Proposed Medicaid change, effective August 1, 2009

There will no longer be a 90-day limit for a Medicaid applicant to submit Social Security Administration (SSA) approval of Retirement, Survivors and Disability Income (RSDI) based on disability (also known as Social Security disability) after a State Medical Review Team (MRT) denial of their Medicaid application. It will allow a previously denied MRT disability application to be re-evaluated by the State without submission of a new application when SSA approves RSDI based on disability.

Court Overturns Marriage Restriction in Trust

Prior to their death, Max and Erla established trusts which included the following provision: "A descendant of mine other than a child of mine who marries outside the Jewish faith (unless the spouse of such descendant has converted or converts within one year of the marriage to the Jewish faith) and his or her descendants shall be deemed to be deceased for all purposes of this instrument as of the date of such marriage." Only one of their grandchildren was married to a person of Jewish faith. After one of the grandchildren initiated litigation alleging improprieties and the misappropriation of millions, the defendants countered with the "Jewish clause." Under the clause, they argued that the plaintiff was deemed to have predeceased Max and had no interest in the estate. Therefore, the plaintiff's claims should be dismissed. The court was then asked to determine whether "the Jewishclause" was enforceable. The Court of Appeals affirmed the trial court, holding that the "Jewish clause was unenforceable because it "seriously interferes with and limits the right of individuals to marry a person of their own choosing."

In re Estate of Feinberg, 1-06-2823 (Ill. App. June 30, 2008)
Full case: http://www.state.il.us/court/Opinions/AppellateCourt/2008/1stDistrict/June/1062823.pdf

Hospice Oversight to Improve

Twenty-five years after Medicare began paying for hospice care, the federal health program has issued a new rule calling hospice providers to closer account on the quality of care they offer. The rule, which will take effect in December, guarantees hospice patients a say in their treatment plans and requires hospice providers to show they are improving in areas where they have been found deficient.

The move comes at a time when hospice care is growing exponentially but is still vastly underused and under-appreciated, hospice providers and advocates say. About 1.3 million people received hospice services in 2006, more than twice as many as did a decade earlier.

What was once a grass-roots, community-based movement in the late 1960s has become a booming health-care business.

For-profit hospices, which accounted for half of hospices in 2005, realized annual profits of about 12 percent from 2001 to 2005, according to the Medicare Payment Advisory Commission. How profitability affects quality of care hasn't been determined. There were 4,500 hospice providers in 2006, up from about 3,100 in 2000, according to the National Hospice and Palliative Care Organization, an industry group based in Alexandria. Last year, Medicare spent about $10 billion on hospice care, up from about $3 billion in 2000.

Many in the field say they find it surprising that hospice care isn't more widely used, given the generosity of the Medicare benefit: There are no co-pays, deductibles or out-of-pocket costs for beneficiaries who use hospice. Malene Davis, president and chief executive of Capital Hospice, based in Falls Church, blames widespread misperceptions (the idea, for instance, that hospice is only for cancer patients, or that once someone is in, he can't leave) for holding down the rate of use.

Not all of the 1.3 million people who received hospice services in 2006 died within the next six months, although a life expectancy of six months or less is often a condition for treatment. Some lived into the following year, and about 220,000 were discharged. Predicting the time of death, though, is a notoriously inexact science.

Linda Neighborgall of Falls Church is an enthusiastic supporter, after using hospice for her mother and mother-in-law, both of whom died from cancer. In her mother's case, hospice made it possible for her father to be a primary caregiver, and for her mother's death, last December, to occur at home.

"She was able to be in friendly surroundings," and "it was peaceful," said Neighborgall, a retired lawyer.

Hospice, she said, provided support for the extended family, confidence that they could manage her mother's death at home, and, near the end, crucial and timely pain management assistance.

"If there really are angels on Earth, I know where they work: They work at hospice," Neighborgall said.

Some devils may work there, too. In 1995 government investigators issued a "fraud alert" on hospice after they found false claims from providers who improperly diagnosed patients as terminally ill or billed for undelivered care. There's still no central repository of complaints data. "We hear terrible stories about even the most reputable hospices," says Naomi Naierman, president and chief executive of the American Hospice Foundation, a nonprofit consumer advocacy group based in Washington.

Anyone can seek out hospice, but a physician must approve the referral before Medicare or private insurers will pay for the program. Hospice care can be provided at home, at the hospital or at a nursing home -- wherever the patient or family desires. It offers the terminally ill spiritual and bereavement counseling, pain management and peace of mind that they won't be a burden, said Naierman.

About one in three deaths occur under hospice care, though that figure varies by location. In Washington, for example, only about 8 percent of deaths occur under hospice, while in Virginia, the figure is about 50 to 60 percent, Davis said.

Measuring Quality

The new Medicare rule may not suddenly increase acceptance of hospice, but it will start reducing variations in how care is delivered, and eventually it will help consumers choose high-quality hospice providers, Davis said.

The increased emphasis on patient rights mirrors a trend among hospice providers, said Judi Lund Person, vice president for regulatory and state leadership at the NHPCO, representing 3,000 hospice organizations and 20,000 individual physicians, nurses, social workers and other providers.

Beginning Dec. 2, hospice organizations will also have to implement a quality assessment and improvement system. Hospices will have to show the Centers for Medicare and Medicaid Services, the agency that administers Medicare, that they are trying to improve in problem areas.

Initially, quality data will be available only to each hospice organization and Medicare. Eventually, providers and advocates expect, data will be shared with the public, as the federal government has done with information on nursing homes, hospitals and home health agencies.

Hospice providers are happy with the new rule, Lund Person said. NHPCO members have already been tracking performance voluntarily through its Quality Partners program, she said. Most hospices also use family surveys to measure how well they have handled a case.

For the full Washington Post article see:

http://www.washingtonpost.com/wp-dyn/content/article/2008/06/27/AR2008062703021.html

Long-Term Care Insurance Will Cost $85,000

A 65-year-old couple needs $85,000 on average to cover insurance costs for long-term care such as nursing home stays in retirement, according to a study to be released today by Fidelity Investments.

The finding underscores the need to financially prepare for the possibility of eventually needing assistance to get by - a burden that often falls on elders' adult children, who can jeopardize their own finances by caring for an ailing parent while finding they must cut their work hours.

Setting aside adequate savings heading into retirement can help defuse family tensions should physical or mental illness hit parents who slowly realize they can no longer perform tasks such as household chores, or bathe or dress on their own.

"If you plan adequately and you have the ability to pay for assistance, in whatever form that might be, it makes it easier on everybody if you can do that," said Kathleen Kelly, executive director of the Family Caregiver Alliance, a nonprofit agency in San Francisco that helps families cope with adults' disabilities. "Families really want to do the right thing, but there are so many pressures on them."

Fidelity, a financial services firm whose mainstay is mutual funds, surveyed insurers offering long-term care policies to come up with the estimate that a couple aged 65 this year can expect to need $85,000 to cover annual premiums for long-term care coverage throughout retirement.

It's the first year Fidelity has conducted the study, which supplements a survey the company completed in March estimating a couple retiring this year would need $225,000 in savings to cover medical costs in retirement. That estimate covers expenses associated with Medicare premium payments, as well as co-payments and deductibles, plus out-of-pocket prescription drug costs.

The $85,000 for long-term care insurance - which can cover costs for everything from regular visits by a caregiver to living in a nursing home - is in addition to the $225,000 for other health care needs.

The study's goal is to get people thinking about long-term care - an unpleasant topic made more difficult by rising costs and the growing demand for such care as Baby Boomers enter retirement and eventually need help caring for themselves.

"A lot of people shy away from thinking about it," said Joan Bloom, senior vice president for Fidelity's life insurance group, which distributes long-term care insurance issued by an unaffiliated firm, Genworth Financial.

Source: San Fransisco Chronicle

For the full story see:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/06/25/BUNM11EVMA.DTL&feed=rss.business

Star Ratings For Nursing Homes

Nursing homes will get a "star rating" from the federal government to help consumers pick the best facilities, a sweeping initiative that a Maryland regulator predicted will create "peer pressure" among owners to improve care. The ratings, from a low of one star to a high of five, will be posted starting in December on the Nursing Home Compare Web site of the Centers for Medicare and Medicaid Services, said the federal agency's acting administrator, Kerry Weems. "I don't think we'll see very many people who are going to be anxious to put a loved one into a one-star home," Weems told reporters yesterday during a conference call. The CMS Web site provides extensive data on nursing homes, but a star rating system will make it easier for consumers to compare them, said Wendy Kronmiller, director of the Maryland Office of Health Care Quality.


Source: Baltimore Sun (19 June 2008)
Full story: http://www.baltimoresun.com/news/local/bal-te.md.rating19jun19,0,4258815.story

New attacks on the homes of Michigan seniors

In newly published rules the Michigan Department of Human Services is proposing regulations that will force some Michigan seniors to sell their homes and use all the proceeds to pay for nursing home care. Currently you cannot qualify for Medicaid if the equity in your home is over $500,000. In the past the common solution was to obtain a mortgage to reduce the equity below $500,000. The mortgage proceeds did not count against Medicaid eligibility.

Now, with the proposed rules, mortgage proceeds would count against Medicaid eligibility. This effectively ends any type of planning to protect homes worth more than $500,000. This new rule results in some unfair situations.

For example, someone with a $450,000 home can keep that home protected and pass it on to his heirs, but someone with a $501,000 home has to sell the home and spend all the proceeds on long-term care expenses. This is obviously an unfair result.

Hopefully, the Michigan Department of Human Services will correct this knee-jerk law change and once again allow for equity to prevail when in comes to the homes of seniors in long-term care.

Michigan Social Security Disability Judge memo

The following is a memo sent out from the Grand Rapids Office of
Disability Adjudication and Review to help attorneys help Social Security make the disability appeals process go more smoothly.

The Representative Memo
[Volume 1, Number 1 – 16 June 2008]
In an effort to maximize cooperation and communication between the Hearing Office and the Local Representative Community, we are reviving the regularly scheduled “newsletter” ....

Scheduling News
We are now scheduling our August & September dockets with cases whose Request For Hearing was filed in July & August 2006. Because of staffing shortages, we are unable to give Representatives as much advanced notice of scheduled hearing dates as we would prefer, so please use the above information to plan your file development to minimize the need for Post-hearing development.

Procedural News
· Scheduling: We are fast approaching the day on which all our cases scheduled for hearing will be e-files. We expect that day will be at the end of the summer or beginning of the fall.
· ERE Registration: if you are not yet using ERE to submit evidence, you may want to register and join because a program is being developed that will allow Registered Representatives to access their clients’ files. The Pilot Program will be starting this summer. The Grand Rapids Hearing Office is not part of the initial pilot program, but the program should go organization-wide in the not too distant future. In the meantime ERE offers another easy-to-use alternative to submission of electronic evidence (Word documents, records you have already scanned into your computer). Check with Patrick Morin to get registered and find out more about this tool.
· As most of you know, we have computers for Representatives’ use at the hearings in Grand Rapids; but for hearings at our St Joseph and Traverse City remote sites, representatives are expected to have their own lap tops at the hearings to view the e-file.

Thank You
On behalf of the entire staff I want to thank the Representative community for your concerted effort in helping us by getting evidence and Pre-Hearing Statements in well in advance of the hearing date. It makes a significant difference in how long it takes us to issue our decisions and enhances the possibility of an OTR or Bench Decision. You are an important part what it takes for us to serve our claimants and your clients and we appreciate your cooperation.

Help!
You can help us even more in very significant ways by:
1. Filing evidence via FECS or ERE & filing evidence only once. Paper duplicates should not be submitted by FAX, mail or hand delivery. The duplicates only create more work for our hard working staff.
2. Using a separate bar code Cover Sheet for each exhibit and using the correct bar code – all medical evidence, including RFC opinions goes in Section “F”. All client forms, Correspondence, Pleadings (including Pre-hearing Statements & OTR Requests) go in Section “E”. Cover letters are not necessary when submitting evidence electronically.
3. Organizing medical evidence before submitting it. This is how medical evidence is organized (from top to bottom):

Hospital Admissions
· Discharge/ER
· History & Physical
· Consultations
· Operative Reports
· Notes
· Medications
· Diagnostic studies & test results (x-rays, pathology reports, EKGs, etc)
· Lab Reports
· Consent & Discharge Instructions.

Office Notes
· Notes (newest on top to oldest on bottom)
· Medication Chart(s)
· Diagnostic Studies & test results (x-rays, pathology reports, EKGs, etc)
· Lab Reports


While we are now adding two new judges, in the past year we have lost 5 staff members and your cooperation is a big part of the solution to the problem of how we prepare enough cases for hearings so we don’t fall further behind. You would be amazed how much time it takes to reorganize disorganized electronic evidence.

Personnel News
· As most of you know, Sue Gilbert has been on special assignment to Chief Judge Cristaudo’s Office since last July and our two Group Supervisors (Patrick Morin and Kim Tripp) have taking turns as Acting Hearing Office Directors. Kim is starting another turn on June 23. Sue has responsibility for leading the introduction of an organization-wide business process for e-files that should improve our ability to provide even more efficient public service to our claimants.
· We are welcoming two new ALJ’s this summer. Judge Paul Jones has already finished his training and started hearing cases. He joins ODAR from the Michigan Attorney General’s Office. Judge Timothy Stueve (“Stee-vee”) will be here for two weeks beginning 6/23/08 after which he will be in training for 4 weeks. He will return to begin hearing cases in August. He joins us from the Coast Guard. Please join us in welcoming our new judges.
· At a date this summer yet to be determined, Judge Toal will be moving to the Milwaukee WI Hearing Office where he will be much closer to his friends, family and roots in Chicago. Please join us in wishing Judge Toal well in his new assignment.

Miscellaneous Items
· This Memo will be coming out at least every other month. Comments & suggestions would be appreciated.

· We will be holding a Representative Meeting this fall to update you on new developments and listen to your problems/questions. Details to follow.

Bill King, HOCALJ