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The Care Planning Act of 2015

The U.S. Senate introduced a bill that would allow doctors to be reimbursed by Medicare for providing end of life planning advice to their patients.  This bill is called “The Care Planning Act,” and it would amend title XVIII (Medicare) of the Social Security Act.  This legislation resulted from findings that because Americans are living longer, they are also facing more serious conditions later in life.  The goal of the Act is to ensure that aging individuals with advancing illnesses understand their treatment options and can assist in making their health care choices before losing capacity.  Previously, Medicare would not reimburse qualified health care professionals for this type of counseling.

By discussing end of life options with a physician, aging individuals would be able to articulate their values and preferences so that physicians would be able to develop an appropriate plan for treatment and decision making.  Under the plan, the number of conversations regarding end of life planning is unlimited.

Those in opposition to the bill have expressed concern that the program is motivated by the desire to cut health care costs due to the large amount of money that is spent on individuals in the last few years prior to death.  Those who favor the Act believe it will enable seniors to make the best decisions for themselves and their families.

In order to be eligible for the “planning services,” an individual would have to be in need of assistance with certain daily activities, or diagnosed with one of the following illnesses:

  • metastatic or locally advanced cancer
  • Alzheimer’s disease/progressive dementia
  • late-stage neuromuscular disease
  • late-stage diabetes
  • late-stage kidney, liver, heart, gastrointestinal, cerebrovascular, or lung disease

If passed by the House and Senate, the proposed bill could go into effect in January 2016.   To read the full bill, click here.

If you or a loved one is in the process of planning for long term care, find out how to protect yourself or loved one and contact experienced elder law attorney, Tanya Hobson-Williams. The attorneys at Tanya Hobson-Williams are available to set up a consultation at 866-825-1529.

Elderly Misuse of Antipsychotics: A Disturbing National Trend

A recent National Public Radio (NPR) investigation revealed that nearly 20 percent of senior nursing home residents receive some form of antipsychotic medications.

Similar reports, drawing from the NPR investigation, found significantly higher rates of antipsychotic drug usage concentrated in the Western New York area.  In the Rochester region, data revealed that antipsychotic drug usage rates reached up to 30 percent.*

These statistics are concerning as recent news has suggested that many seniors in nursing care facilities are often given antipsychotics meant to treat conditions that they do not actually have. For example, a 2011 government study found that 88 percent of Medicare claims for antipsychotics prescribed in nursing homes were for treating symptoms of dementia, even though the drugs were not approved for that. The consequences of such overmedication can lead to unfortunate complications, including an increase in the risk of accident, injury, and even heart failure.

In response to this trend, the federally-operated Center for Medicare and Medicaid Services instituted a national campaign to reduce the misuse of antipsychotics. Despite its efforts, however, investigations reveal that the government has been slow to penalize caregivers that run afoul of the program’s mission.

Federal law prohibits the use of antipsychotics drugs for the convenience of the caregiving staff.  Thus, it is important that loved ones be cognizant of the signs of over-medication. If you suspect that you or your elderly loved one is being subjected to over-medication in his or her Senior Care facility, contact an experienced New York Elder Law attorney at the Law Office of Tanya Hobson-Williams at (718) 210-4744.

*While the numbers are alarming, Medical professionals in the Rochester region maintain that the comparatively higher usage rates reflect the elderly patient’s higher need for the medications. Statistics suggest that the Rochester region leads the nation in care for elderly patients with substantial and complex needs, providing support for the medical professionals’ contentions that such medications are necessary to treat their elderly patients.

Nursing Homes Attempt to Lure in More Medicare Patients to Increase Profit

A recent exposé by the New York Times revealed that as nursing homes revamp their facilities to include luxury living quarters, the disparity between the lavish amenities of short term accommodations, and the quality of care can be drastic.  Although nursing homes are attempting to lure in patients whose short stays will be funded by Medicare dollars, in lieu of Medicaid, many patients are being discharged from the facilities before they have been rehabilitated.  Or worse yet- they leave with more medical issues than they had upon admittance.

Nursing homes are reaping 84% more in profits from short-term patients on the Social Security age based Medicare program than they do from lower income patients whose long-term stays are funded by need based Medicaid program.  Medicare does not provide for long term care funding, so many facilities are creating “luxurious” accommodations that may even include putting greens, restaurants, and private rooms with the hopes of luring in patients and increasing revenue.  Some nursing homes have decided to sustain themselves on Medicare funding alone because it is so profitable, thus excluding Medicaid patients.

Due to the time limits for nursing home stays for Medicare patients, many patients will be forced to leave the nursing home before they are fully rehabilitated or before they have adjusted to their medications.  More facilities are catering to short term care in order to receive the substantially higher Medicare payments.  The quality of care is being compromised by ushering patients out the door with quick (and often ineffective or negligent) treatment with less staff.

One family has decided to sue the nursing facility where their mother was rehabilitating after a fall.  While at the facility, she lost twenty pounds and developed a bed sore that exposed her bone.  As a result of the nursing home’s negligence, the patient’s health had deteriorated so badly that she was brought to a hospital where such succumbed to her condition a month later.

In another case, an 87 year old retired neonatologist who checked herself into a top rated facility to recover from an injured foot also developed bedsores so severe that she had to be brought to the emergency room.  She also claims that the staff did not take precautions to prevent bedsores by turning her over periodically; nor did the staff respond to her diaper change requests promptly or give her a full bath.  The patient is suing the facility for negligent care.

Those in the industry are optimistic that the playing field will even out and the quality of care will stand on equal footing with the quality of accommodations in the not too distant future.  While hospitals are required to pay penalties if too many patients are readmitted, they will likely cease sending patients to nursing homes that perform poorly.  In addition, new payment models are being implemented that reward low costs without sacrificing quality.

To read the full article:  http://www.nytimes.com/2015/04/15/business/as-nursing-homes-chase-lucrative-patients-quality-of-care-is-said-to-lag.html?partner=rss&emc=rss&_r=0

Medicare’s Nursing Home Ratings Fail to Give Complete Depiction

Tanya Hobson-Williams, NY AttorneyA recent investigation into Medicare’s nursing home rating system by The New York Times revealed that the high rating of many top nursing homes, is based on incomplete information about the quality and conditions at the homes.

The report found that the 1-5 star medical rating system is largely based on self-reported data by the nursing homes that the government does not verify. The only data that is subject to review from outside agencies is the results from annual health inspections. As a result, other important measurements of nursing homes — such as staff levels and quality statistics, are mostly left to the nursing home to report to Medicare.

The investigation also revealed that the rating system fails to take into account other potentially negative information such as fines imposed by the state or enforcement sanctions from state agencies.

While federal officials maintain that the rating system can be improved, and that they are working to make it better, many individuals, including former nursing home employees, lawyers and patient advocacy groups, believe that these nursing homes have merely learned how to abuse the rating system. Continue reading “Medicare’s Nursing Home Ratings Fail to Give Complete Depiction”

Medicaid Myths

Tanya Hobson-WilliamsWe all expect and hope to have long and healthy lives. However, the truth is, no one lives forever and all too often health issues and accidents occur, leaving many individuals unprepared and in trouble. But there is something you can do to ensure you are never put in this position: PLAN! By planning ahead, you are able to answer the tough questions and make arrangements while you are in good health and mind.

The harsh truth is that 7 out of 10 people over the age of 65 will require expensive long-term care at some point. Would you be able to foot the bill for an extended stay at a nursing home, assisted living facility or at-home care for you or your spouse? Even if you could, would you prefer to pass your savings and other assets to your loved ones rather than have those assets depleted by costly long term care expenses? To protect your lifestyle and assets, Medicaid Planning is necessary.

Continue reading “Medicaid Myths”

NYS Breaks Record in Medicaid Fraud Recoveries

Tanya Hobson-WilliamsThe New York Office of the Medicaid Inspector General (OMIG), reports that in 2013, it recovered what seems to be the highest ever recovery amount regarding Medicaid fraud in the history of the agency. Gov. Andrew Cuomo made the announcement early this February, reporting a sense of pride in New York and explaining the figures as an illustration of how New York State is “truly leading the nation in fighting fraud and protecting taxpayer dollars.” The exact figures calculated reached $1.7 billion over the past three years, and a record of $851 million in 2013 alone.

Continue reading “NYS Breaks Record in Medicaid Fraud Recoveries”

Medicare Wants the Power to Ban Certain Doctors

Tanya Hobson-WilliamsWhile the main focus of Medicare has historically been to provide affordable and accessible medications to seniors, its focus has recently changed. Early this January, The U.S. Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would bring significant changes to the federal agencies.

The most notable change offered by the proposal is the agency’s new authority to kick out physicians and other providers who engage in abusive prescribing. It could also take such action if providers’ licenses have been suspended or revoked by state regulators or if they were restricted from prescribing painkillers and other controlled substances.

Additionally, the agency will tighten a loophole that has allowed doctors to prescribe to patients in the drug program (known as Part D) even when they were not officially enrolled with Medicare. Under the new rules, doctors and other providers must formally enroll if they want to write prescriptions to the 36 million people in Part D. This requires them to verify their credentials and disclose professional discipline and criminal history. Continue reading “Medicare Wants the Power to Ban Certain Doctors”

New York City Settles Allegations of False Medicaid Claims

Tanya Hobson-WilliamsThe case of Ohlmeyer ex rel. United States of America v. City of New York, a whistleblower action brought by the federal government against the city of New York has been settled. The 2012 complaint accused the city’s education department of submitting false claims to Medicaid for counseling services to special education students, and as of January 2014, New York City has agreed to pay $1.37 million in an official settlement.

The complaint, charged that New York City’s Department of Education (DOE) knowingly billed Medicaid for psychological counseling services for individual special education students who did not receive two monthly counseling session, the minimum number required for payment, between 2001 to 2004.

Continue reading “New York City Settles Allegations of False Medicaid Claims”

Medicaid vs. Medicare 101

Tanya Hobson-WilliamsAlthough Medicaid and Medicare provide essential services for our loved ones and thousands of Americans, many people either do not know the specifics of each program or simply do not know the difference. Well not anymore! Provided below are the basics everyone should know when dealing with these two aid programs and a basic layout of their differing eligibility requirements, coverage, and funding.

Medicare

Medicare is a federally funded and administered program that provides health insurance for individuals older the age of 65, individuals with disabilities, or individuals with End-Stage Renal Disease (ESRD). Its coverage includes: inpatient services from a hospital or nursing facility, outpatient services, doctor visits, and preventive care, prescription drug costs, or a combination of these services. Most seniors are automatically enrolled when they turn 65, yet those that are disabled are required to contact their local Medicaid office if interested in being enrolled, however cost is not distinguished by qualifying factors but rather is the cost depends on the “level of coverage” assessed.

Medicaid

Medicaid is a federal and state program that is administrated by the state government with the purpose of providing coverage for low-income families. Its coverage includes: hospital and nursing care, certified pediatric and nurse practitioner services, access to federally qualified centers, as well as access to rural health clinic or birth centers licensed by the family’s state. All of those who wish to receive Medicaid benefits must apply within their state office in order to become eligible and costs depend on the income of each family.

Can A Person Qualify for Both Medicare and Medicaid in New York?

Individuals may be dually eligible for both programs. In many of these cases, Medicaid will cover Medicare premiums or co payments for the services covered under Medicare. This allows for effective and comprehensive health coverage.

Contact an Attorney

If you believe you qualify for Medicare or Medicaid and wish to receive benefits, or if you have been previously denied coverage, contact an experienced New York Elder Law Attorney. A skilled attorney can analyze your situation, discuss your options with you, and help ensure your legal rights are protected.