Georgia's Trusted Healthcare
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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.

Bill Would Eliminate Several Certificate Of Need (CON) Requirements

Certificate of NeedGeorgia House Bill 1055 Would Eliminate “Certificate of Need” (“CON”) Requirements For Several Types Of Healthcare Facilities

Georgia House Bill 1055 would cause a substantial change in the way the state regulates healthcare providers. Georgia’s CON program is administered by the Department of Community Health (DCH). A CON is required for entities before building, acquiring or expanding healthcare services and facilities. Read the full bill here.

Roots of CON Requirements Almost 40 Years Old

Georgia first created its CON program in 1979 in response to the federal “Health Planning Resources Development Act” of 1974. The federal act was later repealed, but many states including Georgia continue to have CON requirements.

The goal of Georgia’s CON program was to “ensure access to quality health care services and to ensure that health care services and facilities are developed in an orderly and economical manner and are made available to all citizens and that only those health care services found to be in the public interest shall be provided in this state.” § 31-6-1. However, since then, the efficacy of CON programs has been questioned, and bills have been introduced seeking to change Georgia’s CON program one way or another nearly every year.

Larger Healthcare Providers Argue CONs Increase Barriers To Expanding

Larger hospitals oppose measures to weaken CON requirements which restrict potential competitors. Hospitals argue they need to use profits from surgical procedures to subsidize less profitable care they are required to provide to the uninsured. On the other hand, physicians and smaller healthcare facilities tend to advocate weakening or eliminating CON requirements because those requirements create barriers to offering services in certain healthcare areas. If House Bill 1055 passes, it would significantly reduce barriers for building multi-specialty surgery centers. Physicians contend changes like this would help lower healthcare costs.

Get Help With CON Requirements

Unless House Bill 1055 passes, Georgia’s CON program will continue to loom large for health care providers of all sizes. At Jeyaram & Associates, we have extensive experience with the CON process and related Letter of Determination and Letter of Non-Reviewability requirements and can help your practice. Contact DJ Jeyaram at DJ@Jeylaw.com  or Jonathan Anderson at Janderson@Jeylaw.com.

 

60 Day Overpayment Questions Answered – CMS Releases Final Rule

Calendar CMSThe Centers for Medicare & Medicaid Services (CMS) published the Final 60 Day Overpayment Rule on Thursday, four years after the initial rule was released.

This Final Rule clarifies application of the 60-day reporting requirements instituted pursuant to the Affordable Care Act. Under the 60-day Overpayment Rule Medicare providers must report and return overpayments within 60 days of when an overpayment is identified (or the cost report due date, when applicable).

Prior to the publication of the Final Rule, there was much speculation, and interpretation by courts as to how to define “Identification.” This definition is important because when an overpayment has been “identified” as provided in the law, the 60 day clock starts ticking and the deadline for reporting and repayment is set.

Key Clarifications On Overpayment

The Final Rule provides a key addition in how “identification” is defined by adding that an overpayment is “identified” after such overpayment has been quantified. The Rule also requires that providers exercise “reasonable diligence,” which according to CMS requires “both proactive compliance activities to monitor claims and reactive investigative activities undertaken in response to receiving credible information about a potential overpayment.”

The Final Rule further clarifies that providers have up to 6 months to investigate a possible billing error before the 60-days start to run. This replaces an indefinite requirement set forth in the Proposed Rule that providers act with “all deliberate speed.”

Another noteworthy change in the Final Rule is the stated “look-back period.” In the Proposed Rule, overpayments had to be reported and returned if a person identified the overpayment within ten years of the date the overpayment was received. However, the Final Rule reduces this time frame to six years. This shortened “look-back period” is likely to reduce the administrative burden of complying with the law.

To review the Final Rule in its entirety it is available at here

Need Help?

If you have questions about the overpayment rules or need assistance, we can help you. Please contact Danielle Hildebrand at dhildebrand@jeylaw.com or 678.325.3872.

 

DJ Jeyaram, Georiga’s Leading Medicaid Legal Expert, Featured in Medicaid’s Who Who

MedicaidCongratulations to DJ Jeyaram for being featured in Mostly Medicaid’s Who Who Series. Originally posted on Mostly Medicaid.

 

DJ JeyaramMedicaid Who’s Who: DJ Jeyaram – Jeyaram & Associates, P.C.

1. Which segment of the Industry are you currently involved?

ALegal and Regulatory compliance including reimbursement appeals.

2. What is your current position and with what organization?

A: Founder of Jeyaram & Associates, P.C., a healthcare law firm.

3. How many years have you been in the Medicaid industry?

A: 19 years

4. What is your focus/passion? (Industry related or not)

A: Making sure the government follows the rules whether in auditing providers or determining eligibility for services.  Most of the time they wrote the rules, they need to follow them!

5. What is the top item on your “bucket list?”

A: With my wife leading the charge; Creation of the WISH House that will provide housing and services to individuals with Williams Syndrome.

6. What do you enjoy doing most with your personal time?

A: Personal time?  What’s that?

7. Who is your favorite historical figure and why?

A: Rosa Parks.  From the smallest of things come the biggest of changes.

8. What is your favorite junk food?

AChocolate chip cookies.

9. Of what accomplishment are you most proud?

A: Raising happy children!

10. For what one thing do you wish you could get a mulligan?

A: Maybe starting a family earlier.  Being an old dad with young kids is tiring!

11. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

A1: Reimbursement and Audits:  As the government audits more aggressively are providers’ documentation sufficient to avoid recoupment?

A2: Member Benefits:  Even if rates are not reduced, states are seeking to effectively lower payments by lowering the units of service available to members.

A3: Due Process:  Are providers and members getting sufficient notice of reduction of reimbursement/benefits so they can file an effective appeal?

 

 

Georgians With Developmental Disabilities “Shortchanged”

Developmental DisabilityGaps Remain In Community Support Services

Six years after their 2010 settlement agreement that addressed Georgia’s treatment of people with mental illness and developmental disabilities, the State and the US Department of Justice still cannot agree on what exactly that means.

Under part of the 2010 settlement, Georgia must improve care for individuals with mental illness and developmental disabilities. This includes moving these individuals into community settings when appropriate. There are annual reports filed with the court from an independent reviewer about the progress of the settlement.  According to the most recent report, Georgia still has gaps in services and waiting lists mean community integration has not been fully realized.

U.S. Supreme Court Orders Community Integration

Georgia’s compliance with the 2010 settlement will continue to be a contentious issue. A federal judge overseeing the execution of the settlement said, “The state of Georgia always has shortchanged people with mental illness.” Georgia was the focus of the Supreme Court’s 1999 ruling in Olmstead v L.C. In that case, the Court ruled individuals with mental illness and DD have a right to receive services in the most integrated community setting appropriate for their needs.

Most Applications For Assistance Initially Rejected

Despite the disagreement over what is required under the settlement, the 2010 settlement has helped many people move back or remain in their communities. This is thanks to the increased availability of Medicaid waivers. However, some disabled individuals and their families still get discouraged during the application process, especially if the application is initially rejected.

 We Can Help 

 Jeyaram & Associates has helped dozens of families get and keep support services for individuals with developmental disabilities even after an initial rejection. For more information, contact Jonathan Anderson at  janderson@jeylaw.com.

 

Are You Compliant? HHS Issues Guidance & Likely To Continue HIPAA Compliance Scrutiny

HIPAA AuditThe Department of Health and Human Services (HHS) started the year by publishing new HIPAA guidance with respect to patient access to medical records.

While the recent HHS guidance does not add anything new to the regulations, it serves as a reminder to providers of certain provisions in the law. The guidance is intended as a tool to aid individuals in exercising their rights to access their medical records and to help providers ensure HIPAA compliance.

HHS highlighted certain provisions in the HIPAA regulations including provider obligations to respond to a request from a patient within 30 days and provide PHI in an electronic format if requested (assuming the electronic format requested can be readily produced by the provider).

The guidance also reminds providers that covered entities are not required to provide every single record about an individual even if the individual asks. Certain exceptions to a patient’s right to access include:

  • Patients do not have the right to access to information that is not used to make decisions about that individual. For example, certain quality assessment or improvement records, patient safety activity records, or business planning, development and management records that are used for business decisions do not have to be provided to an individual.
  • Individuals do not have a right to access psychotherapy notes that a mental health professional maintains separately from the individual’s medical record and that document or analyze the contents of a counseling session with the individual.
  • Providers can deny access to certain records if a licensed health care professional determines in the exercise of professional judgment that the access requested is reasonably likely to endanger the life or physical safety of the individual or another person.
  • Patients do not have a right to access certain records compiled in reasonable anticipation of, or for use in, a legal proceeding.

Additionally, providers do not have to create new information, such as explanatory materials or analyses, that does not already exist in the record.

The government’s emphasis on HIPAA is expected to continue with pending audits of covered entities and business associates likely to take place this quarter. Now is the time for healthcare providers to review their policies to ensure that they are complying with the HIPAA regulations.

If you would like to review the HHS guidance it is available at http://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html.

If you need help ensuring HIPAA compliance, please contact Danielle Hildebrand at dhildebrand@jeylaw.com or 678.325.3872.

 

 

Jeyaram & Associate Medicaid Fraud Expert Interviewed On “Mostly Medicaid”

Medicaid FraudJeyaram & Associate attorney Kimberly Sheridan was interviewed about Medicaid fraud.

The segment originally aired today on the national site “Mostly Medicaid.”

To hear the interview, click here.

 

Consider Creating A “Care Committee” For Your Special Needs Child

Special Needs TrustWhen setting up a special needs trust, we ask parents to designate someone to serve as their child’s trustee. The trustee’s job is to ensure the child receives the best possible care – without necessarily being the primary care giver.

The trustee oversees things like the child’s finances, overall health, housing, benefits and education. However, finding someone who is extremely knowledgeable in all of these areas and knows all of the members of your family and how they interact with one another – can be a challenge. As a result, we often recommend creating a Care Committee.

However, before we get to care committees, let’s do a quick refresher on special needs trusts. Special needs trusts are legal instruments specifically designed to hold property for a person with disabilities.

Every special needs trust has a trustee – the person responsible for managing the trust’s assets for the benefit of the person with the disability. A special needs trust gives the trustee very broad authority to use the trust funds in whatever way she thinks will best help the trust beneficiary given the beneficiary’s current and future needs and other resources.

Because the trustee of a special needs trust has these discretionary powers and cannot typically be forced to make distributions to the beneficiary, the funds in the trust do not harm the beneficiary’s ability to qualify for government benefits like Medicaid or Supplemental Security Income (SSI).

This brings us back to Care Committees. Since the trustee of the special needs trust cannot always be expected to know everything about the beneficiary’s care and needs, parents may decide to name several knowledgeable people to serve as a formal advisory committee.

The Committee can include any number of people, but it is typically composed of a small group that parents select because they understand the beneficiary’s needs. Committees are often made up of caregivers, doctors, social workers, family members, lawyers and other advocates. The Committee members are supposed to advise the trustee about the best way to utilize the trust assets, even though the trustee usually retains the ultimate authority over the disposition of the trust.

However, in some cases the trust will mandate that the trustee must follow the committee’s advice unless it is clearly against the beneficiary’s best interests.

The Care Committee also facilitates a conversation between the trustee and the beneficiary. Since this relationship can sometimes be difficult, especially if the trust beneficiary is fully competent and resents the trustee’s control over the assets, the Care Committee can advocate for the beneficiary’s needs without antagonizing the trustee.

The Committee can also take some of the pressure off of the trustee, because she will have help making difficult decisions that a lone trustee may agonize over.

Not all parents feel the need to create a Care Committee for a special needs trust, but if you are interested in establishing one, we can help you design the right committee for your family. Contact DJ Jeyaram at DJ@Jeylaw.com or 678-325.3872.