Georgia's Trusted Healthcare
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Former Jeyaram & Associates’ Interns Shine

Best Atlanta Attorney Lawyers Jeyaram Associates Healthcare Special Needs Trusts Guardianship Will Estate PlanningArnall Golden & Gregory, a large Atlanta firm, recently held a mock trial for its associates to practice and hone their skills (a practice by many large law firms and law schools), and the team that won the largest verdict was named “Team Jeyaram!”

After a long day of trial on a recent Saturday, the team consisting of two former Jeyaram & Associates interns Michael Bargar & Madison Pool won the largest verdict – 5x any other award for the day!

My former interns and current friends wrote, “We thought that you would get a kick out of our success given our former roles with your firm!”

We know it was the skills of Michael and Madison that won the day, but maybe, just maybe, their team name helped just a little!

Thanks for sharing this fun story Michael and Madison! We are very proud of you both!

#LoveWhenOurInternsShine

Guardianship: Is It The Right Choice When Your Special Needs Child Turns 18?

Guardianship Special Needs

In most states, a parent is deemed to be the legal guardian of his or her child until their child turns 18. Up until that point, parents make all the medical, financial, educational and day-to-day decisions for their children.

However, once your child turns 18, he or she is legally considered an adult and your authority to make decisions on your child’s behalf stops. This usually isn’t an issue, unless you have a special needs child that may not be ready or able to make good decisions about their care.

Following is a discussion of some options of what you can do when your special needs child turns 18.

Guardianship

With guardianship of your child, you have the legal authority to make decisions about your child’s healthcare, housing, food, clothing, and other subjects that affect your child such as decisions about a their income, property, public benefits and other financial matters.

Guardianship is not automatic. And when your child turns 18, parents (or an adult willing to oversee your child’s care) must petition the court for guardianship.

However, not every child who has disabilities needs to have a guardian. With appointed guardians, your child loses a great deal of independence. Your child will no longer be able to make decisions about their personal life, health care, financial or legal matters.

Alternatives To Guardianship

Most state laws require that guardianship only be imposed only when less restrictive alternatives would not best benefit and protect the child.

Following are a few examples of less restrictive alternatives to guardianship.

Conservatorship

If your child has the capacity to make some decisions, an option to consider is Conservatorship. The individual appointed to serve as Conservator manages your child’s property and financial affairs. Most other decisions are left up to the child.

Power of Attorney

Power of attorney is given to a responsible adult (ex. a parent) that acts on your child’s behalf on financial, legal or business matters but the child still retains the right to act on his or her own behalf.

Representative or Protective Payee

If your child receives Social Security, benefits from the Veteran’s Administration, Railroad Retirement, welfare or other state or federal benefits, the Court can appoint someone to help manage their payments from these entities. All other decisions are left up to your child.

Factors To Consider When Making This Decision

It’s important to take into consideration several factors when deciding whether your child needs a guardian or some other form of support.

  • Your child’s ability to make sound decisions, including understanding the effect and consequences of his her decisions and actions
  • Your ongoing need to be involved in your child’s medical care
  • Your need for continued oversight over your child’s financial affairs
  • Your child’s needs and wants
  • Your child’s ability to communicate his or her needs
  • Your child’s level of independence with respect to self-care (ex. feeding, dressing, bathing, etc.)
  • Whether your child will require outside support such as assisted living or a home health assistant

When To Make A Decision

The conversations and decisions about how your 18-year-old child should be cared for need to happen BEFORE he/she turns 18. These conversations are not easy. In fact, they’re very difficult and there are many variables to consider. As a result, it’s important to start thinking about your child, his or her needs and long-term well-being now.

We Can Help

Although we cannot make the decision for you about what’s the right answer for you and your family, we can guide you through the decision-making process and help you with the legal aspects. I can be reached at DJ@JeyLaw.com or 678.325.3872 for a free initial consultation.

If Your Child Has Autism, Make Sure These 4 Things Are In Your Will

Autsim Will & Special Needs Trust

Although everyone should have a will, as parents of special needs children, we need wills to ensure that our kids are well cared for and have a good quality of life after we pass.

My son has a dual diagnosis of Autism and Williams Syndrome. Here are four things I recommend all parents of children with Autism – or any special needs – include in their wills or estate plans.

1) A Special Needs Trust – A will is a basic legal document that details your last wishes and is often used to distribute your property or assets.

However, a basic will does not include provisions that are needed to protect and provide for your special needs child. This is where a Special Needs Trust comes into play. A Special Needs Trust can be a part of your will or it can be a stand-alone document. It allows you to designate and qualify your assets in a way that doesn’t penalize your child when it comes to his or her public benefits.

Eligibility for many government benefits is determined based on the resources your child or adult ward holds in his or her name. If your special needs child has too many resources, even by just one dollar, he or she may not qualify for, or may even lose, benefits such as Supplemental Security Income (SSI) and Medicaid. Even if your child does not currently receive government assistance, he or she may need it in the future.

A special needs trust is a way to protect your loved one’s current resources and future benefits. Through a special needs trust you can leave assets to your child or ward without negatively impacting his or her government benefits.

2) Designated Guardian – We often assume that a member of our family – maybe a sister or our own mother – will automatically be given custody of our children if something happens to us. However, this is not true unless you have a will, trust or estate plan in place that specifically names them as guardians.

Without a legal plan in place, anyone can request custody and a judge will decide with whom your child/children will live with. Choosing a guardian is perhaps one of the most difficult decisions to make. It’s important to choose someone you trust and who will respect your wishes for your child(ren).

Things to consider when selecting any child’s guardian are the guardian’s age, his or her family values, parenting style, character, willingness to serve as guardian and whether he or she already has an established relationship with your child.

With a special needs child there are even more considerations. Think about the traits that you, as a special needs parent, need to raise your child and does the guardian have these traits?  My top three traits for special needs guardians are 1) Energy; 2) Patience; and 3) The ability to advocate for my child. (See Related Post: 10 Tips On Choosing The Right Guardian)

3) Guardianship Letter & Instructions –  Once you’ve selected a guardian, you need to put them in a position to succeed if they are forced to step into your shoes. You should write instructions to the guardian about things they will need to know on how to parent your child.

Include things like your child’s routines, medicines, information about his or her medical providers, how to deal with sensory meltdowns, what is the best way to get them to eat or sleep. 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.

We’ve had years to learn these things about our kids. Help your child’s guardian avoid having to learn from experience by documenting what you already know!  (See Related Post: How To Create A Successful Care Plan For Your Child’s Guardians)

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.

4) Conservator or Trustee – A conservator or trustee is someone to handle all financial decisions related to your child. A conservator helps ensure that money left to your special needs child is used for your child in ways that best benefit  your child.

Often times families ask me if their child’s designated guardian should also be the conservator or trustee. It depends. Your guardian can serve as both, but sometimes families prefer set up some up checks and balances by selecting different guardians and conservators. It’s important to select someone you trust and who will make smart financial decisions on your child’s behalf.  The guardian and the conservator work together in the best interest of your child.

Getting Started

As a parent of a special needs child and an estate planning attorney, I understand the challenges of adding one more thing to your plate. However, putting into place a will to protect your child with special needs is something we all need to do sooner rather than later – just in case.

We’ll walk you through the will planning process step-by-step. Initial consults are free.  We want to help you create a legal plan that best protects your child with special needs as well as your final wishes for your entire family. I can be reached 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.

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.

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.

Congratulations! Jeyaram & Associates Opened Its Doors 9 Years Ago Today!

DJHeroCongratulations to Jeyaram & Associates’ Owner and Founder DJ Jeyaram for hanging out his shingle 9 years ago today!

With 50% of startups failing in the first five years, Jeyaram & Associates is not only defying the odds, but it’s successfully helping physicians, nurses, hospitals, nursing homes, adult day care facilities, pharmacies, Medicaid and healthcare providers as well as individuals and families in the special needs community.

To celebrate Jeyaram & Asssociate’s 9 year anniversary, we’ve created a super hero figure of DJ Jeyaram as he relentlessly and tirelessly fights for the underdog and individuals who often do not have a voice or are overlooked.

Jeyaram & Associates is a four (4) attorney firm offering extensive legal expertise in healthcare corporate, regulatory and fraud matters; special needs estate planning and guardianship; and Katie Beckett and NOW/COMP appeals. The firm is AV rated and a certified Minority Business Enterprise.

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.