2016 Elder Law Numbers The Centers for Medicare and Medicaid Services (CMS) has released the new Medicare premiums, deductibles, and co-payments for 2016: Basic Part B premium: $104.90/month * (no change from 2015) Part B deductible: $166 (was $147 in 2015) Part A deductible: $1,288 (was $1,260 in 2015) Co-payment for hospital stay days 61-90: $322/day (was $315 in 2015); Co-payment for hospital stay days 91-150: $644/day (was $630 in 2015) All costs for each day beyond 150 days Skilled nursing facility co-payment, days 21-100: $161/day (was $157.50 in [...]
Since the passage of the Deficit Reduction Act of 2005 (“DRA”), the Pennsylvania Department of Human Services (“Department”) has attempted to limit the use of annuities in the asset protection strategy known as “half-a-loaf” gifting. Half-a-loaf gifting is a technique used to reduce a Medicaid applicant’s resources by gifting one-half of his or her resources to a family member, usually a son or daughter, and using the remaining one-half to purchase a DRA compliant annuity. The applicant becomes eligible for Medicaid because he or she has no resources and [...]
The Obama administration touted ACOs as one of the most promising reforms in the 2010 federal health care law. The administration set a goal that by the end of 2018, half of Medicare spending currently based on the volume of procedures a doctor or hospital performs will instead be linked to quality and frugality. But, so far the ACO program generally has been a one-way street, with most doctors and hospitals happy to accept bonuses while declining to be on the hook for a share of any excessive costs run up by [...]
Case Law Update - Federal Appeals Court Rules Short Term Annuities Are Not Resources Preventing Medicaid Eligibility On September 2, 2015, in the case of Zahner vs. Secretary, Pennsylvania Department of Human Services, a federal appeals court ruled that annuities with certain characteristics, including nonassignability clauses, are not assets to be counted as resources” for purposes of Medicaid eligibility. The Commonwealth of Pennsylvania (DHS) argued that the financial instruments purchased by the plaintiffs were not annuities because they were not purchased as investment products, but rather as a way to pay nursing [...]
Illinois Passes Law to Allow Video & Audio Monitoring in Nursing Homes – Should PA & NJ Do the Same?
Illinois has recently joined the small list of states to pass a law that allows nursing home residents and their families to place video or audio monitoring devices in resident rooms. Illinois joins Texas, Oklahoma, New Mexico, and Maryland who have previously enacted granny cam statutes. The new law allows residents of nursing homes and rehabilitation facilities or their family members to purchase and install video or audio monitoring devices in their rooms. The critical provisions of the new law are as follows: Allow for audio and video electronic monitoring devices in resident [...]
On July 16, 2015, CMS published in the Federal Register an exhaustive proposed rule on requirements for long-term care facilities. It is the first update of nursing home regulations in over 20 years. One of the proposed provisions concerns dispute resolution — specifically, binding arbitration agreements — at Sec. 483.70(n). CMS' posted background on this topic provides, “We considered not proposing any requirements concerning binding arbitration agreements. We share stakeholders' concern that some nursing homes may be requiring residents to sign agreements for binding arbitration as a requirement for admission into [...]
Legislation that will require hospitals to notify patients of their status as outpatients has passed Congress and should be signed into law by the President. Outpatient status limits the patient’s ability to receive Medicare coverage for care in a skilled nursing facility after discharge from the hospital. The law will apply in situations where a patient is receiving services as an outpatient for more than 24 hours. It will require hospitals to notify those patients of their outpatient status within 36 hours, or, upon discharge if that occurs sooner. [...]
Medicare has recently proposed reimbursement to health care providers for counseling on end of life issues. You can read about the proposed regulation at the below link. Medicare Proposes Doctor Reimbursement for End of Life Counseling
On June 23, 2015, the Jimmo Implementation Council convened at the US Capitol in Washington, DC sponsored by the Center for Medicare Advocacy (CMA). According to CMA "The purpose of the Jimmo Council is to nurture a community of experts committed to working together to implement the Jimmo v. Sebelius Settlement – to open access to Medicare and care for people with long-term conditions and injuries. Council members include beneficiary advocates, providers from numerous care-settings, nurses, therapists, policy-makers, and other stakeholders. At the inaugural Council meeting, members from throughout the country discussed [...]
This past February, Jerry and I both blogged on the ABLE Act, which created a new type of tax-advantaged savings plans for the benefit of disabled individuals under § 529A of the federal Internal Revenue Code. ABLE accounts will be somewhat similar to educational savings accounts established under I.R.C. § 529. The new provision is important because § 529A provides the disabled ABLE account beneficiary with special treatment in determining the beneficiary’s financial eligibility for Medicaid. Normally, in order to be eligible for Medicaid in New Jersey, the Medicaid [...]
With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has created a Council of beneficiary advocates, providers, policy-makers and other partners to discuss, analyze and advance the implementation of the Jimmo v. Sebelius "Improvement Standard" Settlement. The Council will convene on June 23, 2015 in Washington, DC. I have the privilege of being invited to attend the Council meeting. The Council's goal is to create an active community dedicated to ensuring fair access to Medicare and necessary care for people with long-term and chronic conditions. If you [...]
Effective April 1, 2015, the New Jersey Department of Health and Human Services has announced that the Medicaid penalty divisor has been increased to $332.59 per day or $10,116.28 per month. The previous divisor was $313.50 per day or $9,535.25 per month. The new divisor shall be used for all new and pending Medicaid applications for an eligibility date of April 1, 2015 or later. The Medicaid divisor figure is used to determine the period of ineligibility of a Medicaid applicant if assets are transferred for less than fair market value during the Medicaid five year [...]
he U.S. Senate Special Committee on Aging held its first hearing of the 114th Congress on February 4, 2015. Signifying the importance and timeliness of elder abuse, the Committee chose “Broken Trust: Combating Financial Exploitation of Vulnerable Seniors” as its topic.
By Jane M. Fearn-Zimmer, Esquire Jerold E. Rothkoff, Esquire blogged on new legislation passed by Congress called the ABLE Act, which allows people who can show that they become disabled prior to the age of twenty-six (26) and their families, to enjoy tax-favored savings for a variety of expenses, by establishing an a savings account which functions similarly to a 529 educational savings account. I am pleased to report that President Obama has signed that legislation, and the Treasury Department is now drafting proposed regulations to implement the law. [...]