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Archives for May 2016

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.