverse” to the employee -such as transferring the employee to a position thathas more onerous job duties. The most effective way to minimize the risk of harassment in yourlong term care facility is to conduct regular training on your policies or to implement policiesnow if they do not exist.

Why Long-Term Care Facilities Need to Embrace Change David Rubenstein, a speaker at the marcus evans Long-Term Care CXO Summit Spring 2013, on how long-termcare facilities need to move along with the industry. Interview with: David Rubenstein, Chief Operating Officer, AdCare Health Systems “Do not be static,” is the message that David Rubenstein, Chief Operating Officer at AdCareHealth Systems wanted to convey to long-term care (LTC) facility directors. The healthcareindustry is changing, and facilities have to embrace that to take advantage of businessopportunities, he commented. Ahead of the marcus evans Long-Term Care CXO Summit Spring 2013, in Los Angeles,California, January 28-29, Rubenstein exchanges his ideas on ensuring a LTC facility is patientcentered and evolving with the industry. Q: How can LTC facilities build a person-centered culture? DR: It is important to remember that we do not make products in this industry, but take care ofpeople. A lot of facilities get wrapped up in numbers, rules and regulations, but at the end of theday, our job is to take care of people. I always encourage management to walk the floors of theirfacility every morning before they go to their office and start dealing with all the technical issues,to keep that person-centered focus. Q: How is culture change best done? What do employees resist the most and what is the wayaround it? DR: Most people get into a rhythm of doing things the way they have always done. The problemis that the healthcare industry is constantly changing, whether it is the regulations, referralsources or the types of residents we admit. The facilities that do not embrace change are thosethat typically end up having problems or cannot achieve their goals. They will not achieve themif they do things the way they did ten years ago. LTC facilities need to be ahead of the curve. Weencourage folks to adapt their policies and procedures, so things are not static. For employees to embrace change, the leaders must spend a lot of time communicating andexplaining the game plan. Too often they send out budgets or expectations, without explainingthe rationale behind them. Q: How could LTC facilities be more profitable? What opportunities can they capitalize on at themoment? DR: Each facility needs to assess every department, expenditure, and resident before they comein. The margins in this business are not so large that they can overlook some expenses.Establishing par levels and expectations for supplies and commodities, such as food, could proveeffective. There is also value in outsourcing certain services, housekeeping and laundry forexample, to specialists who can do a better job. It is important to be as efficient as possible on the expense side, and to ensure that the facility isable to attract residents. Q: How will President Obama’s re-election impact the LTC industry? DR: All aspects of healthcare are going to be affected. The nursing home industry is the smallestsector of the healthcare budget, and we have gone through some radical adjustments in theMedicare payment rates over the last few years. We need to meet with our state leaders andlobbying groups to make sure they understand that right now a nursing home is the lowest costalternative for a patient who needs the services we provide. Interview by: Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits Division About the Long-Term Care CXO Summit Spring 2013 This unique forum will take place at the Westin Long Beach, Los Angeles, California, January28-29, 2013. Offering much more than any conference, exhibition or trade show, this exclusivemeeting will bring together esteemed industry thought leaders and solution providers to a highlyfocused and interactive networking event. The Summit includes presentations on AccountableCare Organizations, reimbursement maximization, staff recruitment and retention, and electronicmedical record implementation. For more information please email d.drey@marcusevansch.com, or alternatively, feel free to call416-800-2481.