Georgia's Trusted Healthcare
& Medical Provider Attorneys

Individuals With Disabilities Can Now Set Up Their Own Special Needs Trusts

Special Needs Trust, Jeyaram Associates, Disability, Wills, The Centers for Medicare & Medicaid Services (CMS) issued a letter providing guidance to states indicating that individuals with disabilities can now set up their own special needs trust.

Prior to this guidance from CMS, only guardians, caregivers, family members or other third parties could set up a trust on behalf of the individual with a disability.

This is a step in the right direction in allowing people with disabilities to advocate for themselves and be self-reliant to the greatest extent possible.

Individuals with the cognitive ability to set up their own Special Needs Trust and who are under the age of 65 can now create a trust to set aside assets without negatively impacting their eligibility for Medicaid.

Why A Special Needs Trust?

Eligibility for many government benefits is determined based on the resources an individual with a disability has in his or her name.

If a loved one 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 loved one 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.

How Funds From A Special Needs Trust Can Be Used

Government benefits only cover basics such as medical care, food, clothing, and shelter.

Through a special needs trust, a designated trustee for your loved one will be able to provide your child or adult ward with access to things such as:

• a personal care attendant

• out of pocket medical and dental expenses

• vacations

• home furnishings

• vehicles

• hobbies

• education

How To Set Up A Special Needs Trust

A special needs trust is usually part of a comprehensive Special Needs Estate Plan. Our Special Needs Estate Plan includes:

•  Last will and testament

•  Advanced medical directives

•  Financial and durable powers of attorney

•  HIPAA waivers

•  Legacy statement

•  Letters to guardians

•  Child safety and protection cards

•  Original document storage in our vault

•  And, perhaps most importantly, guardianship designations for minor children

We Can Help

We’ve helped hundreds of families set up Special Needs Trusts. As the parent of a child with disabilities, we understand the need to protect your child’s current or future government benefits financial future.

I can be reached at DJ@JeyLaw.com or 678.325.3872.

GA’s City & Urban Hospitals Will Be Impacted By The American Health Care Act

Emergency Sign Healthcare LawPassage of the American Health Care Act in its current or proposed form with significant cuts to Medicaid and Medicare will not only impact rural hospitals and facilities, but city and urban hospitals as well. Here’s how.

Steep cuts to Medicaid and Medicare will result in many of Georgia’s 95 health clinics being unable to keep their doors open. These facilities serve a population that is often primarily at the poverty level, the elderly, unemployed and uninsured.

As a result, city and urban facilities could see a significant increase in uninsured and under insured patients as these patients do not have access to any other options for healthcare.

City & Urban Hospitals Need To Prepare for New Challenges

Hospitals will need to:

• Increase medical and administrative staffing to handle the influx of additional patients, especially for patients that may utilize ER services in place of what would have been primary care services prior to the cuts.

• Absorb the costs of an increase in patients and staffing as there will be little or no government money (or at best temporary money) to assist (Medicaid or Medicare).

• Review internal policies on how to handle additional patients and billing procedures for patients who cannot afford medical care.

It’s imperative for all hospitals to begin reviewing policies and procedures before an influx of patients occurs and the potential for lawsuits arises.

Experienced Healthcare Attorneys

Jeyaram & Associates has more than 50 years legal healthcare experience and has helped numerous city and urban hospitals conduct internal audits, write policies and procedures and ensure compliance with state and federal laws.

Contact Us

Free initial consults. Contact DJ at DJ@JeyLaw.com or 678.325.3872.

DJ Jeyaram Quoted in Leading National Medicaid Publication

Screen shot 2016-08-26 at 2.03.18 PMDJ was quoted in the national “Part B News” publication – a leading industry information source for healthcare practice managers and physicians.

Check out DJ’s quotes below in the article: “Negotiate For Patient Record Access When Rival Practices Close:”

Negotiate For Patient Record Access When Rival Practices Close

Increase your patient census and practice revenue when a nearby practice closes by striking a deal for limited access to patient records without paying for the privilege.

In fact, in some cases, the closing practice may pay you.

One of the valuable tangible assets of a practice sale is the patient records that come with it. While the purchaser can’t under HIPAA treat these records as their own until the patients affirm via signed waivers that they want to adopt the new provider, the fact that the buyer is holding the records provides an enormous incentive for them to do so.

It isn’t necessary for the buyer to purchase the entire assets of the practice either, notes Patrick Stanley, an attorney with Comitz | Beethe in Scottsdale, Ariz. Patient records may be included in a limited asset purchase agreement. As with a complete purchase, the retiring practice would then give patients notice and direct them to the purchaser to retrieve their records or, if they choose, continue their care with the new practice. Remember that the patients would have to sign on and have the final say. Note: Laws on the disposition of medical records may vary by state.

How to take custody of records

Vasilios “Bill” Kalogredis, chairman of the health law department of Lamb McErlane in West Chester, Pa., says he has negotiated several arrangements between practices that were closing down and practices that wanted to pick up their patients.

“I see this a lot,” says Kalogredis. “A solo practitioner is retiring and he can’t sell the practice, or he’s leaving one state for another. Hospitals and other practices may not want to buy, but they’re interested in the patients.”

Propose a “custodial” arrangement if buying the practice or part of it is too rich for your blood. In that case, your practice just takes responsibility for the safe- keeping of the other practice’s records. Under such an agreement, when the retiring practice gives notice to its patients, it also would inform them that they can retrieve their records from you and that you also are available to provide continuity of care.

The custodial agreement also should address the length of time that the records will be retained, says D.J. Jeyaram, owner and health care attorney at Jeyaram & Associates in Atlanta.

Consult your legal counsel and malpractice insurance carrier before entering into an agreement to make sure you’re handling things properly from the legal and ethical perspectives, Kalogredis suggests.

Some practices may even receive a fee for accepting this responsibility. But note that while receiving a fee for the storage of medical records would be kosher, an arrangement whereby you pay a fee for the right to store the records “could be seen as remuneration for referrals under the federal anti-kickback statute or its state equivalents,” says Jeyaram.

Mind HIPAA rules

Note that in a custodial arrangement, you would be only holding the patient records — they’re not really your records unless and until the patient releases them to you. “HIPAA only allows for the exchange of protected health information (PHI) without a written release if the transfer is between current or prior health care providers for the purposes of providing treatment,” says Jeyaram.

In this circumstance, under HIPAA, you would be a business associate (BA) of the transferring practice that remains the covered entity, says Jeyaram, and you should execute a business associate agreement (BAA) (PBN 7/11/16).

The BAA, which ensures HIPAA compliance in the transfer and storage of records, should be referenced in the custody agreement, Jeyaram says.
Note that though it varies by state, responsibility for retention of medical records is usually seven years or longer; be prepared to follow through on that if you accept responsibility.

Remember: A custodial arrangement gives you a good shot at inheriting these patients, but it’s not “exclusive” — in some states and under some contracts, other providers from the closed-down practice may take their patient lists with them and reach out to these patients too. In the end, it’s always the patient’s choice (PBN 5/2/16). — Roy Edroso (redroso@decisionhealth.com)

Visit http://pbn.decisionhealth.com/ to learn more.CompressedPartBNewsNegotiatePatientRecords8.16-min.pdf”CompressedPartBNewsNegotiatePatientRecords8.16-min.pdf”

Another Katie Beckett Denial Overturned!!!

Katie Beckett Denial OverturnedWe’re so excited!!!

We’ve helped another family overturn a Katie Beckett denial!

Katie Beckett Legal Help Testimonial 

Here’s the review R. Carrington posted on our site:

“When our son’s Katie Beckett was denied after 9 years of approval, we were lost. Mr. Jeyaram walked us through the appeal process, met with us and helped us write a strong letter for review and followed up with us to make sure our appeal was a success.”

“What could have been devastating for our family, was a small bump in the road, easily handled. Mr. Jeyaram’s is a special needs’ family most needed contact. Thank you Jeyaram & Associates! You really saved the day!”

Thank you R. Carrington for the kind words! We love nothing more than seeing our kids get the benefits they deserve!

Our Attorneys Have Extensive Experience With Katie Beckett

Receive notice that your child’s Katie Beckett has been denied? We can help! Our attorneys have an intimate understanding of how the Katie Beckett and NOW/COMP approval process operates through the Department of Community Health (DCH), as well as the Office of State Administrative Hearings (OSAH), the entity that presides over the Katie Beckett and NOW/COMP appeals.

Before joining Jeyaram & Associates, our attorneys worked as DCH Medicaid attorneys and OSAH judge. They have experience with and insight into the Katie Beckett and NOW/COMP Waiver process at DCH and OSAH that other lawyers cannot offer.

We’ve Been Through The Process

Our attorneys have personal experience applying for, initially being denied and then finally approved Waiver services. We’ve been there, and we want to help other parents whose children would also benefit from these programs. We know the application process is frustrating and confusing. Don’t give up. We’re here to help! We’ve also successfully helped dozens of families appeal Katie Beckett and NOW/COMP denials.

Need Help?

Attorney and special needs dad DJ Jeyaram can help. Contact DJ at DJ@JeyLaw.com or 678.325.3872.

Healthcare Providers: Are You Compliant With The New Overtime Rule?

Over time healthcare providerThe U.S. Department of Labor recently announced a Final Rule that substantially increases the number of salaried workers who will receive overtime.

The new rule, which goes into effect on December 1, 2016, is expected to affect 4.2 million workers – including healthcare employees.

Currently, employers did not have to pay overtime to salaried workers earning more than $23,600. The new Final Rule increases that threshold to $47,476 with automatic future increases.

The Final Rule will particularly affect healthcare businesses and professionals. The average salaries for nurses, medical and physical therapists, medical and pharmacy technicians, and paramedics is between $25,710 and $47,010. [1]

However, there is some exceptions for certain Medicaid providers. Providers that serve individuals with intellectual and developmental disabilities do not have to increase salaries until March 17, 2019. The delay is for providers of Medicaid-funded services “for individuals with intellectual or developmental disabilities in residential homes and facilities with 15 or fewer beds.”[2]

The delay addresses concerns that the change would increase the cost of paying workers, without the ability to increase the revenue from Medicaid payments.

While the non-enforcement policy is a boon to home and community based providers, it will not affect private pay ID/DD providers. The Administration’s Final Rule is likely to raise costs for those private pay providers because the cost of labor will increase as many more salaried workers are entitled to overtime pay.

Healthcare providers should review their compensation structures to ensure they comply with the new overtime rules. Providers who believe they meet the exception for Medicaid funded ID/DD services should ensure they meet the exception.

Jeyaram & Associates is a full service healthcare law firm and can review employers’ salary structures to ensure compliance with the new law. For assistance, contact DJ 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.

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?

 

 

Jonathan Anderson Joins Jeyaram & Associates

Jonathan AndersonPlease help us welcome Jonathan Anderson to our legal team!

Mr. Anderson is an associate attorney specializing in healthcare law. Prior to joining Jeyaram & Associates, Mr. Anderson worked as a legal intern on the Disability Integration Project for the Atlanta Legal Aid Society.

Mr. Anderson provided legal support to individuals with disabilities to help them remain in or move back the community rather than live in institutions. He also worked extensively with state Medicaid waivers including appealing the State’s decisions to terminate benefits of disabled individuals.

Mr. Anderson also served as an intern for the Health Law Partnership (HeLP) which serves clients whom meet certain income requirements and have a treatment relationship with Children’s Healthcare of Atlanta (CHOA). He conducted interviews, drafted briefs for Supplemental Security Insurance, and researched how changes in Supplemental Security Insurance regulations affected HeLP clients.

Legal Expertise

  • Medicaid Waivers
  • Medicare
  • Mediation

Jonathan can be reached at janderson@jeylaw.com.

Even If Your Child Doesn’t Receive SSI Or Medicaid, You May Still Need To Set Up A Special Needs Trust

special needs trustSocial Security Disability Insurance (SSDI) is a federal program that typically provides cash stipends to people who have paid into the Social Security system and who can’t work due to disability.  (In some cases, it is possible to receive SSDI even if you haven’t worked.) In most cases, when someone has been eligible for SSDI benefits for two years, the individual also receives Medicare, even if he or she is under age 65.

From a special needs planning perspective, SSDI benefits are fairly easy to deal with because the program does not have an asset limit or a restriction on unearned income, like interest or dividends.  This means that a millionaire who meets the program’s requirements can receive SSDI benefits alongside a completely impoverished person. It also means that from a purely financial perspective, a person with resources doesn’t need to shelter her assets in a special needs trust in order to qualify for SSDI benefits as she would have to do if she were receiving means-tested government benefits like Supplemental Security Income (SSI) or Medicaid.

But this does not mean that SSDI beneficiaries should not have special needs trusts. In fact, there are many benefits to having a special needs trust that go far beyond the ability to maintain eligibility for SSI or Medicaid. For instance, a person with a mental illness may be unable to manage money. A special needs trust would allow that person’s funds to be invested and spent appropriately by a qualified trustee.  In another case, a person with special needs may be able to handle her personal finances but she might live in an environment where she is susceptible to mistreatment by others. In this situation, a special needs trust would provide an appropriate buffer between the beneficiary and the people who would otherwise take advantage of her.

When it comes to special needs planning, you never want to take anything for granted.  Just because an SSDI beneficiary might not need Medicaid and SSI now, it doesn’t mean she won’t qualify for, or require, services from those programs in the future. For instance, an SSDI beneficiary may rely on private health insurance and Medicare, but if she loses her insurance and Medicare doesn’t cover certain medications, it might be incredibly important for that beneficiary to receive Medicaid, which could make a special needs trust essential.

Finally, there is one particular type of special needs trust, called a first-party special needs trust, that is specifically designed to hold the beneficiary’s own assets. In most of the examples above, this is the type of special needs trust that would be required. Unfortunately, only a parent, grandparent, guardian or court can establish a first-party special needs trust for the beneficiary, even if she is completely competent to create a trust on her own. Therefore, if the parent or grandparent of a person who receives SSDI has the capability, it is probably a good idea for him to create the trust for his child or grandchild, on the off-chance that it will have to be used later, instead of relying on an expensive and time-consuming court process.

There are lots of reasons to have a special needs trust beyond merely qualifying for government benefits.  If you or a loved one receives SSDI and doesn’t have a special needs trust, our attorneys can help you determine the best estate planning option to meet your needs. Contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872.