The following is a Statement by Assistant Secretary Greenlee on the 45th Anniversary of the
Signing of the Older Americans Act.
"On July 14, 1965 President Johnson signed the Older Americans Act into law. Sixteen days later, on July 30, he signed legislation creating Medicare and Medicaid. These three programs, along with Social Security enacted in 1935, have served as the foundation for economic, health and social support for millions of seniors, individuals with disabilities and their families. Because of these programs, millions of older Americans have lived more secure, healthier and meaningful lives. The Older Americans Act has quietly but effectively provided nutrition and community support to millions. It has also protected the rights of seniors, and in many cases, has been the key to independence.
In 1965, there were about 26 million Americans age 60 and over. Today, there are 57 million older Americans 60 and over, with many more on the immediate horizon. Our senior population is not only growing larger, but becoming more diverse. Adults over 80 are our fastest growing group, and many will need long term care. Reliance on family members, who currently provide 80 percent of the long term care assistance for our nation's seniors, will increase.
The historic enactment of the Affordable Care Act (ACA) by President Obama on March 23, 2010 provides us with another tremendous opportunity to harness the successes and progress of the last four decades to further improve the health and lives of older Americans and support their caregivers. The ACA represents the biggest change in our national health care delivery system since 1965. And just as they were in 1965, the programs of the Older Americans Act - and our national aging network of state, tribal and community-based organizations, service providers, volunteers and family caregivers - will be called upon to complement, support and enhance these changes. How successfully we weave these multiple responsibilities together will say much for how we will care for seniors in the future. "
Saturday, July 17, 2010
Thursday, July 15, 2010
Donut Hole Checks: Beware of Scams
CMS (The Centers for Medicare and Medicaid Services) said checks will be mailed monthly, starting as early as this summer, and will continue throughout the year as Medicare beneficiaries hit the donut hole. Those who qualify can expect to receive their check within 45 days of reaching the gap.
Seniors beware of scams involving confidential information: Seniors who qualify for the $250 check will not have to give their social security number or bank account information. CMS does not need the Seniors to fill out any forms. The process is automatic: if the senior reaches the donut hole, a check will automatically be sent out in the mail.
The $250 check in the mail is the first tangible benefit the seniors will see from the March 2010 health care reform.
“One of the biggest ways the new law is going to help seniors is by gradually phasing out the Medicare prescription drug doughnut hole, which has made it hard for seniors to afford their medications,” Sebelius said.
CMS (The Centers for Medicare and Medicaid Services) said checks will be mailed monthly, starting as early as this summer, and will continue throughout the year as Medicare beneficiaries hit the donut hole. Those who qualify can expect to receive their check within 45 days of reaching the gap.
Seniors beware of scams involving confidential information: Seniors who qualify for the $250 check will not have to give their social security number or bank account information. CMS does not need the Seniors to fill out any forms. The process is automatic: if the senior reaches the donut hole, a check will automatically be sent out in the mail.
The $250 check in the mail is the first tangible benefit the seniors will see from the March 2010 health care reform.
“One of the biggest ways the new law is going to help seniors is by gradually phasing out the Medicare prescription drug doughnut hole, which has made it hard for seniors to afford their medications,” Sebelius said.
Wednesday, July 14, 2010
What is the donut hole?
The context is seniors and their pharmacy costs.
The donut hole is the commonly used reference to the middle of the year for a senior, where she must pay the full cost of her monthly prescriptions without any assistance from Medicare. Medicare helps around the edges:
First, the senior receiving Medicare must pay her annual deductible. The deductible is $310. On a fixed income, the beginning of the year is not an easy time. Next, after paying the first $310 of pharmacy bills for the year, the senior must pay 25% of her drug costs until her total drug cost reaches $2,830 for the year.
Then, the senior falls into a coverage gap. In this coverage gap or "donut hole," the senior must pay for drugs out of pocket until her annual expenses exceed $6,440. In other words, while the cumulative annual drug costs are between $2,830 and $6,440, the senior is paying 100% out of pocket. Once the senior's drug costs exceed $6,440, she will only pays 5% of her drug costs for the rest of the year.
Eliminating the donut hole is one of the major benefits for seniors of the March 2010 Health Care Reform.
The context is seniors and their pharmacy costs.
The donut hole is the commonly used reference to the middle of the year for a senior, where she must pay the full cost of her monthly prescriptions without any assistance from Medicare. Medicare helps around the edges:
First, the senior receiving Medicare must pay her annual deductible. The deductible is $310. On a fixed income, the beginning of the year is not an easy time. Next, after paying the first $310 of pharmacy bills for the year, the senior must pay 25% of her drug costs until her total drug cost reaches $2,830 for the year.
Then, the senior falls into a coverage gap. In this coverage gap or "donut hole," the senior must pay for drugs out of pocket until her annual expenses exceed $6,440. In other words, while the cumulative annual drug costs are between $2,830 and $6,440, the senior is paying 100% out of pocket. Once the senior's drug costs exceed $6,440, she will only pays 5% of her drug costs for the rest of the year.
Eliminating the donut hole is one of the major benefits for seniors of the March 2010 Health Care Reform.
How Health Care Reform Affects Older Americans
On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March 25, Congress passed the Reconciliation Act of 2010 (H.R. 4872) which modifies H.R. 3590. Taken together, these two bills comprise the health care reform package. Important provisions for older adults and people with special needs include:
SOME OF THE MEDICARE CHANGES
*The new law provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 (Effective January 1, 2010).
*The new law also gradually eliminates the Medicare Part D doughnut hole by 2020:
***For brand-name drugs, the new law requires pharmaceutical manufacturers to provide a 50% discount on prescriptions filled in the Medicare Part D coverage gap beginning in 2011, in addition to federal subsidies of 25% of the brand-name drug cost by 2020 (phased in beginning in 2013)
***For generic drugs, provides federal subsidies of 75% of the generic drug cost by 2020 for prescriptions filled in the Medicare Part D coverage gap (phased in beginning in 2011)
*Under the new law, Medicare will cover an annual wellness visit and creation of a personalized prevention assessment and plan. There is no co-payment or deductible for the annual wellness visit and the assessment. Prevention services include referrals to education and preventive counseling or community-based interventions to address risk factors.
*The new law eliminates Part D cost-sharing for full-benefit, dual eligible beneficiaries receiving home- and community-based services.
The changes to Medicare extend by nine years the life of the Medicare Trust Fund, which was projected to be depleted in 2017.
For a full version of this article, please see the NAELA website. The authors are Brian Lindberg and Gail MacInnes.
On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March 25, Congress passed the Reconciliation Act of 2010 (H.R. 4872) which modifies H.R. 3590. Taken together, these two bills comprise the health care reform package. Important provisions for older adults and people with special needs include:
SOME OF THE MEDICARE CHANGES
*The new law provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 (Effective January 1, 2010).
*The new law also gradually eliminates the Medicare Part D doughnut hole by 2020:
***For brand-name drugs, the new law requires pharmaceutical manufacturers to provide a 50% discount on prescriptions filled in the Medicare Part D coverage gap beginning in 2011, in addition to federal subsidies of 25% of the brand-name drug cost by 2020 (phased in beginning in 2013)
***For generic drugs, provides federal subsidies of 75% of the generic drug cost by 2020 for prescriptions filled in the Medicare Part D coverage gap (phased in beginning in 2011)
*Under the new law, Medicare will cover an annual wellness visit and creation of a personalized prevention assessment and plan. There is no co-payment or deductible for the annual wellness visit and the assessment. Prevention services include referrals to education and preventive counseling or community-based interventions to address risk factors.
*The new law eliminates Part D cost-sharing for full-benefit, dual eligible beneficiaries receiving home- and community-based services.
The changes to Medicare extend by nine years the life of the Medicare Trust Fund, which was projected to be depleted in 2017.
For a full version of this article, please see the NAELA website. The authors are Brian Lindberg and Gail MacInnes.
Sunday, July 11, 2010
HIPPA RELEASE AND AUTHORIZATION
In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Access to our health records is now regulated through this piece of federal legislation.
If you would like some person other than yourself to have access to your medical records and information, and you would like health care providers to release your medical information to that person, you must authorize the release of the information in writing.
Q: Is it a good idea to include a specific “HIPAA release” in the health care proxy/ power of attorney or to have a stand-alone HIPAA release version?
A: Either will work. In fact, it’s not legally required to have specific language related to HIPAA. Practically speaking, it is a good idea to either have a stand-alone HIPAA release or HIPAA specific language in your health care proxy.
THE HEALTH CARE PROXY ROUTE:
The federal law does not require a separate HIPAA release document; however, the health care providers and those whose job it is to release or not to release information are more comfortable when they have a HIPAA release in hand. In addition, a power of attorney for health care becomes effective after you lose your capacity to make or communicate decisions. That means that, unless the draftsperson clarifies otherwise, the power of attorney does not authorize release of medical information to the person named while you remain competent. To clarify, a good, well-written health care proxy or power of attorney authorizes the agent or attorney-in-fact to have access to medical records and personnel of the principal.
THE STAND ALONE HIPAA RELEASE ROUTE:
The primary reason to have a stand-alone HIPAA release is simplicity.
In our experience, a stand-alone HIPAA release document that accompanies the health care proxy is the simplest means of gaining access. It’s a page or two and it’s drafted for lay people to read; in other words, it’s simple and intelligible and gets the job done.
-----------------
If you want some person other than yourself to have access to your medical information and records while you remain competent, you need to complete and sign a HIPAA release or ensure that your attorney has drafted your Health Care Proxy with the correct legal language enabling immediate access.
In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Access to our health records is now regulated through this piece of federal legislation.
If you would like some person other than yourself to have access to your medical records and information, and you would like health care providers to release your medical information to that person, you must authorize the release of the information in writing.
Q: Is it a good idea to include a specific “HIPAA release” in the health care proxy/ power of attorney or to have a stand-alone HIPAA release version?
A: Either will work. In fact, it’s not legally required to have specific language related to HIPAA. Practically speaking, it is a good idea to either have a stand-alone HIPAA release or HIPAA specific language in your health care proxy.
THE HEALTH CARE PROXY ROUTE:
The federal law does not require a separate HIPAA release document; however, the health care providers and those whose job it is to release or not to release information are more comfortable when they have a HIPAA release in hand. In addition, a power of attorney for health care becomes effective after you lose your capacity to make or communicate decisions. That means that, unless the draftsperson clarifies otherwise, the power of attorney does not authorize release of medical information to the person named while you remain competent. To clarify, a good, well-written health care proxy or power of attorney authorizes the agent or attorney-in-fact to have access to medical records and personnel of the principal.
THE STAND ALONE HIPAA RELEASE ROUTE:
The primary reason to have a stand-alone HIPAA release is simplicity.
In our experience, a stand-alone HIPAA release document that accompanies the health care proxy is the simplest means of gaining access. It’s a page or two and it’s drafted for lay people to read; in other words, it’s simple and intelligible and gets the job done.
-----------------
If you want some person other than yourself to have access to your medical information and records while you remain competent, you need to complete and sign a HIPAA release or ensure that your attorney has drafted your Health Care Proxy with the correct legal language enabling immediate access.
Friday, July 9, 2010
Veterans Benefits: Aid and Attendance (Basic Eligibility Part II)
Periods of War: What does this mean? In order to be eligible for Aid and Attendance (or the lesser included pensions) the veteran must have served for 90 consecutive days, and one day must have been during a Period of War.
Our senior population participated in World War II, the Korean conflict and Vietnam. The history book dates are perhaps not an exact match with the dates set forth in the law establishing VA pension benefits. Here are the pivotal dates:
World War Two (WWII): December 7, 1941 through December 31, 1946.
Korean conflict: June 27, 1950 through January 31, 1955.
Vietnam: February 28, 1961 through May 7, 1975 (if the veteran was physically in the Republic of Vietnam) or August 5, 1964 through May 7, 1975 (if the veteran was serving outside of the actual Republic of Vietnam.)
Authority: 38 U.S.C. 101(29)
Periods of War: What does this mean? In order to be eligible for Aid and Attendance (or the lesser included pensions) the veteran must have served for 90 consecutive days, and one day must have been during a Period of War.
Our senior population participated in World War II, the Korean conflict and Vietnam. The history book dates are perhaps not an exact match with the dates set forth in the law establishing VA pension benefits. Here are the pivotal dates:
World War Two (WWII): December 7, 1941 through December 31, 1946.
Korean conflict: June 27, 1950 through January 31, 1955.
Vietnam: February 28, 1961 through May 7, 1975 (if the veteran was physically in the Republic of Vietnam) or August 5, 1964 through May 7, 1975 (if the veteran was serving outside of the actual Republic of Vietnam.)
Authority: 38 U.S.C. 101(29)
Wednesday, July 7, 2010
Special Needs Trusts- Do you Have An Early Termination Provision?
The Trusts and Special Needs Section of the National Academy of Elder Law Attorneys recently advised NAELA members of a change to the POMS (the Social Security Program Operations Manual). While the change to the manual appears now, the actual implementation date is not until later this year.
Effective October 1, 2010, First Party Trusts (D4As and D4Cs) must undergo another test to pass muster with Social Security. Very often the goal of an SNT is to ensure that the assets of the SNT are not considered countable resources by Social Security and thus passing muster is pivotal.
The Social Security manual directs the field officer to review all d4a and d4c trusts established after January 1, 2000. First Party Trusts (in other words, those established with the monies of an individual) drafted over ten years ago need a second look.
A d4c or a d4a trust with a clause that allows a trust to terminate before the individual (the beneficiary) dies are under scrutiny. The clause allowing for a trust to terminate is called an early termination clause, or an early termination provision. The typical clause states that the trust may terminate when the individual is no longer disabled. Another typical clause states that the trust may terminate when the trust fund runs so low on assets that it is not economical to continue the trust.
What to look for in your d4a and d4c trust:
If there is a provision in the trust that permits the trust to terminate before the beneficiary dies, look for these 3 points:
1. All remaining $ in the trust must first be applied to Medicaid debt.
2. After the State has been paid, all remaining $ must go to the beneficiary (OR directly to another d4c trust, per specific limiting language.)
3. The beneficiary CAN NOT have the power to terminate the trust him/herself.
First Party SNTS will be considered countable resources if the early termination clauses gives the beneficiary authority to terminate the trust.
Tuesday, July 6, 2010
Veterans Benefits: Aid and Attendance (Basic Eligibility Part I)
There are three basic components to eligibility for the Aid and Attendance benefit for WWII, Vietnam and Korean War Veterans:
1). Active duty of 90 days.
2). One day of service during a period of wartime.
3). Honorable Discharge.
Veterans of our more recent conflicts have different eligibility criteria, and the emphasis in this blog post is eligibility for seniors who have served in the military.
Each of the eligibility criteria requires an in depth analysis, as the complexities and nuances are the nature of the law. For example, a "period of wartime" is an artificial, VA created, set of dates that does not entirely match the history books. It is best to confirm your dates of service against the list of VA dates.
Monday, July 5, 2010
I would like to set forth a basic primer for those people exploring VA benefits for themselves or for their loved ones.
I will start by addressing some general scenarios that arise in my practice regarding a little known benefit called Aid and Attendance.
Aid and Attendance is a needs based program. It is there to help those Americans who served our country during a period of war time, who now find themselves in need.
As you walk through your day, I challenge you to look around you and query whether there are these veterans in your life that you could be helped by this benefit.
What do these Veterans look like?
They are your neighbors. They are your parents. They are your friends. They own homes. They are not penniless; they just have exceedingly high medical costs.
Example:
Bill is a WWII veteran. He has worked hard all of his life to provide for his wife, Sara, and family. Together they have raised four children. He is now 90 years old and she is 88. A recent fall sent Bill to the hospital. He fractured his hip, requiring surgery and extensive rehabilitation. He has now been in a skilled nursing facility for three months and is ready to come home. He has no intention of dying in the nursing home and Sara is eager to have him home. Bill has an easy smile and a sweet sense of humor. He is really a great guy and someone you would find easy to like.
Sara is fairly healthy; but at 100 lbs she can hardly help lift Bill into his wheelchair or into the shower. Sara can feed Bill and do the laundry, but she can't bathe him by herself. She can't take care of his toileting needs either. This upsets them both. Bill and Sara need help in their home. It's hard to ask for help and it's hard to pay for help. This is not an easy time for either of them. If Bill is like most veterans I know, he does not want to ask for money and he certainly doesn't want hand-outs. He would, however, love to hear from the VA that his time served in WWII now draws a benefit for Sara. He feels awful about the pressure she is under to provide for his care and if cost were not a factor he feels sure she would be open to having help.
Please tell Bill that the Aid and Attendance benefit can step in at this crucial time. While there are income limitations that often deter people from applying for Aid and Attendance, there is significant confusion in this area. Bill's income may seem high, but costs for his care are subtracted from his income.
Subscribe to:
Posts (Atom)
ShareThis