Georgia's Trusted Healthcare
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How To Ensure Proper Care For Our Fuzzy Children In Our Wills

Will Pet Trust

When we think about creating a will or trust, we think about things like our checking or savings accounts, our family heirlooms and if we have children, how we want them to be cared for when we pass.

However, one of the most important – and often overlooked – parts of preparing for our futures is making sure our fuzzy loved ones are cared for too.

And while pets are legally and technically considered – “property” – as pet owners, we know that they mean so much more to us than just being “property.” They are our companions and a big part of our families.

Leaving our pets’ fate unknown and the thought of having them possibly sent to a shelter is unthinkable. This is where legally documenting our wishes for our fuzzy children is important.

Our Pets Are Family Too!

Traditional wills or trusts treat pets as property. One of the challenges with only including your pet in your will is that it often takes time, sometimes years before the probate process is completed. Your pet will need immediate care. So often we see people dividing their estates purely by percentages. Where does a pet go in that scenario?

When clients want to provide for their fuzzy child, there are a couple of options:

1) Specifically designate who gets ownership of your pet when you pass or

2) Create a Pet Trust. A Pet Trust has benefits beyond simply giving ownership of your pet to someone else.

Pet Trusts can be created in your will or be valid while you are alive and can be implemented if you were to become ill and unable to care for your fuzzy child.  A Pet Trust also allows you to allocate funds that can only be used for your pet’s care.  When we see animals go to a shelter in probate situations, many times it is because family members are not willing to accept the financial burdens of having a pet, especially an older pet.

Things To Consider For Your Pet’s Future

The Pet Trust allows you to leave specific instructions on how your pet should be cared for and by whom, as well how money set up in a trust should be allocated. Some things to think about when setting up a Pet Trust are:

  • Who would take care of your fuzzy child in a way that makes you comfortable? Does your pet know this person? Would this person honor your wishes?
  • If you have more than one pet, would your pet’s guardian be willing to keep all of your pets together?
  • How much money should you set aside? Think not only about current costs, but how much care your pet may need as he or she gets older?
  • Including detailed care instructions such as your pet’s favorite toys or treats. Is your pet scared of thunderstorms or other animals or small children?

While the thought of leaving behind our loved ones when we pass is painful, it’s important that we think about how we can best provide for them now – and in the future. And as pet owners, we know that our pets are more than just “property” –  they are our family too!

Need Help Getting Started?

Our attorneys specialize in wills and Pet Trusts. Not only do we have extensive experience with wills and Pet Trusts, but we are avid pet lovers too! Contact DJ Jeyaram at DJ@JeyLaw.com or 678.325.3872.

 

Got Katie Beckett? Your Child Could Qualify For NOW/COMP Waivers Too

NOW/COMP

If your child receives the Katie Beckett Waiver, first and foremost, congratulations!

You survived the laborious process of securing physical, speech and occupational therapy notes, medical histories, doctors’ notes and evaluations – not to mention probably resubmitting your 2-inch completed application more than once!

BUT, as parents of special needs children, we know it’s worth it. Without Katie Beckett our kids would not receive the services they need. So if the thought of going through yet another application process seems overwhelming – read on.

How Children Qualify for NOW/COMP Waivers

One of the benefits of being on Katie Beckett is that your child may also qualify for additional services through the state’s NOW/COMP Waivers – programs designed to help children and adults with developmental or intellectual disabilities (or a closely related condition) live at home or integrate into the community.

One of the Levels of Care that qualifies someone for an applicant for Katie Beckett is the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-ID). The ICF-ID level of care is the same level of care used to qualify an applicant for the NOW/COMP Waivers. So if you qualify under ICF-ID Level of Care for Katie Beckett, you should also qualify for NOW/COMP under the same level of care.

The NOW/COMP waivers increase the independence and quality of life for individuals with developmental disabilities. They cover expenses not typically covered by Medicaid such as respite, job training, housing services, and transportation. Services can be provided to help support the individual during the day, night and weekends.

One of the common misconceptions is that the NOW/COMP Waivers are only for adults. And while it is true that many NOW/COMP services are aimed at older individuals, children may also qualify for the Waivers and utilize services more appropriate for children.

Approximately 12,000 individuals in Georgia receive services through the NOW/COMP waivers. The waiting lists are long and sometimes it takes years to get approved – but it’s worth it. And, here’s the best news yet – once your child receives the wavier, it’s his/hers as long as your child continues to meet the eligibility criteria during annual renewals and continues to need services.

Here are some of the services your child can receive.

Sample of Support Services NOW/COMP Covers

  • Nursing services: If your child has a clinical diagnosis that requires complex assessment and intervention, nursing services are available to help restore your child’s health or prevent further deterioration.
  • Respite – Brief periods of support or relief for caregivers. This includes hourly and overnight care for your special needs child.
  • Specialized Medical Equipment – Devices, controls or appliances that enable your child to increase the abilities to perform activities of daily living and interactive more independently.
  • Specialized Medical Supplies – Food supplements, special clothing, diapers, bed wetting protective gear and other supplies.
  • Vehicle Adaptation Services – Adaptations to your family’s vehicle such as hydraulic lifts, ramps, special sets, etc.

The aforementioned is just a sample of the services available. For a comprehensive list, click here.

How To Get Started

The NOW/COMP Wavier application process is not nearly as arduous as the Katie Beckett application process. But remember, the waiting lists are long and often takes years to secure services. To download the PDF application, click here.

Someone You Love Have Alzheimer’s? Here’s Why They Need An Advance Medical Directive

Advance Medical Directive

Why An Advance Medical Directive Is Important

My wife’s grandfather (we call him Opa) has the last stages of Alzheimer’s. I remember meeting him more than a decade ago and he was vibrant, funny and loved to sing.

Now, at almost 90 years old, he does not remember me and spends his days in bed asking the same questions over and over and over.

Recently my wife called to check on Opa and he was crying hysterically. She asked him what was wrong and his sobbing reply was, “Didn’t they tell you? Your grandmother is gone. She’s gone.” And then he hung up the phone.

Of course, my wife called back immediately and her grandmother answered the phone. She had been standing next to Opa (my wife’s grandfather) the entire time and clearly she was alive and well. However, what was not well was Opa’s memory.

It was heartbreaking to say the least. My wife was visibly upset. She has traveled numerous times to help him when he became sick or was hospitalized. Her grandparents live about 2 1/2 hours away.

But with a young family of our own –  including a special needs child – it’s hard for her to get away. That’s where having an Advance Medical Directive in place has been extremely helpful. Even if my wife cannot be there in person, she can at least talk to the doctors and help make decisions on Opa’s behalf.

Thankfully, before Opa’s Alzheimer’s had progressed too much, he agreed for my wife to be his Healthcare Agent and give her the legal authority to make medical decisions on his behalf.

Advance Medical Directive – Why You & Loved Ones Need It 

An Advance Medical Directive is also known as a health care proxy, durable power of attorney, medical power of attorney, or healthcare agent. The purpose of an Advance Medical Directive is to legally enable an individual to make decisions on your behalf if you cannot speak for yourself or express your wishes about your health. It also helps those individuals and your healthcare providers know about your treatment preferences. Examples of being unable to make medical decisions for yourself include:

• Permanent illness like Alzheimer’s

• Incapacity

• A coma or persistent vegetative state

• If you are having an outpatient surgical procedure and are under general anesthesia

Hospitals, doctors and other health care providers must follow your Advance Medical Directive’s decisions as if they were your own but only if the Directive is properly executed.

By having an Advance Medical Directive, a doctor clearly knows whose direction is to be followed in the event your family disagrees as to what medical treatment you would want.

When Should You Set Up An Advanced Medical Directive?

Now. The unexpected in life happens. It happened to one of our good friends. Our friend received a call that her husband had been in a car accident and was unresponsive. He ended up being in a coma for three weeks. Thankfully there was not a dispute between our friend and her husband’s parents. However, if there had been a disagreement about his medical care, an Advance Medical Directive would have been critical.

Opa named my wife as his Healthcare Agent in his Advance Medical Directive during the early stages of his diagnosis. This is important. If he had signed the document during the final stages of Alzheimer’s, the legitimacy and legality of the Advance Medical Directive could be challenged in court if there was a disagreement within her family about his medical treatment. This is why putting documentation in place before you need it is very important.

How Do You Set Up An Advance Medical Directive?

All 50 states have forms online where you can establish an Advance Medical Directive. However, the state forms do not always address the important nuances of your healthcare decisions. For example, if you are incapacitated and unable to communicate, but not terminal, what do you want your life to look like? Do you want to be somewhere you can have a pet? A room with a view? NetFlix? By having an attorney help you set up an Advance Medical Directive, you ensure that your wishes are complete and clear to everyone involved.

Where Do You Start? 

Start having conversations with your loved ones about your medical wishes. These are not easy conversations, but they are important to ensure that your desires are enacted should you be unable to make decisions about your health.

And if someone you love has Alzheimer’s or other permanent or terminal illness, it’s important to put into place an Advance Medical Directive before their health significantly declines.

Contact Us

Our attorneys specialize in setting up an Advance Medical Directives. I have more than 20 years healthcare experience – working with medical professionals and individuals who need medical help. Further, we’ve personally been through the process with our own families. I can be reached at DJ@JeyLaw.com or 678.325.3872.

 

Georgia Department of Community Health Approves $140 million Medicaid Rate Increase

Georgia MedicaidGeorgia doctors, nursing home operators and other healthcare providers will soon see an increase in Medicaid reimbursements. The Georgia Department of Community Health (DCH) approved a reimbursement rate increase earlier this month that will go into effect July 1, 2016.

The increase addresses concerns that low Medicaid reimbursement rates have made it difficult for practices with high volumes of Medicaid patients to be profitable. The rate increases will most likely have the biggest impact on providers in rural Georgia communities, which serve a high Medicaid population. For some providers, the Medicaid reimbursement rate will go up by more than 50% for some procedures.

The rate increases means $140 million in increased reimbursements for Georgia providers. The increase was funded by the General Assembly earlier this year, but the Department of Community Health did not approve the rate increase until the beginning of May. The total will be paid for in part out of the Georgia budget with about two thirds of the increase coming from the federal government.

Jeyaram & Associates is a full service healthcare law firm committed to helping doctors, nurses, hospitals, nursing homes, adult day care facilities, pharmacies, and Medicaid and healthcare providers. Contact DJ at DJ@Jeylaw.com or 678.325.3872.

Durable Medical Equipment Company’s Pricing Structure Violates Anti-Kickback Statute

DMEDurable Medical Equipment (DME) manufacturers can face serious fines for violating the Anti‑Kickback Statute (“AKS”). In a recent settlement, Respironics, a manufacturer of sleep therapy products, agreed to settle allegations that its bundled pricing structure for sleep apnea masks violated the AKS. Since violations of the AKS give rise to fines under the False Claims Act, DME manufacturers can face trebled damages and fines up to $10,000 per violation.

According to Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division, “The payment of illegal remuneration in any form to induce patient referrals threatens public confidence in the health care system. Americans deserve to know that when they are prescribed a device to treat a serious health care problem, the supplier’s judgment has not been compromised by illegal payments from equipment manufacturers.”

Respironics, Inc. provided call center services to DME companies at no cost so long as the patients ordered Respironics masks. DME companies had to pay a monthly fee based on the number of patients who used masks manufactured by Respironics’ competitors. According to the U.S. Department of Justice, this made suppliers more likely to use Respironics masks. Respironics has since changed the pricing structure of its call center services.

A South Carolina pharmacists recognized that the arrangement likely violated the AKS and filed a qui tam (whistle-blower) lawsuit. The U.S. Justice Department intervened along with 29 other states and the District of Columbia.

Respironics agreed to pay $34.8 million in order to settle the lawsuit even without admitting wrongdoing, and the company continues to maintain that its pricing structure fit within the discount Safe Harbor. However, this settlement serves as a powerful reminder that companies must be aware of potential AKS violations. Respironics’ “good-faith belief” that the arrangement met a Safe Harbor did not save it from AKS scrutiny or a multimillion dollar settlement.

If you have any questions or need assistance with healthcare regulatory issues, Jeyaram & Associates attorneys can help. Contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872.

It’s All In The Details – Creating A Successful Care Plan For Your Children’s Guardians

Death isn’t something we like to talk about, but it’s critical to have a detailed plan for your children’s guardians – just in case. Wills, Trusts & Estates

This past week, my parents came to help my wife and I as we prepared for my wife’s upcoming medical procedure. They came early to learn the kids’ routines such as where their school is, what they eat and their bedtime routines.

Most of us don’t really think much about our day-to-day routines. In fact, we just go. We’re pretty much on autopilot. Having my parents come to help me with the kids was a good dry run for if my wife and I were to unexpectedly pass and we needed our children’s guardians to step in and follow the instructions we’ve prepared.

To help us prepare for her procedure, which would leave her out of pocket for a couple of weeks, my wife typed out every little detail about the kids’ days. Or so we thought. When we did a dry run with my parents, we quickly realized that there were several little – but very important details – that we forgot to include in our notes. And it was these details that would make the difference between a smooth and successful day with our kids versus potential meltdowns and a frustrating experience for everyone.

My wife covered the big ones – what time the kids take their medications, how much and how. Who likes what food, how to maneuver through the carpool line for school and what time they go to bed.

What we forgot to include were things like EXACTLY how to cut my son’s peanut butter sandwich. In her directions, my wife said, “Cut the peanut butter sandwich.” But as my parents were making my son’s peanut butter sandwich during the dry run, they asked, “Do you cut it in half? Do you cut it in quarters?” No. Actually, we have to cut his sandwich into quarter-sized bites and we have to cut off the crust. Wow. Something we do automatically. Failure to include that kind of detailed information could have derailed lunch for my six-year-old special needs son who is in feeding therapy and needs small bites of food to be successful with eating.

Next, my wife wrote specific notes about how to pick up our little girl from preschool (we walk in to get her). As my wife did a walk through with my parents, again, she realized she forgot to include some pretty important details such as:

  • Make sure you have a photo ID or the carpool tag to identify yourself when you pick her up
  • As you walk out of the school, you have to hold her hand as she tends to run out into the parking lot (she’s only 2)
  • And that you need sanitize her hands as soon as you get the car as her brother is medically fragile and a two year old’s hands are a magnificent host for germs.

Again, things we just do without even thinking – but that are really important for keeping our kids safe and ensuring a smooth day.

Further, when my special needs son says “Don Clare” he’s not asking for a person. He’s asking for one of his favorite books. To be honest, I didn’t even know this one. We don’t have a book titled, “Don Clare” and none of the books have a character named “Don Clare.” My son has just begun using two to three word sentences and this was his interpretation of the book titled “Bear Snores On.” How my wife figured this out, remains a mystery to me – and it would have remained a mystery to my parents if my wife hadn’t written it down in our notes after my dad asked her what my son was asking for.  

Our kids, like many others, thrive on routine and have favorite objects or TV shows, books or movies. Simple things like their favorite stuffed animal that they need to go to sleep with at night or where they like to hide their favorite sippy cup or the name of their favorite YouTube videos are small details – but they are of big importance to our children and bring them great comfort.

By painstakingly detailing your routines and including details about what makes your child comfortable or happy in your care plan, you are setting your guardians up for success and for a smooth transition in case something were to suddenly happen to you and your spouse.

Need help planning for your children’s future? We can help. Contact DJ Jeyaram at DJ@JeyLaw.com or 678.325.3872.

How Georgia Healthcare-Related Bills Fared This Legislative Session

Georgia Legislative SessionThe Georgia 2015-2016 legislative session has officially closed. Of the various healthcare-related bills that were introduced throughout the session, here are some significant bills and how they fared this session:

  • SB 145: This bill would have expanded the list of conditions that could be treated with medical marijuana from 8 to 15 including post traumatic stress disorder, HIV/AIDS and autism. Although it passed the House, it was never brought to a vote in the Senate.
  • HB 916: This bill limits the Department of Community Health’s ability to recoup Medicaid funds based on clerical errors. Having been passed by both the House and the Senate, this bill currently awaits Governor Deal’s signature. If signed into law, the bill will give providers an opportunity to fix paperwork errors without penalty.
  • HB 919: This bill would have allowed individuals to receive state tax credits for donations to rural healthcare organizations. However, the Senate never voted on the bill.
  • SB 302: This bill, which requires health insurers to maintain accurate directories of their providers, passed both houses.
  • HB 1055: This bill would have repealed and replaced Georgia Certificate of Need (CON) law. However, it did not make it very far during the 2015-2015 legislative session having failed to make it past crossover day.
  • SB 1/HB 429: This bill was introduced in the Senate but its contents were ultimately combined with HB 429 prior to passing both houses. It requires insurance coverage for treatment of autism spectrum disorders.
  • HB 684: Introduced as a result of the efforts by the Georgia Dental Hygienists’ Association this bill would have allowed dental hygienists in certain settings to perform preventative care services without a dentist present. Neither the House nor the Senate brought it to a vote therefore it did not even make it past crossover day.
  • SB 304: This bill originally addressed the disclosure of certain mental health records with respect to gun background checks. The final bill passed by the legislature focuses on more efficient testing of rape kits.

If you have any questions or need assistance with healthcare regulatory issues, Jeyaram & Associates attorneys can help. Contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872.

Healthcare Providers: Your Business Associates Could Cost You Millions

HIPAAHealthcare providers must ensure business associates adequately safeguard private health information

The Department of Health and Human Services (HHS) recently entered into a HIPAA settlement with a Minnesota hospital for $1.5 million because the hospital failed to have a written business associate agreement with one of its contractors.

Business associates are non-covered-HIPAA entities that require access to protected health information (PHI) to perform services for covered entities, often a contractor or subcontractor. The hospital’s policies failed to ensure the business associate adequately protected consumer’s PHI.

While HIPAA applies to certain covered entities, those entities must also ensure that any business associates also adequately secure PHI. HHS found that the Minnesota hospital overlooked two important aspects of the HIPAA rules.

  1. The hospital did not have a written, compliant business associate agreement with one of its IT contractors, and
  2. The hospital failed to have an accurate and thorough risk analysis of its entire IT infrastructure.

HHS investigated after the hospital reported that a laptop was stolen from an employee of the business associate. The laptop contained password protected but unencrypted PHI for almost 10,000 individuals.

The $1.5 million settlement underscores the importance of HIPAA compliance. Healthcare providers must ensure they have compliance agreements with anyone who has access to protected health information. One example of this is when a healthcare provider contracts IT services. Without compliance agreements, companies can be responsible for hefty fines even if a business associate actually causes the PHI security breach.

If you need help creating policies or contracts to protect safeguard private healthcare information, we can help. Please contact Jonathan Anderson at Janderson@JeyLaw.com or 678.325.3872.

Work In Healthcare? You Could Face Steep Fines Or Jail Time For Healthcare Fraud

Healthcare FraudNewly Released Health Care Fraud Report shows that HHS/DOJ Enforcement Efforts Remain Strong

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released their annual joint report outlining the results of their healthcare fraud enforcement efforts throughout FY 2015.

The Report shows that during that period the DOJ opened 983 new criminal health care fraud investigations and over 800 new civil health care fraud investigations. Additionally, HHS investigations resulted in 800 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 667 civil actions, CMP settlements, and administrative recoveries related to provider self-disclosure matters.

Over the course of the year, the government won or negotiated over $1.9 billion in health care fraud judgment and settlements.

High Number Of Fraud Convictions

The Report also highlights the activity of the Medicare Fraud Strike Force whose efforts resulted in over 300 guilty pleas and 48 defendant convictions throughout the year, and over 260 defendants going to jail. The Report summarizes several successful enforcement actions by the Strike Force including:

  • 2 physicians owners of a mental health clinic were each sentenced to 10+ years in prison for certifying that certain Medicare patients qualified for partial hospitalization services when they did not and paying kickbacks to group home operators and patient recruiters in exchange for referring Medicare patients;
  • An owner of a DME company was sentenced to 84 months in prison for paying kickbacks to medical clinics for fraudulent prescriptions for DME which the patients did not need; and
  • 2 home health directors were sentenced to over 10 years in prison and ordered to pay $18.6 million in restitution after pleading guilty to conspiracy to commit fraud and payment of kickbacks in exchange for Medicare referrals and home health service prescriptions.

You Could Personally Be Fined Or Go To Jail

The government is clearly cracking down and the healthcare industry should heed the warning. The Report indicates that any individual in the healthcare realm, whether physician or hospital CFO, could incur steep fines, penalties and even serve jail time for violating the Federal Anti-Kickback Statute, Stark Law and False Claims Act.

Jeyaram & Associates can help you assess and minimize your risk under these healthcare fraud and abuse laws. If you have any questions please contact Danielle Hildebrand at Dhildebrand@jeylaw.com or 678.325.3872.

To review the Report it is available here.