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Starting Oct.1, 2012, two very important provisions of the Affordable Care Act (ACA) went into effect, which will significantly impact hospitals and other healthcare facilities. The two provisions are: 1) penalizing hospitals for readmitting patients within 30 days of discharge and 2) utilizing hospital value-based purchasing, which ties hospital payments to achieving clinical thresholds.
It is anticipated that more than 2,200 hospitals will be fined at least $125,000 this year as a result of readmissions. As expected, the hospitals are outraged for being fined for conditions that may be out of their control, which includes the readmission of chronically ill people. The variables that will be measured in the first year include: heart attacks, heart failure and pneumonia. The penalty is capped at 1% of the hospital's Medicare payments, rising to 3% in the next few years and adding variables, which includes: joint replacements, stenting, heart bypass and stroke.
Hospitals have been looking to after-hospital care, including: rehab centers, hospices, home health agencies and nursing homes to decrease the incidences of readmissions. The major emphasis has been on effective discharge planning and wellness programs.
Regarding the Hospital Value-Based Purchasing Program, Medicare will look at a set of standard clinical quality measures and on surveys of patients' experience, to determine reimbursement. Medicare has been sharing data with the hospitals to assist with diminishing their impact and the public can view the information on Hospital Compare, located at http://www.medicare.gov/ starting later this month.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /Probate/Disability/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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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The Congressional Business Office (CBO) reports that in 2016, which is when the 2010 health care law becomes fully in effect, 2% of Americans, or roughly 6 million individuals, will be subject to the health care penalty tax. This is significantly higher than the estimated 4 million, in large part due to higher than anticipated unemployment, lower wages and salaries as well as changes to the law since its passage in 2010.
The new penalty is the infamous individual mandate upheld by the Supreme Court as a tax, which requires that you either obtain health insurance or pay a penalty, amounting to $695 or 2.5% of your annual household income. The tax is expected to bring in more than $7 billion in 2016 and $8 billion thereafter.
In addition, the CBO projected that the total amount of individuals who will remain uninsured with be 30 million, up from the projected 21 million. The reason why it is projected that 6 million will be subject to the tax is because the other 24 million include: undocumented aliens, Indian tribe members and those with lower incomes.
The CBO has projected that the total cost for the new law will be upward of $2.6 trillion dollars in the next 10 years, which is significantly higher than the first estimates of $900 billion and covers fewer individuals than first thought.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /Probate/Disability/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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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The Center for Public Integrity recently reported that physician upcoding will cost an addition $11 billion for the past 10 years. When a Medicare beneficiary visits their physician, that service or services gets a billing code. That code is then submitted to Medicare for payment. Upcoding is the practice of billing more expensive services than were performed by the physician. Codes range as low as $20 for a few minutes of a physician's time to more than $140 for more extensive services performed.
Medical groups have quickly defended the physicians' usage of higher codes, stating that the population has grown older and sicker, thereby necessitating the higher codes and ultimately higher reimbursement. However, reports have shown very little shift in cumulative age or infirmity.
Medicare spending is a hot button issue right now as both campaigns are focused on the $500 billion paid out for services in 2011. Upcoding contributes significantly to the costs of Medicare, upwards of $43 per claim, with more than half of the upcoding charges from physician visits and the rest from nursing homes and hospitals.
One explanation for the prevalence of upcoding is the move to electronic medical records and billing systems. The new technology makes it very easy to make the changes and document the justification for the higher codes. In addition, Medicare hasn't kept up with the technology and lacks a uniform standard for coding, leaving it up to the providers to set their own standards, which is a prescription for error.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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The Department of Health and Human Services released a report touting that the healthcare law-ACA-saved an estimated $2.1 billion dollars on healthcare insurance premiums. The numbers are reported by the insurance companies as part of a transparency and accountability measure contained in the healthcare law (the "reporting rule"). This new reporting rule began on Sept. 1, 2011, requiring each health insurance company to publically report proposed rate increases, implemented an approval procedure if the increases were to be more than 10% and established a grant for a rate review program. So far 42 states have obtained grant money for the rate review programs.
As a result of the savings, consumers and in larger part, employers are expected to share in approximately $1.1 billion dollars in direct rebates from their health insurance provider. This initiative requires insurance companies to spend at least 80 percent of premiums on the consumers or provide rebates to their customers. Insurance companies that did not meet the new standards rule will provide nearly 13 million rebates this year. The average rebate is approximately $151 per household. However, it is still uncertain whether individuals or their employers will receive the rebates, how much the rebates will be and when the rebates will show up in your mailbox.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit www.nyandctlaw.com for more information.
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The Supreme Court has ruled! Unless you have been living under a rock, you what the 9 justices decided about the constitutionality of the ACA (Accountability Care Act) case. Or do we?
Let's start from the top. Like all of you, including President Obama, I was watching the television news media when the decision came down. In fact for a brief time I was part of the media as a few newspapers asked me to send comments right after the ruling. Unlike CNN and FOX, I have read enough Supreme Court rulings to know that you never know the outcome until you read the end. And true to form the media reported that the individual mandate was struck down, which was entirely incorrect.
It was a good thing I didn't comment until I read the ruling.
So is this a really big deal? YES!
Just to clue you in. We now have a comprehensive national healthcare plan. This is something I have been hearing about since grade school -- universal healthcare is coming along with the metric system; but universal healthcare, or, according to Chief Justice Roberts, comprehensive healthcare, is nearly a reality. What the law does is take Medicaid, which is health insurance for the elderly, disabled and poor, and transform the program to meet the healthcare needs of the entire non-elderly population based on income, not on disability status or age.
Like I said, a big deal.
The Justices preserved the individual mandate (the part of the law requiring everyone to either purchase health insurance or pay a penalty) and thus by "law" transforming what the government called a penalty into a tax. This was because they court chose to not expand Congress' power to penalize us on inaction or our failures to do something, in this case buy health insurance. However, they found that it is perfectly fine to tax us on our failure to purchase health insurance, like the taxes we pay on gasoline or other goods.
Additionally, the other part of the ruling, the one that garnered much less press, but will prove to have the most impact (mark my words), stated that the Federal Government cannot force individual states to implement this law by taking away all their Medicaid money. In fact Chief Justice Roberts said this would be "a gun to the head" of the individual states. So now the individual states can opt out of the law. Although, it would be difficult to imagine New York offering universal coverage and Connecticut not. As a state-based system, there are vast differences in Medicaid coverage now between states.
So is anything solved? That's the easy question. Not a bit.
As I was told by a wonderful care manager, John Murphy, who I had the pleasure of speaking with about this issue, when Medicare came into practice in the ‘60s no one knew what to make of it and it has been transformed several times; so will this law.
The good news is that for healthcare devotees as myself and many of you, we will get to see the transformation, write about it and maybe even have hand in shaping it. Certainly 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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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In a rare glimpse into political backdoor dealing, emails were released this last week revealing exactly how the White House was able to convince the pharmaceutical industry to embrace the controversial healthcare law. The emails, which were released from the Pharmaceutical Research and Manufacturers of America show that in exchange for their support of the law, the White House pledged to abandon price controls for prescription drugs and would prohibit importing cheaper drugs from foreign countries. In return, the pharmaceutical industry pledged to back the law.
In addition, emails reveal that it was made clear that if the industry did not back the law, the administration would seek a 15% rebate on Medicare drugs and try to remove a tax deduction that would cost the industry around 100 billion dollars over the next 10 years. Moreover, the pharmaceutical industry agreed to pay higher Medicaid rebates and publically supported the law. For their support, the drug companies were given input into the very policies that would govern their industry.
The administration fired back, defending their alignment with the drug companies as a private/public partnership and considers the release of the emails a political measure. As many of you are aware, the Supreme Court will be ruling on the constitutionality of the law at some point this month. This article will have a full analysis of the ruling as it is announced. 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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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If the Affordable Care Act (ACA) is upheld by the Supreme Court later this month, many existing health plans will be required to enhance health insurance benefits by early 2014 to comply with the new regulations. The law will require basic or essential health benefits be offered to all insured. According to the journal Health Affairs, more than half of the current health plans do not offer the basic requirements and will have to be enhanced in order to comply.
Under the new standards of the ACA, consumers will not only be entitled to additional health plan benefits, but will also pay lower out of pocket costs; however, the new expansive benefits will not come without an increase in premiums. Under ACA, there will be four types of insurance plans offered through the insurance exchanges: bronze, silver, gold and platinum. Using the bronze plan as the benchmark, Health Affairs found that most of the health insurers will have to increase the basic coverage, more specifically in the following areas:
- Annual out of pocket costs will be capped at $6,050 for an individual or $12,100 family;
- Maternity coverage will be required to be covered; and
- Eliminate an insurer's ability to refuse to offer coverage for individuals with pre-existing conditions.
It is hard to tell how much premiums will increase due to the new regulations; estimates are in the 6-7% range. The increase will most likely occur because patients with pre-existing illnesses will now be able to purchase insurance, which should drive the total costs upward.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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When you are admitted to a hospital there are new standards that hospitals must abide by regarding your visitation rights. In the past, hospitals would generally limit visitors to immediate family members, which potentially excluded and discouraged friends and domestic partners from visiting. In addition, the hospital would also limit their discussions of surrogate decision making to immediate family members as well. However, in a little-noticed change in policy, President Obama mandated that hospitals notify patients of their right to decide who visits. This now has become a condition of participation in Medicare and Medicaid programs and part of a hospital's reaccreditation by the Joint Commission.
- A hospital is now required to notify and explain to all patients their right to choose who may visit them regardless whether the visitor is a family member, a spouse, a domestic partner or another type of visitor. These changes also protect the rights of hospital patients to choose a representative to act on their behalf. Hospitals must give deference to a patient's wishes concerning representatives;
- Advise patients of their right to withdraw or deny consent at any time;
- Respect the rights of a same-sex partner as patient representative to make decisions on behalf of a partner with respect to visitation if the patient is incapacitated; and
- Inform patient representatives of their rights to serve as the support person for an incapacitated same-sex partner.
If you find yourself in a hospital and they do not abide by your wishes regarding visitation or whom you appoint as a decision maker and you feel that your rights have been violated, you can report the violation to that hospitals quality assurance committee, your local department of health or to JCAHO directly.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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With all of talk about JP Morgan Chase's $2 billion blunder and whether more regulations will prevent the squander of taxpayer's money, HHS just released final rules that will ease regulatory burdens on hospitals and healthcare providers, purported to save nearly $6 billion. However, the question remains to be seen whether the new rules, which ease bureaucratic red tape, will actually save as much as HHS suggests and improve patient care.
The regulatory changes include:
Allowing physician extenders (NPs and PAs) to be appointed to hospital medical staffs, with all of the rights and privileges of physicians, including the ability to administer anesthesia and powerful pain killers, vulnerable to abuse;
- Permitting podiatrists to lead a hospital medical staff, despite lacking a specific degree in medicine or doctor of osteopathic medicine degree;
- Allowing one governing board to oversee multiple hospitals within a single system;
- Eliminate outdated infection control standards for ambulatory surgical centers; and
- Allowing smaller hospitals to outsource some laboratory and radiology tests.
The administrative changes should save money in the long run and certainly are logical. The effects of expanding the role of physician extenders, while many would argue is needed since there will be a shortage of primary care physicians, remains to be seen. In this instance, the educational programs should be updated in light of the recent changes, to ensure proper training.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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HHS Secretary Kathleen Sebelius announced the availability of funding for the construction and renovation of school-based health centers. These new investments, totaling up to $75 million, are part of the School-Based Health Center Capital (SBHCC) Program, which was created by the Affordable Care Act of 2010.
School-based health centers enable children with acute or chronic illnesses to attend school as well as help to improve the overall health and wellness of children and adolescents through health screenings, health promotion and disease prevention activities.
"Whether establishing a new site or upgrading an existing facility, the availability of funding for school-based health centers will help kids more easily get the health services they need to thrive," said Sebelius. "The goal is to keep our children healthy so they can learn, grow and prosper."
The Affordable Care Act appropriated $200 million for the SBHCC Program to address capital needs in school-based health centers. The funding opportunity is the third in a series of awards that will be made available to school-based health centers through the Affordable Care Act. The Health Resources and Services Administration (HRSA) oversees the SBHCC Program.
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Very soon many readers will be part of a new healthcare program that will integrate cutting edge technology, coordinate care amongst many different providers and even take an active interest in your well-being. Curious?
Twenty-seven large medical groups have been selected by CMS to be the first participants as Accountable Care Organizations (ACOs). ACOs are new multi-provider organizations that incorporate hospitals, physician groups, laboratories, and even nursing facilities, coordinating care among the various levels through technology and follow-up. This should reduce unnecessary and harmful duplication of services, improve the overall quality of patient care and lower costs to the healthcare system.
ACOs are required to adhere to 33 quality standards, including patient safety, usage of preventive healthcare and coordination of care. In return, the ACOs will share in the savings and receive up to 25% of the savings produced.
In addition, ACOs will be required to carefully monitor chronically ill patients, who are known to be the most expensive participants (i.e., diabetics and those with pulmonary and heart ailments). The monitoring of these patients will be particularly challenging,
If the program works, we will all be part of an ACO in the near future.
Click here to see a list of the 27 organizations selected.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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In what may prove to be a model for the Medicaid system and healthcare in general, Oregon Governor John Kitzhaber signed a new Health Care Initiative aimed at significantly decreasing Medicaid expenditures.
The new law, known as Bill 1580, provides legislative approval to start creating local coordinated care organizations. The network of providers will deliver more comprehensive mental, physical and dental care for the state's 600,000 Medicaid clients.
The new health plan utilizes an Accountable Care Organization approach, by using the coordination of care amongst many providers, including physicians, nurses, mental, dental and health providers, to ensure better communication and outcomes. In addition, those providers who save Medicaid money will be financially compensated for keeping their patients healthy, especially those with chronic illnesses, which costs millions of dollars to the Medicaid system each year.
Unlike the federal healthcare law, the Oregon law does not have mandates for the uninsured or for private insurers, but it does create oversights for the program. The new law is expected to save Oregon Medicaid $155 million in the next year, and by 2017, as much as $4.6 billion. If successful, this bill may very well be the future healthcare model.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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This week Congress and the Senate
passed legislation that will have an immediate effect on healthcare payments to
most providers, including: hospitals, physicians, rehabilitation specialists and
laboratories. The new legislation, which is called the Middle
Class Tax Relief and Job Creation Act of 2012, extends the payroll tax
cut and unemployment benefits, as well as makes the following adjustments to the
healthcare system:
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Freezes the current
reimbursement rate that Medicare pays physicians, preventing the proposed 27.4%
cut in payments, which was to begin on March 1, 2012. The cuts are now
postponed to Dec. 31, 2012;
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Extends the outpatient
therapy cap exception process, whereby Medicare beneficiaries can exceed the
caps on obtaining therapy as long as the physician certifies that the therapy
is medically necessary; and
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Stops a planned reduction in hospital payments
for evaluation and management services in outpatient departments.
To assist paying for the cuts in
reimbursement, the bill reduces the amount of money hospitals and nursing
facilities are reimbursed for bad debt. Under current law, Medicare reimburses hospitals
and nursing facilities for 70% of what they are unable or unwilling to collect
and 100% of the nursing facility bad debt resulting from the treatment of the dual
eligibles (those with Medicare and Medicaid).
This provision would reduce the
reimbursement to 65% within a 3 year period, saving approximately $7 billion to
the Medicare system; however, it would cause unknown harm to the providers, who
have razor thin margins already.
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 Timins & LaMagna, LLP,
practicing Health Care Regulatory, Elder /disability/veteran’s law, 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 914-819-0663 or visit Attorney LaMagna’s website at www.nyandctlaw.com
for more information.
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It is hard to imagine a more decisive issue that has erupted across the nation, putting contraception, religion and politics at the forefront of this election year.
In August 2011, the White House issued an interim final rule which required health insurers to cover a wide range of preventive services for women, including:
- Well-woman visits;
- Gestational diabetes screening;
- Contraception; and
- Breastfeeding counseling and supplies.
The health plans were required to cover the services without any cost-sharing, deductibles or co-pays.
Since August, the White House and President Obama have been under tremendous scrutiny from religious organizations, especially the Catholic Church and other non-profit employers who would be required to cover the contraceptive services, despite deep religious views opposing such usage.
However, the White House announced last week that they would compromise and exempt churches, other houses of worship and similar organizations from subsidizing, providing, paying for or referring to contraception usage or services based on religious objection, instead shifting the responsibility directly to the employers' insurance providers. The services would be required to be offered free of charge to the insured.
It is unclear what the impact will be on health insurance premiums, as the White House predicts the coverage will be budget neutral, however it is hard to predict at this time.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, 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 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.
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Consumers concerned
about the quality of care they will receive at their next hospital visit, can
turn to the Internet. Armed with the knowledge that hospital acquired infections
are one of the leading causes of death in this country, approximately 100,000
deaths a year, more than car crashes or breast cancer, utilizing a free and
easy online tool is a necessity prior to scheduling surgery. By accessing www.hospitalcompare.hhs.gov, consumers
can access clinical, patient outcome and satisfaction data that can assist them
with making an informed decision.
Hospital Compare
is a consumer friendly website that provides data through the joint efforts of CMS
and the Hospital Quality Alliance (HQA), a public and private partnership. The
clinical and performance related data includes variables such as the rates of:
·
Surgery
patients who were given an antibiotic at the right time to prevent infection;
·
Surgery
patients whose doctors ordered treatments to prevent blood clots after certain
types of surgery;
·
Appropriate
initial antibiotic selection for pneumonia;
·
Death
rates for heart attacks, heart failure and pneumonia;
·
Hospital
readmission rates for heart attacks, heart failure and pneumonia; and
·
Central-line
associated bloodstream infections (information available next year).
The website allows
the reader to compare up to three hospitals against national benchmarks as well
as the individual hospitals. At the very least, if the hospital being used by your
physician did not measure up to the standards of care, you can ask for
clarification and the measures undertaken to improve the quality of care or
patient satisfaction.
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 Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder
/disability/veteran’s law, 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 914-819-0663 or visit Attorney LaMagna’s website at www.nyandctlaw.com for
more information.