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The Politics of Health Care

VA Crisis, Dishonorable Discharge of Management
June 3, 2014 10:02 AM by Michael LaMagna
Each semester that I teach health care administration at Long Island University, graduate school, I try to instill a sense of importance to the students about managing the healthcare of the people that they will serve and how they are taking on the responsibility for people's lives.  I explain that we are working with and for frail/sick people, not widgets and that these management jobs are not for everybody, as it's an awesome responsibility.  Well I will tell you that not only is the VA healthcare system sick, but the system is being mismanaged by people who do not realize the higher calling that they undertook.  As an attorney who works with Veterans and as a healthcare administrator, I am disgusted at the mismanagement and response by the VA administration.

Let's start with the basics.  Last month it was reported in the Arizona Republic that up to 40 Veterans died while awaiting services at the Phoenix VA hospital and that there was a suspicion that some staff members cooked the books and had "secret lists" of people waiting for care.  Then upon further investigation, it was reported that at least 1,700 military veterans were never placed on a waiting list at all and were never even scheduled an appointment.

Then upon further investigation, it was found that Georgia, Texas, Florida and Pennsylvania also had wait time issues and that it is suspected that all 42 VA centers have problems with wait times and lack of scheduling appointments.  Interestingly enough, wait times are tied to bonuses and raises. 

The good news is that there is finally something being done with the archaic and broke VA system.  Eric Shinseki, formed Secretary of Veterans Affairs resigned, the Veterans who were "left out" of the system are being sent to private healthcare facilities and we now have Congress calling for further investigations. 

However, this is just the very beginning of this crisis, but far from the conclusion.  I go back to my original thought, that the management of healthcare is an awesome responsibility.  Many times you are working with the sick, frail and vulnerable and it takes very special dedicated people.  It is obvious that they need to brush up on their hiring skills.   

 

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna & Spinola, LLP., practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut.    Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.hhrls.com for more information.        

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Medicare Reviewing Denied Claims
February 4, 2014 9:37 AM by Michael LaMagna
As part of the settlement of the Jimmo v. Sebelius lawsuit, in which Medicare conceded that coverage is available for skilled services to maintain or not diminish an individual's condition, costing unnecessary cost and coverage denials, Medicare is reviewing previously denied claims. What this means is that if a person had a Medicare part A or part B claim denied, in part because it was determined that his/her condition plateaued or you show improvement, between Jan. 18, 2011 to Jan. 23, 2014, Medicare will review the claim, utilizing the new standard and may reverse the denial.

More specifically, a Medicare beneficiary may be eligible for the review of a past claim, if they:

1) received skilled nursing or rehabilitation services in a nursing home, home health care or outpatient therapy; and

2) received a partial or full denial of a claim based on the fact that they lacked improvement ; and

3) The denial was final and non-appealable on or after Jan. 18, 2011.

Appeals are always time sensitive. If a claim became final from Jan. 18, 2011 to Jan. 24, 2013, the deadline for the review is July 24, 2014; if a claim became final between Jan. 25, 2013 to Jan. 23, 2014, the deadline to file for the review is Jan. 23, 2015.

You can access the appeal form on the Center for Medicare Advocacy's website: www.medicareadvocacy.org.

 

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna & Spinola, LLP., practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.hhrls.com for more information.

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Countdown to Healthcare Exchanges
September 18, 2013 10:18 AM by Michael LaMagna
With just about two weeks left until the health care marketplaces (exchanges) go into full swing, which happens on Oct. 1, 2013, there still appears to be a lot of confusion. If fact, in a recent USA TODAY study, 17% of seniors incorrectly believed they would be required to purchase insurance on the new health care marketplaces, replacing Medicare. Even more people believe they can sign up for Medicare through an exchange, which is also incorrect.

If you keep the spirit of the law in mind, which was to insure the people who have no insurance, it is clear that those with Medicare, who obviously have health insurance, will be impacted the least. Medicare beneficiaries are required to stay on their Medicare plan (unless they change their plan during the Medicare open enrollment time) and those individuals who become eligible for Medicare will be required to terminate their exchange plan and enroll in Medicare.

In New York state there are four different types of plans, Bronze, Silver, Gold and Platinum, which all have different premiums, co-pays, deductibles and co-insurance. Even still, plans are county specific and only some plans are offered in some of the NY counties. With all of this confusion, it is no wonder why people are still not sure what will happen with their coverage. Stay tuned for more information as the clock ticks away.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna & Spinola, LLP., practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.hhrls.com for more information.

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Consumers Can Now Create Healthcare Accounts Online
August 6, 2013 1:50 PM by Michael LaMagna
HHS Secretary Sebelius announced Monday that consumers can now open personal healthcare accounts online at healthcare.gov. However, "serious shopping will have to wait until sometime in September when details on insurance plans and premiums offered in local areas will become available through the new online marketplace," according to an article by AP. The AP adds that although the announcement "may sound like partial progress only, Sebelius quickly moved to put the law's doubters on notice," saying, "Let me be clear. ... We are on target and ready to flip the switch on Oct. 1."

USA Today (8/6, Kennedy) reports that along with the webpage, the government launched "training videos and infographics" to "help Americans better understand the health insurance exchanges that will launch Oct. 1."

The Hill reports in its "Healthwatch" blog that the AARP has launched two websites "to help consumers navigate ObamaCare and their new coverage options." The group said the sites, healthlawanswers.org and healthlawfacts.org, "are part of a wider campaign to educate consumers about the law." The sites, which have sections targeted to different groups including seniors, young seniors, young people, and small business owners, "offer basic information" about how the law works and the benefits available.

CQ reports that the websites show AARP "is not limiting its guidance and information just to seniors." As Nicole Duritz, vice president of education and outreach at AARP, pointed out, "We have tons of members who have kids who are in their 20s and 30s. It matters to them. We were founded on the fact that people needed health coverage ... this is part of our organizational DNA."

The Wall Street Journal reports that with the Oct. 1 start date for enrolling in the new health insurance marketplaces looming, the Administration last week reduced the training requirements for workers to help people enroll in the exchanges because officials were concerned there would not be sufficient time to train the "navigators" before the exchanges open. The Journal notes that grants to hire and train workers in the 34 states where the Federal government will run all or part of the market places will not be released for another two weeks, leaving only 32 business days to hire and train the helpers.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut.    Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information.     

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Prepare for Long-Term Care Expenses
July 23, 2013 1:07 PM by Michael LaMagna
The Congressional Budget Office (CBO) just printed a report suggesting that many families are going broke paying for long term care costs. The CBO reported that in 2011, approximately $36 billion was spent on LTC facilities and $3 billion was spent on in home services, some of which is being used inappropriately because of the lack of LTC knowledge and the underutilization of professionals to assist with proper care.

Not to be an alarmist, but LTC is the looming healthcare crisis of our generation. With more than one-third of adults over 65 requiring some sort of assistance with their activities of daily living, someone needs to be compensating for those needs. Of course there is no point in sounding the alarm without making suggestions as to how to alleviate some of the high costs:

  • A) Plan Ahead

If you are eligible for long-term care insurance, you should actively look into this form of insurance, which would allow you to make choices as to who provides care and where.

  • B) Hire a Financial Advisor

A qualified financial planner will assist you to organize your finances in such a way as to maximize your income, which will enable you to extend the time frames to pay for LTC.

  • C) Hire Competent Caregivers and Care Managers

By hiring competent caregivers, you minimize your chances of going into a facility. There may even be ways that family members can be "hired" utilizing a personal services contract to compensate them for caring for you as you age and your needs increase. Care managers can assist with the selection of qualified caregivers and can monitor the situation to ensure that you are kept safe and in the correct level of care.

  • D) Look Into Tax Breaks

Some healthcare expenses qualify for a medical expense reduction from federal income taxes. A qualified tax accountant can assist you to assess what is and what is not deductible.

  • E) Hire an Elder Lawyer

A lawyer who is knowledgeable in senior, long-term care and disability matters is able to steer you in the right direction by making suggestions about advance directives, financial and legal matters. They also can act as the quarterback to ensure that the plan put into place is individualized and optimal for your overall long term care success.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, NY on May 16, 2013 from 6:00-7:30pm. RSVP by calling The Kensington at 914-220-4259. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

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Key Provision of ACA Delayed: Employers Get One Year Break
July 9, 2013 2:32 PM by Michael LaMagna
In a stunning reversal, the Obama administration announced that a key provision of the Affordable Care Act, the one that mandated medium and large employers (those with more than 50 full time employees) were required to offer health insurance or risk a penalty, would be delayed until Jan. 1, 2015. This is seen as a significant development as many of the key features of the law are starting to unfold. The Administration felt the heat from businesses, especially restaurant and retail employers, who were complaining about the lack of guidance and administrative costs related to the mandate, many threatening to stop offering insurance in favor of the penalty, which would have been $2,000 to $3,000 per employee.

The delay is seen as both a catering to the business community and a realization that the mid-term elections are right around the corner and they did not want this feature of the law to become an issue. It is not surprising that delaying the feature would also become a hot button issue; even I could have told them that! 

The extra year will allow the administration to both offer guidance to businesses and modify any wrinkles in the Health Care Exchanges, set to debut on Oct. 1, 2013. 

The delay will certainly further complicate the law, as now you can have many individuals who choose to purchase insurance on the exchanges, without knowing the employer's information or what subsidies individuals may qualify for. 

Speaking of the unknown, the Obama administration also announced it would not be verifying consumer's qualifying information for insurance on the exchanges until at least 2015. What this means is that they will solely rely on individuals self-reporting their income to qualify for health insurance subsidies (think back to the no verification mortgage loans and the self- reporting of tips for restaurant employees). However, there is a provision in the law that makes lying about your income subject to a $25,000 penalty and pay back. 

This just keeps getting more interesting each week.   

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut.    Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information.     

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The Health Insurance Exchange Website Is Open for Business
June 25, 2013 12:57 PM by Michael LaMagna
As many of you are aware, starting on Jan. 1, 2014, the health insurance markets door is going to be swung wide open. This is the date when there will be online access to purchase health insurance, using the principles of capitalism, competition and technology. In addition, the enrollment period will begin on Oct. 1, 2013. In the first step toward this monumental task, a new website, Healthcare.gov (CuidadoDeSalud.gov in Spanish) and a 24-hour consumer call center number, 800-318-2596, have started fielding the myriad questions regarding how and how much the new insurance will cost.

The purpose of the website and call center is to assist consumers with information on the insurance plans and eligibility for either Medicaid or other private insurance subsidies. Incrementally over the next 3 months, consumers will be able to access additional information on the website. By Oct. 1, 2013, consumers will be able to create accounts, complete an online application and actually purchase their healthcare plan right on HealthCare.gov.

I think it's important that we all become very familiar with the website and its functionality. It is clear many people still aren't familiar with the concept of a healthcare exchange or even that they may be eligible for assistance with purchasing plans. In fact, in recent polls more than half of Americans weren't aware they will be required to purchase health insurance or risk a penalty. This is obviously concerning and with less than 100 days until Oct. 1, I am sure there will be information coming from many sources, this being one of them, stay tuned!

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information.

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How Obamacare Is Shaping the Immigration Debate
June 18, 2013 9:25 AM by Michael LaMagna
When people ask me why I enjoy healthcare law and all of its related fields, I always answer that healthcare relates to everything. At first glance, the immigration debates seem very separate from the Affordable Care Act (ACA) and it is not apparent how they are interrelated. However, it is very possible that the entire Immigration Reform Bill will pass or fail, because of ACA.

As I am writing this there is hot debate on whether the Immigration Reform Bill will pass Congress; however, the latest sticking point is when or even if immigrants who are granted permanent status would be granted health benefits. Senate Republicans are advocating that immigrants would be ineligible for federal health subsidies for five years after they become legal residents and House Republicans are advocating that they be required to purchase private health insurance, without access to Federal money. At the same time, many border-state governors are rejecting the implementation of ACA altogether, the effects of which remain uncertain. One thing that is clear is that neither the Senate nor House Immigration Bill will help the uninsured illegal immigrants get health insurance.

Another related Immigration Bill concern is the usage of a National Identification Card, which can be used for identification, medical records retrieval, healthcare monitoring and is tied to the Department of Homeland Security nationwide computer. This is causing both sides to discuss not only the security issue, but the privacy of healthcare information and who will have access. I am not sure if we are quite prepared to turn over our private healthcare information to the government, who will be monitoring our healthcare, could very well be a conflict.

Once again, I say to all of you out there, healthcare certainly affects every part of our life and shapes the national debates in one way or another.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information.

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Medicare Remains Solvent, at Least Until 2026
June 3, 2013 1:19 PM by Michael LaMagna
In what certainly can be touted as good news, the Medicare Trustees reported in their annual report that the Medicare Trust Fund, which holds all of our payroll deductions, is scheduled to remain solvent until the year 2026. This is two years greater than reported last year. The main considerations for the brief extension were the improving economy and slowing healthcare costs.

The slowing healthcare costs can be attributed, at least in part to, the Affordable Care Act, new policy limitations on the Medicare Part C or Medicare Managed Care Plans, reduced hospital re-admissions and payment changes to healthcare facilities. What impact the Affordable Care Act, which goes into full swing on January 1, 2014, remains to be seen.

Although, this was certainly good news, the Trustees cautioned there is still significant work to be done with respect to Medicare and Social Security, the federally funded programs.  It is well known that the programs are not sustainable in their current forms, especially since there are approximately 10,000 people retiring each day. In even more alarming developments, the Social Security Disability Trust Fund is scheduled to become depleted in 2016. 

If the retirement fund become depleted, it is not likely that benefits will stop completely; Medicare will pay less and less of the projected benefit, based on what is contributed. To fix the Medicare and Social Security Disability solvency issues would include raising the payroll tax or decreasing benefits, two very unpopular political moves that all sides appear reluctant to promote.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP, practicing elder law/probate/disability/wills, trusts and estates, healthcare regulatory, Medicare sppeals, Social Security and general legal practice in both New York and Connecticut.  Email: Mlamagna@hhrls.com, phone: 914-437-5955 www.HHRLS.com for more information.     

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Coming to a TV Screen Near You: Obamacare Campaign
May 28, 2013 4:24 PM by Michael LaMagna
We usually associate summer with BBQs, pool parties and the like, but brace yourself because this summer we will be barraged with Obamacare commercials. The White House is just starting their campaign throughout the U.S. urging people to buy health insurance when it becomes available Oct. 1, 2013 (just four months away). In fact, the goal is to sign up at least 7 million people in the first year.

What we can expect is TV ads, door-to-door interaction and newspaper advertisements touting the benefits of signing up for the mostly unknown benefits and with healthcare exchanges, which are mostly unknown as well. This can be especially challenging as more than 4 in 10 Americans do not even recognize the law as surviving the Supreme Court. In addition, the success of the program depends on at least 7 million people signing up in the first year, with a majority of those people being younger and well. If more chronically ill people sign up, there can be enormous fiscal implications.

Even more troubling is the impact of the states that haven't fully accepted the law and those ill-equipped to implement. Will people migrate from state to state to obtain insurance, and what would be the eligibility requirements, much like Medicaid eligibility requirements are state based. The good news is that we have the summer to answer some of our questions and come up with a few more.

I would like to know what you think about the advertisement blitz and its effectiveness and your thoughts about people calling and visiting your homes.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, practicing elder law/probate/disability/wills, trusts and estates, health care regulatory, Medicare appeals, Social Security and general legal practice in New York and Connecticut. Contact him at Mlamagna@hhrls.com; 914-437-5955; www.HHRLS.com.

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Health Insurance for Young Adults: What You Need to Know
May 20, 2013 2:03 PM by Michael LaMagna
If there is one thing that many of us are guilty of, it's neglecting our own health and focusing on our children and their needs. I am sure that most of us are aware that our health plans are now required to keep young adult children on their parent's health plans until they reach age 26, but many people, including the plan participants, do not know what is covered and what is not. 

Currently, there are more than 3 million young adults covered under their parent's plans.  Although this group may be covered for comprehensive medical needs, young adults who are covered under their parent's plans find themselves not covered for mental health issues, substance abuse and maternity care, which are common healthcare occurrences in the 26 and under crowd. There may be some hope starting in 2014, health plans will no longer be able to turn people down because they have preexisting medical conditions and with the advent of healthcare exchanges, young people will be free to shop around for individual plans if they don't want to stay on their parent's plan. All non-grandfathered healthcare plans will cover 10 essential health occurrences, including maternity and newborn care, mental health and substance abuse services.

In addition to the comprehensive plans available on the exchanges, young people up to age 30 will have the option of choose a catastrophic plan, which will cover preventive services without any cost sharing and three physician visits after a $6,350 deductible is met.

Of course there are exceptions called grandfathered plans, which you should be aware. Large-group employers are exempt from covering the 10 essential health benefits, which may exempt young people from mental health, substance abuse and maternity care. While Medicaid can be an option for specific care, there are strict income and asset guidelines that must be adhered to, which will make it impossible for most non-disabled working people to qualify.

Even still, many mental health professionals and counselors who provide outpatient services may not take many of the health plans or accept Medicaid. It is vital that you become very familiar with your health plans and know your rights regarding coverage and the appeals process in case you or your children get denied coverage. It is common for bills for these services to be in the tens of thousands of dollars, which many people do not have to pay the hospital bills, especially those 26 and under and their parents.  

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, NY on May 16, 2013 from 6:00-7:30pm. RSVP by calling The Kensington at 914-220-4259.  Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut.    Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information.     

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The Price of Long-Term Care Keeps Rising
May 7, 2013 9:57 AM by Michael LaMagna
Long-term care costs continue to rise, many times keeping the costs and more importantly, the needed care out of reach for the individuals who need the services. Genworth Financial, which itself just announced cuts to its long term care insurance portfolio, just released its 10th annual survey of Long Term Care Costs. Here are some highlights:
  • adult day care costs rose 6.56% to an average daily rate of $65.
  • nursing home care private room costs increased 3.6% to $230 per day/ $83,950 per year.
  • nursing home care semi-private room rates increased 3.3% to $207 per day/ $75,555 per year.
  • home health care costs have remained relatively flat.
  • Assisted living care costs increased 4.55% to a national median monthly rate of $3,450.

As you can see the high costs are staggering and increasing each year. It is vital that everyone think about long term care early enough to prepare for the unpredictable future.  Further, long term care insurance is one of many possible solutions; however, it is important to explore each possibility, which also includes utilizing estate and long term care legal and financial planning.  Although, skilled elder lawyers can assist when you are in crisis, i.e. in a facility or hospital, the best plan is to plan early and prepare for the unexpected. 

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, N.Y., on May 16, 2013.

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Michael LaMagna is a partner at Helwig, Henderson, Ryan, LaMagna and Spinola, practicing elder law/probate/disability/wills, trusts and estates, health care regulatory, Medicare appeals, Social Security and general legal practice in both New York and Connecticut.  Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit www.HHRLS.com.     

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Six Ways the 2014 Fiscal Budget May Change Healthcare
April 23, 2013 8:58 AM by Michael LaMagna
With all of the talk regarding the sequester and budget cuts, I decided to focus on what the fiscal 2014 budget would mean to the 54 million+ Medicare beneficiaries, if the budget was passed in its current state. Currently, the 2014 proposed fiscal budget contains $4 trillion in cost savings, with almost $400 billion in Medicare spending reductions over the next decade. The cost-saving provisions are spread amongst all beneficiaries and providers of care. I highlighted the six provisions that would directly affect Medicare beneficiaries and their providers of care:
  1. Higher Part B deductibles:  Medicare Part B, which pays for physician and ancillary services, will have an increase of approximately $75, which is a significant increase over the $147 current deductible. This is true despite more than half of Medicare beneficiaries having an annual income of less than $22,500 in 2012;  
  2. Home Health Care Visits:  Starting in 2017, new Medicare beneficiaries would be expected to pay $100 for five or more home healthcare visits paid by Medicare if the care was not provided after a hospital or rehabilitation visit;
  3. Surcharge for Medigap premiums:  Also starting in 2017, new beneficiaries who purchase the often critical supplemental or Medigap policy, will have a 15% surcharge to discourage over usage;
  4. Medicare Part B and Part D premiums to increase for wealthier individuals: Although individuals with incomes above $80,000 and couples who have incomes over $170,000 already pay a larger share of Medicare premiums, the budget calls for higher premiums for those with higher incomes:
  5. Doughnut Hole Closing: The good news is that the dreaded doughnut hole would be closing as soon as 2015;
  6. Cuts to Healthcare Providers: Hospitals would see the amount of money provided to them because of bad debt slashed by almost two-thirds and the amount paid to teaching hospitals also decreased.

Of course, this is just a snapshot of the proposed budget, but it is vital that all of us take notice of the possible changes and the likelihood that many of these provisions will become enacted and to prepare accordingly.    

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, NY on May 16, 2013 from 6:00-7:30pm. RSVP by calling The Kensington at 914-220-4259.  Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut.    Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.     

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Medicare Class Action Suit Settled
April 18, 2013 9:39 AM by Michael LaMagna

There are big changes to your Medicare benefit that will assist you to obtain a longer stay at a rehabilitation center or more outpatient therapy. Medicare just settled a lawsuit, Jimmo v Sebelius, which clarifies when a rehabilitation center, home health care or outpatient therapy provider can discontinue services paid by Medicare.


As most readers know, your Medicare Part A benefit pays for rehabilitation after a 3 day hospital stay for a period up to 100 days, day 1 to 20 at 100%, day 21 to 100 at 80% (you are responsible to pay the 20% co-pay of $148/per day or a supplemental plan will cover the daily fee). Prior to the recent settlement of the Jimmo lawsuit, Medicare providers would discharge beneficiaries, thus denying them more services during the 100 days if there wasn't any "Improvement." This rule of thumb "Improvement Standard" meant that the provider would determine that there wasn't any further rehabilitation or restoration potential, leaving the beneficiary to pay privately (at $400 to $500 per day), be discharged or appeal the decision.

Jimmo, which was a class action lawsuit against Medicare based on this very issue, was just settled. Effective immediately, Medicare can no longer deny a claim because of a lack of rehabilitation potential, but is expanded to pay for rehabilitation which prevents or slows further deterioration in a beneficiaries' clinical condition. This new standard will allow many Medicare beneficiaries to continue on with their therapy, even if they do not show restorative potential, but require more time to prevent further physical deterioration. This should save beneficiaries thousands of dollars and more importantly, allow beneficiaries to obtain the therapy they need to prevent them from further harm after discharge.

Therefore, if you are currently obtaining Medicare paid rehabilitation services in a rehabilitation center or at home and you are being discharged because of a lack of improvement, you may be able to stop the discharge by reminding the provider of the new Medicare policy clarification.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

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Crisis Medicaid Planning Tool Ruled Valid
April 2, 2013 7:22 AM by Michael LaMagna
For those of you who have placed a family member in a nursing home, you already know the costs are astronomical. In the Westchester, N.Y., area most nursing homes run $14,000-$16,000 per month and it's even more in New York City. To qualify for Medicaid to pay for your nursing home bill, you either spend-down all of your assets or use a Medicaid crisis planning tool called a promissory note, or "note," where in many instances you can gift almost half of your money, which would otherwise go to the nursing home. This method should be explored only by a qualified lawyer skilled in elder law matters.

A promissory note allows a nursing home resident to loan a sum of money to another person with specific written repayment terms detailing the interest rate, the amount of principal and interest to be paid each month and the term of the note. This loan must be made in conjunction with a non-exempt transfer or gift of assets which causes a period of ineligibility ("penalty period") for that person. The end result is that the Medicaid applicant should be eligible to receive institutional Medicaid benefits ("Nursing Home Medicaid") upon the expiration of the term of the note and the penalty period, saving almost half of the money they would otherwise be given to the nursing home.

As you can imagine, there have been challenges to this Medicaid loophole. This week a U.S. District Court in Oklahoma upheld a promissory note as a "valid form of Medicaid planning" and the state cannot penalize the applicant for taking advantage of a lawful loophole that Congress has not foreclosed. The result was that the note was not considered a resource and does not subject the Medicaid applicant to a transfer penalty, Lemmons v. Lake (U.S. Dist. Ct., W.D. Okla., No. CIV-12-1075-C, March 21, 2013). I would be happy to explain more about this strategy in a legal consultation.

A better method of preserving assets is to start the Medicaid planning process several years prior to the entrance into a nursing home, however, if you do not have the opportunity to plan ahead, the promissory note is certainly a valid and acceptable Medicaid planning technique, which can save you hundreds of thousands of dollars that would otherwise go to the nursing home.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Health Care Regulatory, Elder Law/Probate/Disability/Wills, Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

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