Friday, August 23, 2013
Monday, August 19, 2013
Pennsylvania has become the hotbed of "filial support law" enforcement suits, with health and long-term care facilities leading the charge.
In 2012, in Health Care & Retirement Corp.(HCR) v. Pittas, an intermediate court of appeals held an adult son liable for more than $92k in nursing home costs incurred by his mother under Pennsylvania's filial support law, 23 Pa.C.S.A. Section 4603. For a brief video analysis of the Pittas case and Pennsylvania law, see here.
The Pittas case was controversial in part because the court did not point to any fault on the part of the son as justification for enforcement. For example, there was no discussion of "improper" transfers or theft of the parent's assets, facts that had sometimes been the background of previous cases.
The Pennsylvania trend certainly has not gone unnoticed by the media or courts and legislatures in other states. I receive regular calls from attorneys and parties on all sides of the "filial support" enforcement controversies asking me to compare their state's (or even foreign countries') laws to Pennsylvania. For more on comparative analysis of filial support enforcement issues, see my recent Elder Law Journal (University of Illinois School of Law) article here.
Perhaps we are now seeing the pendulum swing the other way, rejecting modern enforcement attempts. One of the latest rulings on filial support law occurred in Montana. In a July 2013 decision, the trial court granted summary judgment in favor of a son on a nursing home's claim of close to $15k incurred for his mother's care. The court declined to enforce a cause of action for filial support, citing a bar on "third-party guarantees" under federal Medicare and Medicaid law, and thus suggesting enforcement of the state's separate filial law was preempted. For a scanned copy of the decision in Heritage Place, Inc. v. Jarrell, Case No. DV-11-430(D), in the 11th Judicial District Court, Flathead County, Montana, see the link available through ElderLawAnswers.
Perhaps even more significant is recent action by the New Hampshire legislature, changing state law to eliminate a statutory basis for an adult child to be held liable to support his or her parents. See 2013 New Hampshire Laws Ch. 212 (H.B. 481), approved July 10, 2013 and effective on January 1, 2014, amending N.H. Rev. Stat. Sections 167.2 and 546.A:2.
Will Pennsylvania legislators take similar action? For an answer to that question, follow Pennsylvania Senate Bill 70 and House Bill 224, for the 2013-2014 legislative session. Both the nursing home industry and the Pennsylvania Department of Public Welfare have opposed repeal efforts in recent years, while the Pennsylvania Bar Association has supported repeal.
Tuesday, August 13, 2013
One of the realities of Medicaid funding is the move towards "managed care models" for long-term services and supports (LTSS), a move that raises eyebrows (and perhaps alarm flags) for a whole host of stakeholders, especially on the issues of protecting consumer choice and continuity of care.
AARP Public Policy Institute's commissioned study of these concerns was released in July 2013, based on analysis of contract provisions in 14 states and implementration practices in three states, Kansas, New York and Wisconsin. The study's findings suggest early strategies for effective transition to managed care for Medicaid LTSS, including the importance of both careful oversight and flexibility.
Hat tip to Alissa Halperin, both for her role on this study and in bringing the report to our attention.
The 66th Annual Meeting for the Gerontological Society of America (GSA) takes place in New Orleans on November 20-24, 2013. As lawyers and law professors are aware, "Elder Law" is an inherently multi-disciplinary field. The GSA meeting is an opportunity to discover and share the latest in interdisciplinary research on medicine, clinical care, basic science, social science, behavioral science, and public policy for issues connected to aging. The meeting attracts an international audience, with more than 4,000 attendees, and some 400 substantive sessions.
The theme for this year's meeting is "Optimal Aging through Research," and there is a special workshop on the topic of family caregiving for persons with dementia, which should be particularly interesting for those seeking the latest in evidentiary bases for state or federal legislation to support caregivers. Further, the deadline for "late-breaking" abstracts for poster submissions is September 15.
Full details on the annual meeting are available at GSA's website.
Saturday, August 10, 2013
In many states, the "county home" is a dying institution. Some would say, "good riddance," and yet a careful review of the history of public care for older adults reveals states with well-run, publicly-supported alternatives for long-term care.
Arizona has a unique history. In 1909, handwritten-legislation was enacted in the territory to establish a house "for aged and infirm Arizona pioneers." Designed by female architect W.S. Elliot, construction was completed in 1911, a year before Arizona was admitted as the 48th state. Admission criteria required proof that an individual had been a resident of Arizona "for not less than twenty-five years and ... active in the development of Arizona ... and who shall have reached the age of sixty years or over."
Now in its 102nd year of operation, the Arizona Pioneers' Home has capacity for 150 residents. It continues with funding from several sources, including state land trusts, a miner's hospital fund, and the state's general fund. In addition, residents pay for a portion of their care, according to their incomes. The annual budget is reported to be appoximately $50 million.
Criteria for admission has changed over the years. The threshold age for admission is now 70 and residents must have a history of at least 50 years of residency in the state, with more relaxed standards for miners.
Situated on a hill with dramatic views overlooking Prescott (the mile-high territorial capital for Arizona), the Arizona Pioneer's Home is a well-known landmark. The state and its residents appear to take pride in its history, with a website devoted to famous (and sometimes infamous) early residents of the house. The home and grounds have been kept up-to-date.
Perhaps that sense of pride explains the state's continuing public commitment to care.
Tuesday, September 11, 2012
High Stakes for Legal Services Clients:
Concentrating Resources on
Convincing States to Adopt the New Medicaid Eligibility Category
Webinar hosted by Clearinghouse Review
October 9, 2012
11 a.m. - 12 p.m. CDT
The Affordable Care Act (ACA) fills a gaping hole in the Medicaid program, offering eligibility to 16 million individuals with income below 138 percent of the federal poverty level, a life-changing positive development for all of them. But the Supreme Court’s recent ruling, as a practical matter, has caused states to view this new Medicaid eligibility as optional. They need to be convinced to do it.
Attorneys--and not just health care experts--are urgently needed to provide their expertise and voice during this critical time when states are choosing whether to add this new Medicaid eligibility category. Legal services managers should consider re-prioritizing program resources during this critical time.
To address these challenges, the Clearinghouse Review team of the Sargent Shriver National Center on Poverty Law is hosting a webinar on October 9 at 11:00 a.m.-12:00 p.m. CST. Webinar attendees will gain an understanding of:
- The ACA’s new Medicaid eligibility category and the Supreme Court’s ruling on this provision;
- The enormous impact that filling this gap in Medicaid coverage can have on legal services clients--not just on their healthcare, but in many aspects of their lives and opportunities;
- Examples of practical advocacy strategies that legal services attorneys (in all types of programs) can engage in to ensure that their state implements this new Medicaid eligibility category; and
- Available resources to make this happen, including next steps.
Friday, June 29, 2012
he National Senior Citizens Law Center and the National Committee to Preserve Social Security and Medicare have released an analysis detailing the positive impact the Supreme Court’s decision to uphold the Affordable Care Act will have on older Americans. Most Americans will be touched by the ruling, but America’s older adults will be impacted in these ways:
- They will continue to receive prescription drug savings through brand name and generic discounts
- The Part D prescription drug coverage gap known as the ‘donut hole’ will continue to be phased out
- Covered annual wellness visits for beneficiaries will continue to be provided in Medicare
- Older adults will pay less for preventive services. Under the ACA, Medicare will fully cover screenings like mammograms, pap smears, bone mass measurements, depression screening, diabetes screening, HIV screening and obesity screenings
- Eight years has been added to Medicare’s solvency thanks to the Affordable Care Act
The future of an estimated 3.3 million uninsured seniors, aged 50-64, who would have received health coverage under Medicaid and many of the 16 million older adults and individuals with disabilities who rely on Medicaid for long-term services and supports, is less certain with this ruling as the Court has limited the government’s ability to penalize states who do not participate in the expansion of Medicaid.
Read the complete analysis here.
Wednesday, May 23, 2012
ational Senior Citizens Law Center presents:
Long Term Services and Supports in a Managed Care Environment: Advocacy Strategies for Increasing Independence
Monday, June 11, 2012
11 a.m. – 12 noon PDT
This free webinar is for advocates interested in how to influence the future of long term services and supports as states increasingly look to the managed care model for care coordination, rebalancing of services and cost control. The one hour, free webinar will feature experts from the National Senior Citizens Law Center (NSCLC) and the Disability Rights Education and Defense Fund (DREDF).
· Eric Carlson, Directing Attorney, NSCLC
· Georgia Burke, Directing Attorney, NSCLC
· Mary Lou Breslin, Senior Policy Advisor, DREDF
· Silvia Yee, Attorney, DREDF
The speakers will discuss public policy advocacy strategies to protect consumer interests in managed care, introducing and utilizing an LTSS consumer protection checklist developed by NSCLC and DREDF.
The University of California, San Francisco’s Center for Personal Assistance Services will host this webinar which is accessible to individuals who use screen readers; you will only need an updated version of Java on your computer (instructions on how to check for this are in your confirmation e-mail). Real time captioning will also be provided. However, if you require other accommodations, please send an e-mail to email@example.com no later than June 6.
Monday, February 13, 2012
This webinar by attorneys from the National Senior Citizens Law Center will identify key budget-driven trends that limit access to critical Medicaid health benefits – particularly home and community services – that serve older adults, including: benefit and service caps, eligibility restrictions, service eliminations, proposals to shift older adult beneficiaries to managed care, and related issues. It will examine recent legal challenges brought by NSCLC and others with a focus on what those cases can teach us about the promise and potential pitfalls of Medicaid Act and Americans with Disabilities Act (ADA) litigation. Finally, the presentation will cover new challenges to advocacy presented by states’ transition to managed care models of service delivery.
Eric Carlson, Directing Attorney
Anna Rich, Staff Attorney
Evin Isaacson, Borchard Law and Aging Fellow
Additional sponsorship for this Webinar is provided by a grant from the Administration on Aging. This webinar is part of a series of National Elder Rights Training Project webinars for the National Legal Resource Center.
There is no charge for this webinar.
All time listings are in Eastern Standard Time.
If you have any questions email firstname.lastname@example.org
Title: State Medicaid Cases: Trends and Challenges
Date: Wednesday, February 29, 2012
Time: 2:00 PM - 3:30 PM EST
After registering you will receive a confirmation email containing information about joining the Webinar.
Friday, September 16, 2011
Oct. 19-21, 2011
Loews Don CeSar Hotel
St. Pete Beach, Fla.
In its 13th year of teaching excellence in the field of special needs trusts, the National Conference will provide an in-depth review and discussion on both basic and advanced levels of the major issues presented in the creation, administration, and monitoring of special needs trusts. Attorneys, trustees, estate planners, financial advisors, CPAs, and special needs professionals will benefit from attending this cutting-edge seminar that will cover critical topics about special needs trusts.
The Pre-Conferences (Wednesday, Oct. 19, 2011)
The National Conference is offering two pre-conferences this year. One pre-conference workshop will be oriented toward legal assistants, case managers, financial/investment staff, property managers and related professional; the other pre-conference workshop is designed for issues for pooled trust administrators and attorneys. Please note: For the pre-conferences, tuition includes pre-conference materials on a flash drive, as well as individual, per person admission to all sessions and refreshment breaks. If purchasing attendance to both pre-conferences, tuition will include all of the above for both pre-conferences. If purchasing attendance to only one individual pre-conference, tuition will include all of the above only for the purchased pre-conference.
The Conference (Oct. 20-21, 2011)
The National Conference is hosting a two-day main conference offering excellent speakers and support materials on basic and advanced topics for a variety of professionals who work in the field. Please note: For the main conference, tuition includes conference materials on a flash drive, as well as individual, per-person admission to all sessions, continental breakfasts, refreshment breaks, lunches, and the attendee reception. If purchasing attendance to both days of the main conference, tuition will include all of the above for both days. If purchasing attendance to only one individual day of the main conference, tuition will include all of the above only for the purchased day. However, the attendee reception is only included with Thursday individual day tuition purchase or Thursday/Friday both day tuition purchase.
Thursday, June 23, 2011
In a continuation of the Obama Administration's effort to extend rights to same sex couples, the Centers for Medicare & Medicaid Services (CMS) issued a new State Medicaid Director Letter 11-006 (SMDL). There are currently federal protections against homelessness and financial ruin that apply to heterosexual couples. The SMDL sets out steps that states are permitted to take to extend these protections to same-sex spouses and domestic partners of individuals receiving Medicaid long-term care services. The SMDL, dated June 10, 2011, was written by Cindy Mann, Director of the Center for Medicaid, CHIP and Survey & Certification, CMS to all State Medicaid Directors. A copy is available at
The SMDL addresses provisions of Medicaid law having to do with the placement of liens against real property, the imposition of penalties for transferring assets without receiving fair market value and the recovery of property from a deceased Medicaid beneficiary's estate. It does not address provisions that allow a spouse receiving Medicaid for long-term care services to give a portion of his or her income to the non-Medicaid spouse to protect against impoverishment.
Tuesday, April 5, 2011
GOP FY 2012 BUDGET PLAN SETS STAGE FOR MEDICARE, MEDICAID CHANGES
Posted April 5, 2011, 10:34 A.M. ET
The House Republican budget resolution for fiscal 2012 would decrease federal deficits by $1.649 trillion over the 2012-2021 period by cutting spending by almost $6 trillion, according to a summary of the proposal released April 5.
The plan would set the stage for major changes in the two biggest federal health care programs, Medicaid and Medicare, and put in place "enforceable spending caps" to restrain outlays. It would also make permanent the 2001 and 2003 tax cuts and repeal the 2010 health care overhaul.
In the area of changing Medicare, the House budget document said current program beneficiaries would not be affected. When younger workers become eligible for Medicare, they would be able "to choose from a list of guaranteed coverage options, enjoying the same kind of choices in their plans that members of Congress enjoy today. Medicare would then provide a payment to subsidize the cost of the plan. In addition, Medicare will provide increased assistance for lower-income beneficiaries and those with greater health risks."
And for Medicaid, the summary said the Republican budget proposal would end "an onerous, one-size-fits-all approach by converting the federal share of Medicaid spending into a block grant that gives states the flexibility to tailor their Medicaid programs to the specific needs of their residents."
According to the summary, the resolution would cut spending by $5.812 trillion compared to projections under current law by the Congressional Budget Office. In comparison, the CBO said March 18 President Obama's budget would raise outlays by about $412 billion over the same period, mostly to pay for interest costs on debt.
But the deficit-reduction impact of the spending cuts would be offset by revenue cuts almost as large. The summary showed revenues would fall by $4.162 trillion over the 2012-2021 period, much more than$2.331 trillion revenue loss seen in the Obama budget. Much of that revenue loss is in both cases is tied to the costs of extending the 2001 and 2003 tax cuts.
Even with additional tax cuts, the GOP budget would decrease the deficit, in contrast with the Obama plan. The CBO said the Obama plan would add $2.733 trillion to the deficit over the 10-year period.
Text of the budget summary will be available at http://op.bna.com/der.nsf/r?Open=csaz-8fmj2j.
Thursday, June 24, 2010
Center for Elder Justice and Policy Publishes Protocol on Identifying and Addressing Financial Exploitation
Wednesday, April 7, 2010
|Via Elder Law Answers:|
After a year of legislative wrangling and premature forecasts of death, historic legislation overhauling the nation's health insurance system has passed the Congress and been signed into law by President Obama. The measure that finally prevailed, the Patient Protection and Affordable Care Act, is the same legislation the Senate had approved on Christmas Eve of 2009, although it was amended somewhat by a separate "budget reconciliation" measure that President Obama also signed into law.
Because the core health reform measure enacted is the Senate version, much of what we wrote in our earlier article, "The Effects of Health Care Reform on Long-Term Care," still applies. Just substitute "the newly enacted law" wherever "the Senate bill" appears in the earlier article. The legislation that President Obama signed still contains:
Help for Medicare Recipients and Early Retirees
Of perhaps greatest interest to seniors, the law will eventually close the Medicare Part D coverage gap known as the "doughnut hole." As most seniors know, the Medicare Part D prescription drug program covers medications up to $2,830 a year (in 2010), and then stops until the beneficiary's out-of-pocket spending reaches $4,550 in the year, when coverage begins again. Many seniors fall into this "doughnut hole" around Labor Day, at which point they have to pay for the medications out of pocket through the end of the year.
The law starts the process of closing the gap by providing a $250 rebate to Medicare beneficiaries who fall into the doughnut hole in 2010. Then, beginning in 2011 there will be a 50 percent discount on prescription drugs in the gap, and the gap will be closed completely by 2020, with beneficiaries covering only 25 percent of the cost of drugs up until they have spend so much on prescriptions that Medicare's catastrophic coverage kicks in, at which point copayments drop to 5 percent.
For the rest of this piece, go to http://www.elderlawanswers.com/resources/article.asp?id=8171§ion=4
For the full text of the the Patient Protection and Affordable Care Act, click here.
For the full text of the Reconciliation Act of 2010, click here.
Tuesday, April 6, 2010
Via HHS E-News:
The Department of Health and Human Services invites you to participate in a live Webcast as the U.S. Department of Health & Human Services unveils its Open Government Plan. This Plan seeks to take Open Government at HHS to the next level by expanding opportunities for sharing data with the public – especially though the use of new information and communications technologies.What does this mean for the U.S. Department of Health & Human Services, and how will it affect you? This webcast is an opportunity for you to ask these questions. Please send your questions about our Open Government plan in advance to email@example.com. We will try to answer as many of them as we can during the live Webcast.
We hope you can join Chief Technology Officer at HHS, Todd Park, Director of the Office of Policy at the Centers for Medicare & Medicaid Services, Karen Milgate, Principal Deputy Commissioner of the Food & Drug Administration, Joshua Sharfstein and Acting Assistant Secretary of Public Affairs at HHS Jenny Backus as they discuss Open Government at HHS, and what it means for you.
The Webcast is this Wednesday, April 7, at 1:30 PM EDT. Join us live at hhs.gov/live.
This webcast will be a chance for you to understand how these improvements will affect you and how our plan will unfold in the coming weeks, months and years.
After the Webcast, visit www.hhs.gov/open to read and comment on our Plan.
Thursday, April 1, 2010
On February 2, 2010, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the Internal Revenue Service (IRS) and the Employee Benefits Security Administration of the Department of Labor (DOL), (collectively referred to as the Departments), released interim final rules implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
The interim final regulations go into effect on April 5, 2010 and replace regulations implementing previous law. Health plans and group health insurance plans generally must begin complying with the interim final regulations for health plan years that begin on or after July 1, 2010. The effective date may be later for some collectively-bargained plans. Comments on the interim final regulations may be submitted to CMS, the agency designated to accept them, and must be received no later than May 3, 2010.
MHPAEA amends the Mental Health Parity Act of 1996, which requires parity in dollar and treatment limits for mental health and substance use disorder benefits and medical/surgical benefits. MHPAEA provides that a group health plan that offers both medical/surgical benefits and mental health or substance use disorder benefits may not require more restrictive financial or treatment limitations for mental health or substance use disorder benefits than for medical/surgical benefits. MHPAEA defines financial requirements to include deductibles, co-payments, coinsurance, out-of-pocket expenses, and annual limits. Further, MHPAEA defines a treatment limitation to include frequency of treatment, number of visits, days of coverage, and "other similar limits on the scope of duration of treatment." One of the biggest changes made by MHPAEA is to expand the parity requirements to include protections for substance use disorder benefits.
Wednesday, March 17, 2010
Call for Papers – Future of Elder Law Practice
William Mitchell Law Review, Vol. 37, Issue I (Fall 2010)
The William Mitchell Law Review is proud to dedicate its first issue of the 2010-11 academic year to Elder Law in its upcoming Volume 37 (Fall 2010). We are currently seeking papers that examine the future of elder law practice. Submissions may either take the form of shorter commentaries or longer law review articles. The deadline for submissions has been set for July 1, 2010.
The William Mitchell Law Review is highly regarded both regionally and nationally. Our Law Review recently ranked twenty-second in citations by judges and ranked fifty-seventh in citations by other law journals, culminating in an overall ranking of seventieth. Over the years, the William Mitchell Law Review has featured the works of various scholars and practitioners such as Congressman Tim Penny, and former Vice President Walter Mondale. The William Mitchell Law Review has also published nationally known legal experts ranging from Philip Bruner, to Supreme Court Justices Sandra Day O’Connor, Byron White, and Harry Blackmun. Now, we would like to invite you to join us to publish in our upcoming volume.
Please direct inquiries to Executive Editor Sanjee Weliwitigoda at firstname.lastname@example.org. Please send submissions to email@example.com or mail them to our Editorial Office. Please note that the Law Review prefers electronic submissions.
March 17, 2010 in Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management, Retirement, Social Security | Permalink | TrackBack (0)
Tuesday, February 10, 2009
The National Health Law Program recently released a new study entitled, “Fact Sheet: Developments Affecting Medicaid Cases Filed under 42 U.S.C. §1983.” The analysis offers useful information and legal strategies for advocates representing Medicaid recipients and applicants who encounter difficulties when state Medicaid programs do not comply with mandatory requirements of the federal Medicaid Act. The publication can be found on: www.healthlaw.org.
The Kaiser Family Foundation issued an updated report, “Challenges of Providing Health Coverage for Children and Parents in A Recession: A 50 State Update of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-sharing Practices in Medicaid and SCHIP in 2009.” For further information, go to: http://www.kff.org/medicaid/upload/7855.pdf
Source: National Health Law Program Communique, http://www.healthlaw.org
Wednesday, February 4, 2009
Friday, January 23, 2009
Medicaid continued to be the largest source of funding for nursing and residential care facilities in 2007 at $59 billion, according to the U.S. Census Bureau. These tabulations come from the 2007 Service Annual Survey: Health Care and Social Assistance, which focuses on health care and social assistance providers for individuals, and gives estimates and sources of revenue for businesses with paid employees. Overall, health care and social assistance revenue increased 6.8 percent in 2007 to $1.66 trillion, up from $1.56 trillion in 2006.
Revenue for continuing care retirement communities grew 10.1 percent to $20 billion. These communities include establishments that provide a range of residential and personal care services, including on-site nursing care and assisted-living facilities. Homes for the elderly, which do not include on-site nursing care facilities, saw their revenues increase by 7.1 percent to $14.5 billion.Revenue for hospitals grew 6.5 percent in 2007 to $687 billion. Revenue for physicians’ offices increased 5.6 percent to $346 billion and revenue for dentists’ offices increased 6.5 percent to $94 billion.
Medicare was the leading source of revenue for kidney dialysis centers, reaching $9.1 billion in 2007, a 10.4 percent increase from 2006.
Revenue for emergency and other relief services decreased 13.2 percent to $6.9 billion in 2007. This is the second year in a row revenues decreased. Revenue has now returned to a level roughly equivalent to that of 2004. The Service Annual Survey (SAS) provides data that help to measure America’s current economic performance. Using a sample of about 70,000 service companies, the SAS collects revenue, expenses and e-commerce sales. The services provided by establishments in this sector are delivered by professional, trained health practitioners or social workers. Excluded from this sector are aerobic classes; amusement, gambling and recreation industries; and nonmedical diet and weight reduction centers. Although these can be viewed as health services, they are not typically delivered by trained health practitioners.