Sunday, July 16, 2017

How to Protect Yourself when Signing Nursing Home Admission Agreements

Placing a family member in a nursing home is a difficult and traumatic event. One of the obstacles to be overcome is reviewing and signing the facility’s admission paperwork. This typically involves many pages of complicated provisions and jargon. There is a temptation to just sign wherever directed without even trying to read and understand the terms.
It’s best to try to overcome the urge to get this onerous task over with as quickly as possible. This paperwork is important. And by signing the admissions paperwork you may be agreeing to be personally responsible for the costs of your family member’s care.
Of course it would be ideal to have a lawyer review the paperwork and explain it to you before you sign. But, that may be unrealistic given the demanding and stressful circumstances. You may be pretty much on your own.
The law does provide some protections for caregivers who find themselves confronted with nursing home admissions paperwork. The Nursing Home Reform Act prohibits certain types of conduct by skilled nursing facilities that participate in Medicare and/or Medicaid.
Unfortunately, the reality is that some nursing facilities include illegal provisions in their admission contracts. I recently encountered an otherwise respected nursing facility that was attempting to have a family member sign as a “co-signer guarantor” to personally guarantee the payment of all charges incurred by the resident. The guaranty read in part: “If the resident does not or cannot pay, I will pay the amount owed to [nursing facility] for residency charges, services, equipment, supplies, medication, and other charges.”
It didn’t matter that this type of third party guarantee provision has been prohibited since the Nursing Home Reform Act was implement more than 25 years ago. There it was – in this nursing home contract in 2017. When the family member questioned this provision he was told that signing it was required. It wasn’t until an elder law attorney (me) spoke with the facility’s chief financial officer that the facility backed off with an apology.
The prohibition of third party guarantee agreements is not a hidden or ambiguous part of the law. I’ve reproduced the relevant section of the regulation below.
The bottom line is – take care to review nursing home admission paperwork and know what you are signing. It is a legal agreement that could put you on the hook for tens of thousands of dollars.
Get the paperwork reviewed by your lawyer if you possibly can do so. If not, try to educate yourself as best you can ahead of time. Strike out and initial provisions to which you do not want to agree. Sign the paperwork as the representative of the resident only and try not to take on personal liability. For example, you can sign the line for the signature of the applicant/resident in a way that shows you are signing only in the capacity of being the agent of the resident: “John Resident by Family Member, his agent.” Try to avoid signing as “responsible party” or “guarantor.”
Be aware that if the resident has already been admitted to the facility and moved in, there are only a few reasons that can cause them to be discharged. (I’ve reproduced the regulation stating the 6 reasons for discharge below). A family member’s refusal to sign an agreement to become personally responsible for the cost of care is not one of those reasons.
The Regulations
The federal requirements for skilled nursing facilities can be found at 42 CFR Part 483, Subpart B. Section 483.15 of these regulations lays out the requirements regarding admission policies. I’ve highlighted subsection 3 which prohibits facilities from requesting or requiring a third party guarantee of payment.
(a)Admissions policy.
(1) The facility must establish and implement an admissions policy.
(2) The facility must -
(i) Not request or require residents or potential residents to waive their rights as set forth in this subpart and in applicable state, federal or local licensing or certification laws, including but not limited to their rights to Medicare or Medicaid; and
(ii) Not request or require oral or written assurance that residents or potential residents are not eligible for, or will not apply for, Medicare or Medicaid benefits.
(iii) Not request or require residents or potential residents to waive potential facility liability for losses of personal property
(3) The facility must not request or require a third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may request and require a resident representative who has legal access to a resident's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources. [emphasis added]
(4) In the case of a person eligible for Medicaid, a nursing facility must not charge, solicit, accept, or receive, in addition to any amount otherwise required to be paid under the State plan, any gift, money, donation, or other consideration as a precondition of admission, expedited admission or continued stay in the facility. However, -
(i) A nursing facility may charge a resident who is eligible for Medicaid for items and services the resident has requested and received, and that are not specified in the State plan as included in the term “nursing facility services” so long as the facility gives proper notice of the availability and cost of these services to residents and does not condition the resident's admission or continued stay on the request for and receipt of such additional services; and
(ii) A nursing facility may solicit, accept, or receive a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to a Medicaid eligible resident or potential resident, but only to the extent that the contribution is not a condition of admission, expedited admission, or continued stay in the facility for a Medicaid eligible resident.
(5) States or political subdivisions may apply stricter admissions standards under State or local laws than are specified in this section, to prohibit discrimination against individuals entitled to Medicaid.
(6) A nursing facility must disclose and provide to a resident or potential resident prior to time of admission, notice of special characteristics or service limitations of the facility.
(7) A nursing facility that is a composite distinct part as defined in § 483.5 must disclose in its admission agreement its physical configuration, including the various locations that comprise the composite distinct part, and must specify the policies that apply to room changes between its different locations under paragraph (b)(10) of this section.
The rules for discharging a resident are found at 42 CFR Part 483, Subpart B, Section 483.15(c):
(c)Transfer and discharge -
(1)Facility requirements - (i) The facility must permit each resident to remain in the facility, and nottransfer or discharge the resident from the facility unless -
(A) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;
(B) The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;
(C) The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;
(D) The health of individuals in the facility would otherwise be endangered;
(E) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Non-payment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicareor Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or
(F) The facility ceases to operate.
Further Reading
An excellent online resource for learning about the rights of nursing home residents and their families is the website of the National Consumer Voice.

Be aware that in some states, including Pennsylvania, family members can become liable for a parent or child’s unpaid cost of care under what are known as filial support laws. See my article on this subject: Law can require children to pay support for aging parents. It’s a good idea to meet with an experienced elder law attorney as soon as possible if your parent or spouse r needs nursing home care.

Thursday, July 13, 2017

Pennsylvania's New Notary Law

Pennsylvania has adopted a version of the Revised Uniform Law on Notarial Acts. The new law, which takes effect on October 26, 2017, codifies provisions relating to notaries in Title 57 and repeals existing laws relating to notaries.
The new law will be of interest not only to notaries but to lawyers and anyone who employs notaries.
A copy of the law (57 Pa.C.S. §301-331) is available here. An overview of its major changes to prior law is available here.  The National Notary Association has a useful compendium of various PA statutes that are related to the notary process:  
Further information on the regulation of notaries in Pennsylvania is available on the PA Department of State website:
Further Reading:

Sunday, July 9, 2017

How to Avoid an Estate Planning Tragedy

You see me here, you gods, a poor old man,
As full of grief as age; wretched in both.
-King Lear, 3.2

I recently purchased a copy of King Lear. Somehow, I had never read this Shakespeare classic. Now, being semi-retired I have some time to read things like this that I missed.

Wow. This is a serious tragedy. And it arises from a failure of retirement and estate planning.

In case you missed the story (or read it many years ago) here is an overview. As the play begins, an aging and addled King Lear decides to divide his lands among his three daughters. He decides to give the largest share to whoever flatters him the most. Lear’s corrupt daughters, Regan and Goneril, are quite willing to lie to their father with excessive expressions of love they do not feel.

Cordelia, his one honest and loyal daughter, refuses to flatter Lear but says with sincerity that she loves him as a daughter should. Offended, Lear disowns and banishes Cordelia.

Lear turns his estate over to Regan and Gonerli and then their true natures are revealed. They treat their father with disrespect and conspire against him. 

Virtuous daughter Cordelia returns with an army in an attempt to protect her father but she loses the battle against her evil sisters. Eventually Cordelia is executed. Goneril poisons Regan and later kills herself.  Lear himself ends up blind, impoverished, sick and overwhelmed by grief. The strain overcomes Lear who falls dead on top of Cordelia’s body.

King Lear’s story illustrates the hopes and fears of many of us as we grow old.  We want security and respect, good health (and health care) as we age. We want to leave a positive legacy and a family at peace after we are gone. All of these goals eluded King Lear.

How sharper than a serpent's tooth it is
To have a thankless child!
King Lear, 1.4

While the Lear story is extreme, I have seen bits and pieces of his tragedy occur many times over my long career. Children do sometimes treat their aging parents very badly. Sibling rivalries that have been submerged since childhood can reawaken with volcanic force when a parent becomes incapacitated or dies. A plan that leaves things uncertain under the philosophy that “the kids will sort it all out after I’m gone” can be a recipe for serious family discord. Siblings can battle for years over an inheritance and end up spending more on lawyers and litigation costs than the inheritance is worth.

While a good estate planning lawyer is not going to be able to prevent you from having a thankless child, expert advice and advance planning can minimize the problems that will result. Advance planning for the reality that we are aging and will eventually die can help avoid problems for both you and your family. Heed the lessons of King Lear:

  • Don’t wait until you are addled (like Lear) to plan your estate
  • Plan and prepare in advance for the possibility that you may lose mental capacity in the future
  • Set up a plan to protect your future  financial security
  • Have a well thought out Will and estate plan
  • Get expert professional help from an experience elder law and estate planning attorney
  • Read Shakespeare (or attend a theater production).

Sunday, July 2, 2017

Pennsylvania Veterans Registry

Are you a veteran? Pennsylvania wants to connect you and your family with information about valuable benefits, programs and services that you may not know about.
The Pennsylvania Veteran’s Registry  is intended to provide veterans with information on many benefits, programs and services that are available to them, It’s operated by the Department of Military and Veterans Affairs (DMVA).
The registry is a fine idea, but it has not been particularly successful to date. It is too limited in scope and has been underutilized by veterans. An initial barrier is that veterans have to be aware of the existence of the registry and apply to receive information about benefits and programs. And not many veterans have applied. Currently, the online registry captures only about 7,000 of the over 894,000 veterans in Pennsylvania. That represents less than 1% of PA veterans.
Pennsylvania House Bill 1231 (HB 1231) is bi-partisan legislation that is intended to expand the scope, utilization and impact of the Veterans Registry.
The bill requires coordination by DMVA with other state agencies that have contact with veterans. Other agencies will inform veterans of the existence of the registry and assist those who wish to be included. The bill protects privacy by prohibiting the information collected from being sold or used for commercial purposes. It requires the DMVA to submit an annual report on how many veterans are accessing the registry.
HB 1231 bill passed the House on June 28, 2017 by a vote of 198-0. It awaits action in the Senate. But you don’t have to wait for HB 1231 to be enacted to register. You can apply for the registry now here. The current registry provides information on many benefits and programs such as:
  • Compensation/Pension Claims
  • Disabled Veterans Real Estate Tax Exemption
  • Veterans Temporary Assistance
  • Blind Veterans Pension
  • Educational Gratuity
  • Amputee and Paralyzed Veterans Pension
  • Persian Gulf Conflict Veterans Bonus
  • State Veterans Homes
  • PA Veterans Trust Fund
  • Honoring Our Veterans License Plate / Driver’s License and ID Card Veterans Designation
  • Military Family Relief Assistance Program

 Hopefully, an expanded registry as envisioned by HB 1231 can eventually become a one-stop shop for information on veterans benefits. If you support the expanded registry you might want to let you state Senator know.  You can get the name and contact information for your Senator here.

Tuesday, June 27, 2017

In The End, Even The Middle Class Would Feel GOP Squeeze On Nursing Home Care

[Jeff’s comment: This story was written by Jordan Rau for Kaiser Health News. I thought it was important enough to republish on this blog. It is republished with permission of Kaiser Health News]
In The End, Even The Middle Class Would Feel GOP Squeeze On Nursing Home Care
By Jordan Rau Kaiser Health News, June 26, 2017
ORANGE, Va. — Alice Jacobs, 90, once owned a factory and horses. She raised four children and buried two husbands.
But years in an assisted living facility drained her savings, and now she relies on Medicaid to pay for her care at Dogwood Village, a nonprofit, county-owned nursing home here.
“You think you’ve got enough money to last all your life, and here I am,” Jacobs said.
Medicaid pays for about two-thirds of the 1.4 million elderly people in nursing homes, like Jacobs. It covers 20 percent of all Americans, and 40 percent of poor adults.
On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly health care entitlement. But little has been said about what would happen to older Americans in nursing homes if these cuts took effect.
Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.
“The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”
States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.
The 150 residents of Dogwood Village include former teachers, farmers, doctors, lawyers, homemakers and health aides — a cross section of this rural county a half-hour northeast of Charlottesville. Many entered old age solidly middle-class but turned to Medicaid, once thought of as a government program exclusively for the poor, after exhausting their insurance and assets.
A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation. (KHN is an editorially independent project of the foundation.)
“People are simply outliving their relatives and their resources, and fortunately, Medicaid has been there,” said Mark Parkinson, president of the American Health Care Association, a national nursing home industry group.
With more than 70 million people enrolled in Medicaid at an annual cost of more than $500 billion, the program certainly faces long-term financial challenges. Federal Medicaid spending is projected to grow by 6 percent a year on average, rising to $650 billion in 2027 from $389 billion this year, according to the Congressional Budget Office.
Even if Congress does not repeal the Affordable Care Act, Medicaid will remain a target for cuts, experts say.
“The Medicaid pieces of the House bill could be incorporated into other pieces of legislation that are moving this year,” said Edwin Park, a vice president at the Center on Budget and Policy Priorities, a Washington nonprofit that focuses on how government budgets affect low-income people. “Certainly, nursing homes would be part of those cuts, not only in reimbursement rates but in reductions in eligibility for nursing home care.”
While most Medicaid enrollees are children, pregnant women and non-elderly adults, long-term services such as nursing homes account for 42 percent of all Medicaid spending — even though only 6 percent of Medicaid enrollees use them.
 “Moms and kids aren’t where the money is,” said Damon Terzaghi, a senior director at the National Association of States United for Aging and Disabilities, a group that represents state agencies that manage programs for these populations or advocate for them. “If you’re going to cut that much money out, it’s going to be coming from older people and people with disabilities.”
The House health care bill targets nursing home coverage directly by requiring every state to count home equity above $560,000 in determining Medicaid eligibility. That would make eligibility rules tougher in 10 states — mostly ones with expensive real estate markets, including California, Massachusetts and New York — as well as in the District of Columbia, according to an analysis by the Center for Budget and Policy Priorities.

Dogwood Village receives about half of its $13 million annual operating costs from Medicaid, with rates from $168 to $170 a day. Some residents who come to the facility after a hospital stay are initially covered by Medicare, but if they stay longer than 100 days, that benefit ends, and those without savings move to Medicaid.
“You have patients who have spent their life savings, and they come here,” said Kristen Smith, the admissions coordinator. Smith said patients now were older and sicker than they used to be, frequently arriving directly from a hospital.
“It used to be hips and knee” surgeries, she said. “And now a lot of those patients are going home. What we’re seeing is more complex, sicker patients.”
With cinder-block walls brightened by pictures of horses that evoke this equestrian county, the nursing home offers crafts, bingo and other activities.
Mary Ann Mohrmann is 85, the average age of Dogwood Village residents. An elementary school teacher for 25 years, she has Charcot-Marie-Tooth disease, a neurological disorder that has weakened her legs, feet and thumbs and compromised her fine motor skills.
Two of her children have it, too, she said. None of them can take care of her at home. “I’ve been here years,” she said. “I don’t know how many.”
Medicaid helps pay for care for people with disabilities, like Nancy Huffstickler, 64, who has been here four years and regards herself as “a medical disaster.”
She listed her ailments: spinal cancer in remission, restless legs syndrome, high blood pressure and multiple ulcers. She has had spinal reconstructive surgery and a hip replacement. She is undergoing physical therapy with the hope that, one day, she will be able to leave her wheelchair and use a walker.
Huffstickler is fearful of Republicans’ health care changes. “It may save the federal government money, but what about us?” she asked.
Major Medicaid cuts would compel the facility to cut staff, supplies and amenities — changes that would affect the quality of care for all residents, not just those on Medicaid.
If that does not save enough money, the facility might have to reduce the number of Medicaid residents, said Vernon Baker, who resigned as administrator in April. “It’s not like our toilet paper or paper towels are like the Ritz-Carlton’s,” he said.
Some residents do not even know they are on government insurance; administrators often complete the paperwork to start Medicaid once other insurance expires. Others are embarrassed that they are dependent on a program that still carries stigma.
They should not be, said Jennifer Harper, the assistant director of nursing. Relying on Medicaid for nursing home care has become the new normal.
“These folks have worked their whole lives, some with pretty strenuous jobs, and paid into the system,” she said. But with changes looming, she said, “it may be a system that fails them.”
 Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation. 

Monday, June 19, 2017

Your Hospital Discharge: The Fast Appeal

You are notified that you will be discharged from the hospital this afternoon. But you are concerned that your discharge is taking place too soon. You think you need additional in-patient care in the hospital. What can you do? Can you stop your scheduled discharge?
Hospital discharges don’t always take place at the ideal time. You can be notified that you are being discharged before you think you are ready. If you find yourself in this situation Medicare provides a relatively simple appeal process for hospitalized beneficiaries to use to delay their discharge while its appropriateness is reviewed.
If you think you or your loved one is not ready for discharge, you can file an expedited “fast” appeal. The hospital is required to give you a notice that contains the information you need to file this appeal. The notice you should receive is called the ”Important Message from Medicare” [IM] notice. The IM form was updated in June 2017 and a copy is available here.
You and your representative should read your IM notice carefully. It tells you that you have the right to appeal your planned discharge if you have concerns about it.  The appeal will involve a review of your case by a Quality Improvement Organization (QIO).  The QIO (also called a BFCC-QIO) is an independent outside reviewer hired by Medicare to look at your case to decide whether you are ready to leave the hospital.
If you want to appeal, you must contact the QIO no later than your planned discharge date and before you leave the hospital. If you do this, you will not have to pay for the services you receive during the fast appeal (except for charges like copays and deductibles).
Page 2 of the IM notice form contains step by step instructions for calling the QIO and filing an appeal.
[This is one of a series of articles I have written on the topic of being discharged from a hospital. My other recent articles on this subject are: Preparing for your Hospital Discharge; and  Preparing for your hospital discharge (Part 2)]
Medicare regulations require that the IM form be given to hospital in-patients at or near the time of their admission, but no longer than 2 calendar days following admission.  If you don’t receive it, ask for it. If you still don’t receive it, the Medicare website has the information you need to file a fast appeal for yourself or your hospitalized loved one.
After you file your fast appeal, you should receive a detailed notice from the hospital (or your Medicare Advantage or other Medicare managed care plan if you belong to one) that explains the reasons they think you are ready to be discharged. The QIO will ask for your opinion. You (or your representative) need to be available to speak with the QIO, if requested. You (or your representative) may give the QIO a written statement, but you are not required to do so.
The QIO will notify you of its decision within 1 day after it receives all necessary information. If the QIO finds that you are not ready to be discharged, Medicare will continue to cover your hospital services.  If the QIO finds you are ready to be discharged, Medicare will continue to cover your services only until noon of the day after the QIO notifies you of its decision
The fast appeal is only the initial step in a potential series of appeals you can file. But the fast appeal may be only step you will need to take. At the very least, it will buy you some time at minimal or no cost to you. Don’t be shy about using this process – getting a QIO review of your discharge is your right.
As good brief overview of the fast appeal process is available here.
Here are a couple of other points to note about fast appeals:
  • A second follow-up copy of the IM notice is supposed to be given to you no more than 2 calendar days prior to your discharge. However, the follow-up notice may not be required if the time between your admission and the proposed discharge is short.
  • You QIO’s telephone number should be listed on the IM notice you receive. If you don’t have it you can get the QIO’s phone number by visiting or calling 1-800-MEDICARE (1-800-633-4227). TTY users should call1-877-486-2048.
  • The hospital has the burden of proving the appropriateness of your planned discharge and must justify it to the QIO. The discharge can be justified either on the basis of lack of medical necessity or on Medicare coverage policies.
  • If you win the fast appeal - the QIO disagrees with the hospital’s decision to discharge you - your Medicare covered stay can continue;
  • On the other hand, if the QIO issues a decision which agrees with the hospital’s decision to discharge you, you have the right to file another appeal – called a “Request for Reconsideration.” You must file this Request by noon of the day after you receive the initial QIO’s decision. Note, however, that you may become financially responsible for the full cost of care you receive starting as of noon of the day you received the QIO’s negative initial decision.
  • The fast appeal process applies whether you are enrolled in original Medicare or in a Medicare Advantage plan. For Medicare Advantage plans see the regulation regarding beneficiary notice of discharge rights at 42 C.F.R. §§422.620, For more information on appeal rights from Medicare Advantage plans see the Medicare website here and here. If you have coverage through Programs of All-inclusive Care for the Elderly (PACE), which are referred to as “LIFE” programs in Pennsylvania, your appeal rights are different. The PACE organization should provide you with written information about your appeal rights.
  • Fast appeal rights apply to beneficiaries who have been admitted as hospital in-patients. But you may be in the hospital on “observation status” rather than as an in-patient. The hospital should provide you with notice if you are in observation status. For more information regarding the problems related to observation vs. in-patient status see FAQ: Hospital Observation Care Can Be Costly For Medicare Patients; and see my earlier article Hospital Patients to Receive Notice of Observation Status.
Before you file your fast appeal, try to talk with the physician involved and/or with the hospital discharged planner assigned to your stay. Tell them why you think you are not ready to be discharged and ask them to reconsider the discharge decision. Feel free to them that you are planning on filing a fast appeal. But be sure not to delay so long that you fail to initiate your appeal within the time required.  Contact the QIO no later than your planned discharge date and before you leave the hospital.
Further Reading
Medicare Appeals (Centers for Medicare and Medicaid Services)
Discharge Planning  (Center for Medicare Advocacy)

Thursday, June 15, 2017

Relief from the Medicare Part B Late Enrollment Penalty

Medicare to Provide Relief for Late Medicare Part B Enrollment Penalties in Certain Circumstances
[This article was written by Elizabeth White, CELA*, an Elder Law Attorney with Marshall, Parker and Weber. It is posted here with her permission.]  
Many Americans who enroll in Medicare Part A mistakenly think that because they have a Marketplace Insurance plan, they do not need to enroll in Medicare Part B. Unfortunately, enrolling in Medicare Part B late can result in late-enrollment penalties. These penalties can affect a person’s Medicare premium for his or her entire lifetime.
Medicare Part B covers medical services such as doctor’s visits, surgeries, durable medical equipment, laboratory tests, and inpatient and outpatient hospitalization.
The good news is that there is currently a waiver program being offered in certain circumstances for those who did not enroll in Medicare Part B. The Centers for Medicare & Medicaid Services (CMS) is offering equitable relief for Medicare beneficiaries who are currently enrolled in Medicare Part A and have coverage through an individual Marketplace plan, also known as a Qualified Health Plan. This relief is available for an individual who had an initial enrollment period that began April 1, 2013, or later, or was notified of retroactive premium-free Part A on October 1, 2013, or later.
Those individuals who were enrolled in a Marketplace plan who want to enroll in Medicare Part B can request a late enrollment penalty reduction. However, this relief is only available through September 30, 2017. To be eligible for the relief, a request must be made by the September deadline.
Additionally, for individuals who qualify for relief, CMS will allow coverage to begin the month that the individual enrolls in Medicare Part B, instead of imposing the typical waiting period for coverage. However, to prevent any possible gaps in coverage, if a person currently has a Marketplace plan CMS recommends keeping that Marketplace plan in place until verification of enrollment in Part B is received.
Individuals who were enrolled in Medicare Part A and a federally-facilitated Marketplace plan should have received a notice explaining the relief. If an individual terminated his or her Marketplace plan and already enrolled in Medicare Part B with a late-enrollment penalty, a notice will not be sent, but the relief is still available.
If you received a notice or believe you may qualify for relief, CMS directs that you contact the Social Security Administration by telephone or visit your local Social Security office and mention equitable relief. Documentation of Marketplace enrollment must be provided to Social Security when seeking such relief.

*Elizabeth White has been Certified as an Elder Law Attorney by the National Elder Law Foundation, under authorization by the Pennsylvania Supreme Court. 

Monday, June 12, 2017

How to Begin your Estate Planning

[This article was written by Tammy Weber, Managing Attorney with my law firm, Marshall, Parker and Weber]
Estate planning is a process that you use to protect your loved ones and your home and savings. You know you should do it, but where should you begin? How are you supposed to know what estate planning documents make sense for you?
It is hard to get started. Earlier in my law career in the mid- to late-1980s I was a federal judicial law clerk for the Honorable Louis C. Bechtle in Philadelphia. Each day there was a case to review or hear that would affect a person’s liberty, involve a significant fundamental right or encompass a dispute worth millions of dollars. It was challenging to begin the process of research that would lead to the ultimate court decision. Judge Bechtle would always say “the way to begin is to begin.” While simple, it was profound. Start somewhere.
Here are some suggestions for how you can begin the estate planning process.
1.    Determine why you need an estate plan.
Think of your life and your estate planning as a puzzle. Each piece of the puzzle is a question that needs to be considered or a decision that needs to be made. Below are a few examples. Do you want to:
  • Decide who gets your assets when you pass away?
  • Name someone to take care of your minor children when you pass away?
  • Name someone to handle your finances if you cannot?
  • Spell out all of your medical treatment decisions in advance?
  • Name someone to make your health care decisions if you cannot?
  • Add new children, grandchildren or other family members to your existing documents?
  • Organize your digital assets, such as passwords for online bill payments and email?
  • Pay for nursing home care for a parent, spouse or loved one?
  • Arrange in-home care for a parent, spouse or loved one?
  • Prepare to pass your business to your children?
  • Find out if you qualify for Veteran’s benefits?
  • Have help handling the estate of a loved one who passed away?
  • Learn how to get the most out of your gas royalties?
  • Make sure your pet is taken care of when you pass away?
  • Make sure my child’s social security income is not affected by an inheritance?
  • Protect your child with special needs?
Use an online tool such as to direct you to information about possible solutions.
2.    Have the conversation(s) with your loved ones.
Life is full of many uncertainties, but planning ahead and talking with your family can be one of the greatest gifts you can give to those you love. It may be a conversation just with your spouse or significant other, or it could involve a conversation with your aging parent(s) and siblings. Be open about the decisions that have been made. Often parents are concerned about offending their children or becoming a burden to them. To the extent that you feel comfortable sharing your reasoning, the  more information and explanations you can give your family while you are alive, the less resentment they will feel when they learn about your choices when you are gone.
Talking to your parents can be more difficult than talking to your children. They have always taken care of you, and now maybe it is time for you to help take care of them. It is important for your parents to understand you are trying to do what is best for them. If they become upset or agitated, drop the conversation and try again some other time.
3.    Create a plan.
Just like no two people are alike, no two estate plans should be identical. Below are some common legal documents that may help you achieve your goals.
  • Will – Signing your Will in the best way to ensure that everything in your estate will go where you want it to go. This is especially important if you have children from a prior marriage or relationship.
  • Financial Power of Attorney – A Financial Power of Attorney will allow you to name someone to make financial decisions for you, pay your bills and write checks if you are unable to do so.
  • Health Care Power of Attorney – If you were unable to make your own health care decisions one day, the person you name in your Health Care Power of Attorney can make decisions about your health care.
  • Family Asset Protection Trust – This specific type of irrevocable trust is a “tried and true” way to protect your hard-earned assets and land from the cost of long-term care, divorce or creditors.
In addition, your assets that pass by beneficiary designations, such as life insurance, retirement accounts and annuity products as well as land ownership should be coordinated with your plan.
4.    Revisit and adjust the plan, as needed.

Once you have an estate plan in place, you have created a foundation, but the plan should change as time goes on. Any significant changes in wealth, family dynamics or a death in the family are a reason to resume the conversation and update the plan. Remember, estate planning is an ongoing process.