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Archives for February 2016

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 The federal act was later repealed, but many states including Georgia continue to have CON requirements.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.

 

5 Things People Forget to Include in Their Will

DJ Jeyaram is quoted in this article published on GoBankingRates and Philly.com. Congrats DJ!

Article by Alaina Tweddale

Many people overlook writing a will until they become parents, launch a business or buy a first home. And even when they do finally craft this important document, estate and financial planning experts say, it is easy to overlook some important details.

We uncovered the biggest things people overlook when drafting a will. Find out if you’re missing a one of these key elements.

1. Alternate Beneficiaries

While most wills include at least one primary beneficiary, it is a common mistake to fail to prepare for a backup plan in the event the beneficiary predeceases the testator.

Furthermore, “it is important to consider whether a beneficiary is capable of inheriting the asset and can manage the asset properly,” said Sandra Martin Clark, partner at the law firm of Manning, Fulton, & Skinner in Raleigh, North Carolina.

Martin Clark says some reasons a loved one should be passed over for beneficiary status include:

  • Age
  • Mental capacity
  • Inability to properly manage assets

“Oftentimes, after a will is drafted and signed, the document is never looked at again until someone has passed away. At that point, it is too late to correct any error or consider a more appropriate planning opportunity,” said Martin Clark.

If the testator’s intent is unclear, or the beneficiary is a minor or found to be incompetent, it can be overwhelmingly difficult and costly to find a solution, Martin Clark said.

2. Provisions for Digital Assets

Digital assets are among the most important things left out of wills today, said Steven J.J. Weisman, an attorney in Amherst, Mass., professor who teaches estate planning at Bentley University, and author of “A Guide to Elder Planning.”

Websites, domain names and online accounts can all have economic value. Planners should also include account numbers and passwords within a will.

“So much of what we do is online or on our computers,” said Weisman. “Without the proper user names and passwords, as well as authorizing someone to have access to these matters, the estate can be severely compromised.”

Information for social media accounts can be important. Although there may not be a monetary value associated with a Twitter handle or a Facebook account, it can be awkward for loved ones to see greetings or birthday wishes posted to the deceased’s wall or news feed.

3. Prearrangements for Pets

Although you cannot leave assets or property directly to a pet, you can – and should – specify a caregiver for your pet, said David Walters, a certified financial planner and portfolio manager with Palisades Hudson Financial Group in Portland, Ore.

Consider naming a secondary caregiver in the event the primary caregiver is unwilling or unable to care for your pet, Walters added. Pet owners can even name a beneficiary for assets earmarked for the care of your pet.

If you do not make any specific provision for your pet’s care, the arrangements may become a source of contention among your loved ones. In the worst case, your pet could end up in a shelter,” Walters said.

4. A Personal Property Memorandum

Personal property mementos can be the most prized items in the estate of a parent or loved one.

“Sometimes, what people fight over are the least valuable items,” said Erik Hartstrom, attorney with Estate Plan Pros in Elk Grove, California.

Examples include a grandfather clock, Mom’s favorite costume jewelry, or even a $1.50 tchotchke Dad kept lovingly tucked in his dresser drawer.

An estate that has heirlooms worth a substantial amount of money can exacerbate the problem.

When there is no written personal property memorandum affixed to the will, beneficiaries may quarrel and sometimes even fracture long-standing relationships.

“Have a conversation with your beneficiaries and find out what is meaningful to each,” said Hartstrom. “You may be surprised.”

5. Trustee and Guardian Designations

It is critical to keep contact and designation information about trustees and guardians up-to-date, said Atlanta-based estate planning attorney DJ Jeyaram.

“This is especially important if both parents or a single parent suddenly passes and there are minors involved,” he said. “The guardians need to be immediately notified to ensure proper care of the children.”

A named trustee and guardian don’t have to be the same person. Without explicit instructions, an unintended new guardian may raise a child, or care for an incapacitated adult. Assets intended for the care of the minor can transfer to someone the deceased did not prefer.

In a worst-case scenario, said Jeyaram, “the children may be put into state custody.”

When you’re ready to put your final wishes on paper, thoroughly consider how you want all aspects of your estate handled – even the seemingly insignificant items. An experienced estate attorney can help you determine all the items you may want to consider when planning your will.

New Medicare Prior Authorization Process For Durable Medical Equipment In 2 Weeks

DMEStarting February 29, 2016, certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) must go through a prior authorization process in order to be approved for Medicare payment.

Pursuant to a Final Rule published December 30th, the Centers for Medicare and Medicaid Services (CMS) will soon require that DMEPOS items included on a Required Prior Authorization List (RPA List) undergo a review prior to being supplied to beneficiaries. The RPA List is to be updated on an annual basis and published in the Federal Register.

Providers are to initiate the process by submitting all relevant documentation for review by CMS or its contractors. After the review, CMS will provide a decision based on the documentation submitted. A claim submitted with a “provisional affirmation” decision will be paid so long as all other requirements are met. A claim submitted with a “non-affirmation” decision or a claim for items that did not undergo the mandatory prior authorization process will be denied. If a provider receives a “non-affirmation” decisions, a prior authorization request can be resubmitted.

CMS has stated that Medicare will make a reasonable effort to render an initial prior authorization determination within 10 business days. An expedited review process will also be available in certain circumstances.

The commentary published with the Final Rule states that a denial of prior authorization for DMEPOS coverage is not an appealable decision because it is not an initial determination.

CMS plans to publish sub-regulatory guidance to implement the Rule.

If you would like to review the Final Rule it is available here.

If you have any questions about the Final Rule or need assistance navigating through the prior authorization process 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?