Source: http://www.zaporelderlaw.com/blog
Timestamp: 2019-04-26 08:38:35+00:00

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The issue of becoming disabled during working years is often ignored. But the probability is very high that someone will become disabled and may even not be able to work because of it. According to the Social Security website on disability there is a 33% chance that a 20-year-old worker will become disabled before reaching retirement age. This does not necessarily mean the disability would prevent that person from working or allow that person to receive a Social Security disability benefit. Nevertheless, the importance of receiving replacement income in case of disability should not be overlooked.
As part of the planning process, individuals who most recently have experienced an accident, injury or debilitating illness may need some guidance in applying for Social Security disability. We have included information here on some of the basics.
Generally, anyone receiving Social Security disability will continue to receive that income until reaching normal retirement age which for everyone currently younger than 65 is anywhere between 66 and 67 years old. At normal retirement age, the disability income reverts to standard social security income.
A "duration of work" test to show that the person worked long enough under Social Security.
1.5 years of work during the three-year period ending with the quarter your disability began.
Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled.
Work during five years out of the 10-year period ending with the quarter your disability began.
The following table shows examples of how much is needed to meet the "duration of work test" if the disability manifested at various selected ages. For the "duration of work" test, the work does not have to fall within a certain period of time.
Social Security will review a disability application to make sure the applicant meets some basic requirements for disability benefits. They will check whether the person worked enough years to qualify. They will also evaluate any current work activities. If these requirements are met, they will send the application to the Disability Determination Services office in the applicant's state.
This state agency completes the disability decision. Doctors and disability specialists in the state agency ask attending doctors for information about the condition. They will use the medical evidence from doctors and hospitals, clinics or institutions where the applicant has been treated.
The state agency staff may need more medical information before they can decide about disability. If more information is not available from the applicants current medical sources, the state agency may schedule a special examination. Social Security will pay for the exam and for some of the related travel costs.
If the applicant is working and earnings average more than a certain amount each month, Social Security generally will not consider there is a disability. The amount changes each year. For the current figure, see the annual Update (Publication No. 05-10003).
If the applicant is not working, or they monthly earnings average the current amount or less, the state agency then looks at the applicant's medical condition.
2. Is the medical condition "severe"?
For the state agency to decide that a disability exists, they medical condition must significantly limit the applicant's ability to do basic work activities—such as walking, sitting and remembering—for at least one year. If they medical condition is not that severe, the state agency will not consider a disability. If the condition is indeed that severe, the state agency goes on to step three.
3. Is the medical condition on the List of Impairments?
The state agency has a List of Impairments http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm that describes medical conditions that are considered so severe that they automatically result in a determination of disability as defined by law. If the condition (or combination of medical conditions) is not on this list, the state agency looks to see if the applicant's condition is as severe as a condition that is on the list. If the severity of the medical condition meets or equals that of a listed impairment, the state agency will decide that disability will be awarded. If it does not awarded disability, the state agency goes on to step four.
4.Can the applicant do the work he or she did before?
At this step, the state agency decides if the applicant's medical condition prevents him or her from being able to do the work that person did before. The disability allows for the same type of work, the state agency will decide that there is no disability. Otherwise, the state agency goes on to step five.
5.Can the applicant do any other type of work?
If the applicant cannot do the work he or she did in the past, the state agency looks to see if he or she would be able to do other work. It evaluates the medical condition, age, education, past work experience and any skills that could be used to do other work. If the person cannot do other work, the state agency will decide that that person is disabled. If the applicant can do other work, the state agency will decide that there is no disability.
If a person disagrees with a decision made on a claim, it can be appealed. The steps are explained in The Appeals Process (Publication No. 05-10041), which is available from Social Security.
A spouse 62 years or older may also qualify for benefits based on a disabled applicant's work history. In some situations, a divorced spouse may qualify for benefits based on the applicant' s earnings if the marriage lasted at least 10 years, if the divorced spouse is is not currently married and is at least age 62. The money paid to a divorced spouse does not reduce the benefit or any benefits due to a current spouse or children.
Medicare coverage is provided automatically after a beneficiary has received disability benefits for two years.
As Congress turns from health care reform to Tax reform, you need to know what is currently on the table and how it will affect you. Here is a short list of the proposals by the Treasury Secretary and the National Economic Council Director.
Below is an outline of the Administration’s Proposed Tax Plan as presented by National Economic Council Director Gary Cohn and Treasury Secretary Steven Mnuchin. The central feature of the White House’s plan would be a big reduction in tax rates for virtually all Americans and businesses.
1. Eliminate the seven existing income tax brackets and replace them with three brackets, containing new rates of 10 percent, 25 percent, and 35 percent, based on someone’s income. Which income levels would be impacted by the higher tax brackets has not been specified.
2. Roughly double the standard deduction that Americans can use to reduce taxable income. The deduction for married couples would move from $12,600 to $24,000, providing an incentive to people not to itemize their tax returns and instead use the standard deduction, simplifying the process and potentially saving taxpayers thousands of dollars each year.
3. Eliminate the alternative-minimum tax.
4. Repeal the estate tax immediately.
5. Virtually eliminate all tax deductions that Americans claim, provisions that they argued primarily benefited wealthier Americans. This includes the tax deduction for the state and local taxes people pay each calendar year. These taxes can be significant in states with higher taxes, such as California and New York.
6. Preserve tax breaks that incentivize home ownership, retirement savings, and charitable giving.
7. Lower the corporate tax rate from 35 percent to 15 percent, and also allow smaller businesses, structured in such a way that they are affected by the individual tax rate, to also use the 15 percent threshold.
8. Propose a one-time tax “holiday” to incentivize companies to bring several trillion dollars currently being held in other countries back into the United States.
Earlier this year, Donald Trump ordered the Department of Labor to reconsider the Obama administration’s retirement savings protections due to begin taking effect in April, with an eye toward revising or completely eliminating them.
This protective ruling is based on two core ideas. First, if you are an individual investing for retirement, your best interests should come first. Your financial interests should not take a back seat to the financial interests of your financial adviser. And, the second idea of the ruling maintains that how your adviser gets paid cannot conflict with your best interests.
You may lose hard-earned retirement money.
The Labor Department created the new retirement investor protections because lots of evidence showed working people and retirees were paying a huge price for conflicted investment advice through higher fees and worse returns. If you continue to live with that conflicted advice, you could end up with about 25% less in retirement money over 35 years of investing than if you were getting recommendations from someone who is paid to work in your best interest. This easily could amount to tens, if not hundreds, of thousands of dollars less for you when you retire. Or, you might have to work longer to make up for it.
You won’t automatically be able to trust your retirement investment adviser.
Trusting the wrong person to help you make good decisions about your retirement investments can cause you deep and permanent financial harm. If the Trump administration gets rid of or weakens the retirement investor protections, it will continue to be your job to figure out whom you can trust—that is, who is a “fiduciary” legally required to act in your best interest versus who is just a salesperson getting paid with commissions and kickbacks.
Even though a U.S. federal judge upheld the Obama-era rule, the case could still be appealed to a higher court. So, for now, the protective ruling is alive. However, the case is not closed. In the meantime, whether the ruling is ultimately done away with or not, you don’t have to be the one to suffer. If you have a plan stick with it. If you don’t have one, find a respected fiduciary investment adviser to work with immediately. Working with a fiduciary financial adviser can at least assure you that your interests are above theirs.
This week, the Congress is preparing to Repeal the Affordable Care Act and, perhaps, replace it with another plan. The Kaiser Family Foundation has provided comparisons of the most prominent plans to date in terms of coverage, costs, pre-existing conditions. and other factors. You can see these comparisons of Rep. Paul Ryan, Sen. Rand Paul, Rep. Tom Price, and Sen. Bill Cassidy to the current law by going to http://kff.org/interactive/proposals-to-replace-the-affordable-care-act/.
As I stated in my post on Linked in, the Op-Ed on the replacement of the Affordable care act, the proposals for block grants to fund Medicaid and/or Medicare would mean the end of these programs. As of June, 2016, 1,356,251 Colorado citizens were enrolled in Medicaid. Many of these are in long term care facilities. Perhaps you did not know that Medicaid is the only government program that assists in paying for long term care for the elderly and disabled. Perhaps you did not know that the average cost of care in a facility in Denver is over $8,000.00 per month. But you do now. Even for those who have saved $200,000, the cost of such care will wipe out these savings within two years whereas the average stay for a person in care is three years. Home care for these people is not an option unless a family member quits working. That results in loss of tax income and an increase in emergency room admissions for people who cannot pay for health care.
GOP to protect pre-existing conditions?
There are many bills that are in the process of introduction in the House of Representatives to repeal and replace the Affordable Care Act, also known as Obamacare. Many of us are anxious about the future of the program and how it will affect our Seniors and the disabled community. Many of the bills propose the repeal of the ACA without any replacement, which would leave approximately 20 million Americans without health insurance.
The main sticking point for many of the Representatives and Senators seems to be the cost of insuring those with pre-existing conditions or severe illnesses.
In other words, if a person is discontinued from their previous insurance for any reason, the insurance company could charge any amount to re-insure the person. "The biggest problem? Both premiums and other costs remained too high for many people with health conditions to afford. The federal program ran out of money almost a year before it was scheduled to end. Sometimes the pools got so expensive for states that they had to impose waiting lists for coverage. And often, to keep costs down, risk pools set up waiting periods before they started paying bills for the very illness that made people high risk." Kaiser Health News.
The other problem with the proposals is that, under the ACA, the Congress was supposed to provide block grants to the states to support the Act. Instead, of the grants, most states were provided with "loans" to support the program and less than one-half of the money that was supposed to fund the program was allocated.
"But the GOP plan also would likely make insurance more expensive for older people by proposing a broader range for premiums based on age. Current premiums can vary only three-fold based on age, which is “driving out younger and healthier patients” who can’t afford them, the GOP aide said.
Under the plan, insurance companies could not charge higher rates to people with pre-existing conditions so long as they maintain continuous coverage, whether from an employer or in a policy they purchase themselves. The new high-risk pools would be available for those who have a break in coverage, or who fail to purchase during a one-time open enrollment under the plan.
The plans to replace the Affordable Care Act are not affordable for our Seniors and would limit benefits for the most vulnerable in our society. If an elderly person were to need surgery to prolong life, would they get it? Maybe not under managed care proposals. We have all had experience with denials of care because a clerk somewhere decided it was not reasonable or necessary. I had to defend an ambulance to transport my 90 year old aunt to the hospital because Medicare said she could have taken a cab.
Be care what you wish for.
Provided to you by Rose Mary Zapor, Esq.
New laws in most states provide an easy way to prevent impaired elders from being financially exploited. The impaired elder's credit cannot be increased and new credit lines cannot be opened. This type of "credit freeze" can be handled by someone acting on behalf of the elder, such as an agent under a POA. Clinical Law Professor Kate Mewhinney, CELA, discusses the North Carolina "protected consumer credit freeze" law, a 2016 statute that is similar to new laws passed in other states. She examines the benefits and ambiguities of the law and gives practice tips on how to use it to help prevent elder exploitation.
Sometimes an older person’s most valuable asset is a strong credit rating. Unfortunately, like any other asset, credit is often the target of financial exploitation. Predatory actors aren’t the only risk. Every elder law attorney knows of clients who get carried away with online shopping or investment trading. The temptations of the internet have been the financial undoing of many well-educated, savvy older people -- particularly those who are lonely or bored.
In our field, we probably don’t need a lot of data to know that financial matters often go awry when mild cognitive impairment hits. See, e.g., Tara Siegel Bernard, “As Cognition Slips, Financial Skills Are Often the First to Go,” N.Y. Times, Apr. 25, 2015. Now we have a new tool to address it.
An easy way for any adult of any age or health status to get protection from identity theft is to put a “security freeze” on his or her credit report. Placing a security freeze prevents someone else from stealing the person’s identity by opening a new account or increasing a credit line. Visit the National Conference of State Legislatures for the security freeze laws in 50 states and the District of Columbia. The three credit reporting agencies are Equifax, Experian, and TransUnion. A freeze can be put into place at any or all of these agencies. It is also fairly easy to remove the freeze if a person decides to open a new credit card or alter an existing account, but not so easy that they’ll be buying a huge flat screen TV on impulse.
In North Carolina, effective January 1, 2016, a guardian or an agent under a power of attorney (POA) can put a credit freeze in place for the principal if the principal is “incapacitated.” N.C.G.S. §§ 75-61, 75-63.1 (2015). Twenty-seven states have enacted these “protected consumer” laws in recent years and others are considering them now. For a list of these states, see Heather Morton, “Consumer Report Security Freeze State Laws,” National Conference of State Legislatures, October 12, 2016. The protected consumer statutes also allow parents and guardians to protect minor children from being the victims of identity theft, so “protected consumer” also applies to those age 16 or 18 and younger, depending on the state.
Who Is an “Incapacitated Person”?
The new statute in North Carolina sets out the procedures for creating and for removing a security freeze on what is termed a “protected person.” A “protected person” is defined as someone who is “incapacitated,” under age 16, or for whom a guardian or guardian ad litem (g/a/l) has been appointed. N.C.G.S. 75-61(11a) (2015).
North Carolina’s new statute does not define “incapacitated” and, unlike some elder abuse statutes, is not triggered by the person having reached a certain age. Unlike states requiring the consumer first to be found incompetent, such as Florida, Indiana, and Tennessee, by not requiring a finding of incompetency in guardianship before a person can be a “protected consumer,” North Carolina opted for a broad application of the law. Fla. Stat. § 501.005 and 501.0051; Ind. Code § 24-5-24-1 et seq. and Ind. Code § 24-5-24.5-1 et seq.; Tenn. Code § 47-18-2101 et seq.
Besides the statute’s failure to define “incapacitated,” it also fails to include any requirement as to the evidence needed to establish incapacity. It may be that a verbal or written assertion by the representative will suffice. And what if the consumer simply disagrees with the allegations made by the representative that the consumer/principal is “incapacitated?” Sound like a familiar story? Is using a wheelchair or suffering from arthritis sufficient to meet the criteria for incapacity? The credit reporting agency seems to be put in the position to adjudicate what it means to be “incapacitated” -- with no set criteria to guide that decision. The only guidance is a provision that the freeze can be lifted if the consumer or his or her representative made a material misrepresentation of fact that caused the freeze to be put into effect. N.C.G.S. 75-63.1(c)(2) (2015).
In addition to an agent under a POA, the statute also authorizes a “guardian” to request a freeze for a protected consumer. The statute does not specify whether it be a guardian of the estate or a general guardian. However, as we know, a guardian of the person has no authority over financial matters. N.C.G.S. 35A-1241 (2015). It makes sense that POA agents and court-appointed guardians should have the authority to ask for a security freeze because they have statutory authority to make financial decisions. The third category of authorized persons, though, does raise some questions.
The new statute provides that when a g/a/l has been appointed, a credit freeze can be requested. But, interestingly, a g/a/l is not listed in the statute as an entity with the authority to make such a request. The new statute only requires a consumer reporting agency to place a freeze if the “protected consumer’s representative” makes the request N.C.G.S. 75-63.1(a)(1) (2015).
3. A written, notarized statement signed by the person that expressly describes the authority of the representative to act on behalf of the protected consumer. N.C.G.S. 75-61(16) (2015).
The statute does not make clear whether “person” is referring to the consumer or the representative. In at least a few states, the definition of “sufficient proof of authority” is clear in that the written, notarized statement is to be signed by the representative. What “authority to act” the person has, without a POA or guardianship, is hard to imagine. Perhaps family members who are Social Security representative payees will use that status to assert this authority?
If “person” is referring to the consumer, then it seems possible for a guardianship respondent, prior to any adjudication of incompetency, to authorize the g/a/l to make a security freeze request on the respondent’s behalf. However, in my experience, most respondents are in no shape to do so. With this in mind, where appropriate, the g/a/l should ask the Clerk of Court to issue an order authorizing the g/a/l to request a security freeze for a guardianship respondent.
Additionally, the statute allows the request to be made by first-class mail, phone call, or secure website or secure electronic mail, but the statute doesn’t address how the proof of one’s authority is established when the credit freeze request is made by phone. TransUnion, and perhaps the other agencies, currently only accepts written requests for protected consumer security freezes.
Doesn’t a POA Already Allow an Agent to Request a Freeze?
It seems that a broad, general power of attorney should already be legally adequate to request a security freeze without waiting until the principal becomes “incapacitated.” As we know, it is not always clear when a person has reached that point. Also, if the POA is adequate to buy and sell real estate, file tax returns, and handle all financial affairs, why wouldn’t it suffice to simply freeze the principal’s credit?
Should the Agent Under a Springing POA Be Able to Request a Freeze?
Consider the adult who has a springing POA that is triggered only by a doctor’s determination of the principal’s incapacity. Will consumer credit agencies notice if the springing POA hasn’t yet technically “sprung” (since there is no doctor’s letter) and the agent isn’t yet authorized to handle financial issues?
The process for a “protected consumer security freeze” is more focused on providing protection from identity theft and improvident spending than on giving impaired individuals a chance to keep taking out credit. At the outset, when a security freeze is put in place for most consumers, the agency must send a written confirmation to those consumers within three business days of placing the freeze. N.C.G.S. 75-63(c) (2015). Also, the “regular” consumer is provided a personal identification number or password to be used when the consumer wants to lift the freeze for a specific party, for a specific time period, or permanently. Id.
This statutory provision is not referenced in the new statute on security freezes for protected consumers, so it is not clear how an incapacitated person would know that a freeze had been put into place or how to request that it be removed. Frankly, the process for an incapacitated person to remove or lift the freeze is such that an impaired elder would probably not be able to figure it out or get it done. This is especially true if the person is not provided notice that the freeze was put in place or an explanation of how to contest it or ask to lift it.
To remove the freeze, the statute allows the protected consumer to submit proof that the “authority for the […] representative is no longer valid.” N.C.G.S. 75-63.1(c)(1)(b) (2015). Presumably, this would include revocation of the POA by the consumer, dismissal of a guardianship petition concerning the consumer, or the consumer’s restoration to capacity in the guardianship context. The protected consumer must submit a request to remove the freeze to the consumer reporting agency in the manner specified by the agency. N.C.G.S. 75-63.1(c) (2015).
The protected consumer may have to pay a fee to have the freeze removed. Unless the consumer is over age 62 (or under 16), the agency may require payment of up to $5. N.C.G.S. 75-63.1(d) (2015). This fee is also waived if a report of identity theft was made to law enforcement. Id.
The statute seems to contemplate that the process for lifting (and placing) a freeze on a protected consumer’s credit will work slowly. The agency has up to 30 days to process the request to lift (and place) the freeze. N.C.G.S. 75-63.1(c) (2015). For unprotected consumers, however, the lift must occur within 15 minutes of an electronic request or within 3 days of receiving a written or telephonic request. N.C.G.S. 75-63(j) (2015).
North Carolina’s new statute allowing a security freeze for protected consumers provides an easy process for preventing and addressing identity theft and profligate spending that might result from cognitive impairments. While it won’t prevent an impaired elder from “giving away the farm,” it might keep them from mortgaging it!
First, it is probably easiest to simply help the principal put a security freeze in effect without using the new protected consumer statute. The agent should be sure to keep track of the PIN or password provided, in case the freeze on the principal’s credit needs to be lifted for a new account or simply for a credit check.
The complete name and address of the principal and the agent.
Social Security card of the principal and the agent.
A government issued I.D., such as a driver’s license, for the principal and the agent.
A letter enclosing a copy of these items, saying the principal is incapacitated.
Note that Experian also requires a copy of the following items for both the agent and the principal: a birth certificate plus one of these: a utility bill, bank statement, or insurance statement.
Clinical Professor Kate Mewhinney manages the Elder Law Clinic at Wake Forest University School of Law. She is a Certified Specialist in Elder Law by the N.C. State Bar and the National Elder Law Foundation, and a former chair of the NCBA Elder Law and Special Needs Section. She thanks Rebecca Daddino, third-year law student, for her research assistance on this article. If you use your state's protected consumer statute, please share your experiences with her at mewhinka@wfu.edu.
IF YOU HAVE ANY QUESTIONS ABOUT CREDIT FREEZE IN COLORADO, FEEL FREE TO CONTACT MY OFFICE.
Kaiser Health News has reported that keeping Americans healthy is going to be harder than just a catch phrase like Repeal and Replace. First, repeal of the law would take 60 votes in the Senate, whereas Democrats now hold 48 of those seats and Republicans now only 51. Second, both President Elect Trump and Vice President Elect Pence have made statements regarding maintaining parts of the ACA that provide coverage to those already dependent on the program. Third, there is no plan yet to repeal and replace the coverage for 20 million people at this time. Even the base of the Republican party will not allow their representatives to just erase a program that has become more popular in the last few years.
I am not so naive as to believe that the ACA will never be repealed, but the replacement plan will have to be part of the plan in order for the GOP to retain their base of hard working Americans. The repeal will not be in one big swoop, but will take little bites from the plan through tax amendments like the one vetoed by President Obama earlier this year. But the replacement will have to be a one piece legislative effort, open to scrutiny by the public and by the insurance industry.
This is not the time to panic, but it is the time to keep vigilant.
A key deficiency in the process of planning for long term care occurs when seniors fail to provide for the orderly distribution of assets after death or fail to let their family know what to do when the senior can no longer handle his or her own affairs.
Estate planning from a qualified estate planning attorney, a financial adviser who specializes in estate planning or a CPA planner is the design of documents to provide the orderly transfer of assets and property to the next generation. Wills, living trusts and a myriad of other trust documents or business arrangements to avoid estate taxes are some of the principal planning strategies used. Other planning might center around income tax and real estate capitol gains. Estate planning also concerns issues of business succession and consideration of eligibility for government sponsored benefits.
Estate planners need to become more involved in the planning process for long term care by helping in the production of a written long term care plan. This should include meetings with potential family caregivers and instructions or checklists for these people. This important part of the planning process is often overlooked.
Because long term care planning is often overlooked, elders or their families who are assisting them should insist on more careful planning for long term care issues when doing an estate plan. Some advisers have recognized this need for care planning and have put together a team of experts such as attorneys, care managers and financial planners who provide a more complete and comprehensive approach to estate planning, long term care and end-of-life issues.
Be Sure to Have Your Eyes Checked!
New research shows that an early detection of Alzheimer's may be available through tests of our senses, especially eyes and smell. While this may seem strange, it is actually logical. The senses of sight and smell are directly connected to the brain. Unlike our sense of touch that is routed through our spinal column, the sense of sight is directly connected to the brain through the optic nerve.
Four studies being presented at the Alzheimer’s Association International Conference in Copenhagen, Denmark, strengthen earlier evidence that the earliest signs of Alzheimer’s disease might show up in the eyes and nose.
That could mean earlier treatment, and could give people a chance to plan, said Maria Carrillo, vice president of medical and scientific relations at the Alzheimer’s Association.
Two used fluorescent compounds to detect deposits of the protein amyloid in the eye.
The authors of these studies believe the amount of amyloid found is a good indicator of how much is present in the brain, where it forms sticky clumps in those with Alzheimer’s.
Two other studies suggest a loss in the ability to detect odors could be an early sign of the disease.
Dr Simon Ridley, of Alzheimer’s Research UK, said: “It is difficult to diagnose Alzheimer’s disease accurately and, in many cases, by the time the symptoms have developed, damage has already been going on in the brain for a number of years.
“A quick, cheap, non-invasive test to detect Alzheimer’s would be an important step in helping people to receive an early diagnosis .
More research is reported in the Journal of the Alzheimer's Association that discusses a possible blood test for Alzheimer's.
A BLOOD test which will be a “major step forward” in fighting Alzheimer’s could be available in just two years, scientists say today.
Scientists have identified a unique combination of protein molecules in the blood which give an early warning that a patient is likely to develop dementia. This finding will help them devise a test to diagnose people quicker and could lead to new treatments, they say.
The test, likely to cost between £100 ($171.00 U.S.) and £300 ($514.00 U.S.), can show with almost 90 per cent accuracy which individuals suffering from mild memory loss will develop Alzheimer’s within a year.
In the largest study of its kind, researchers analysed 26 proteins previously linked to dementia in 1,000 patients. They found 16 molecules present in people with mild cognitive impairment. A specific combination of 10 molecules were identified in patients who developed Alzheimer’s within a year.
An Alzheimer’s Society (UK) spokesman said the test has so far shown just 87 per cent accuracy, meaning that one in 10 people would get an incorrect result. “Only through further research will we find answers, so we will watch the progress of this with interest,” he said.
For more information on clinical trials in the United States, go to www.alzfdn.org for a list of ongoing trials.
Per the Jimmo Settlement, CMS will now implement an Education Campaign to ensure that Medicare determinations for SNF, Home Health, and Outpatient Therapy turn on the need for skilled care – not on the ability of an individual to improve. For IRF patients, the Manual revisions and CMS Education Campaign clarify t hat coverage should never be denied because a patient cannot be expected to achieve complete independence in self - care or to return to his /her prior level of functioning.
Plaintiffs in Jimmo vs. Sebelius are represented by the Center for Medicare Advocacy and Vermont Legal Aid. Jimmo is a certified national class action lawsuit brought by individual Medicare beneficiaries and national organizations. It was formally settled by the Plaintiffs and Secretary Sebelius on January 24, 2013, when federal Judge Christina Reiss approved the settlement Agreement .
Medicare only covers home health care if, among other requirements, the beneficiary is homebound. As of November 19, 2013, the Centers for Medicare & Medicaid Services (CMS) will require new criteria for purposes of meeting the homebound requirement . These new requirements will leave many Medicare beneficiaries without access to the medically reasonable and necessary home care coverage to which they are legally entitled.
In other words, the current policy clarifies that a person will be considered homebound if her ability to leave home is restricted – and the policy provides a number of ways in which to demonstrate this is the case. If a beneficiary requires the aid of supportive devices, the assistance of another person, or if leaving home is medically contraindicated, it establishes the requisite restriction on the ability to leave home even without a taxing effort. Under the Statute and current CMS policy, there is no specific requirement that the person must require the assistance of another, require an assistive device, or special transportation to leave home or that it is medically contraindicated for the person to leave home. Indeed the statute states that the individual's condition "should be such that there exists a normal inability to leave home and that leaving home requires a considerable and taxing ef f o rt … "
If the patient meets one of the criteria in Criteria- One, then the patient must ALSO meet two additional requirements defined in Criteria- Two below.
This March 2012 OIG statement is far more akin to the relatively flexible "confined to home" standards set out in t he Medicare Act . Similarly, the current policy is closer to the statute than the proposed policy. Where the statute and current policy indicate what should usually be present to meet the homebound definition, the proposed policy states what must be present . Further, the proposed policy deletes the introductory language of the current policy, which includes a sense that an individual's circumstances as a whole should be looked at to determine whether he/she is homebound.
For example, an individual with chronic obstructive pulmonary disease may not have an assistive device, may not need another person to help her leave her home, and may not need specialized transportation. Nonetheless, she may still have an ordinary inability to leave home for multiple reasons including shortness of breath, dizziness upon exertion, or inability to climb stairs . Under the Statute and current CMS policy, this individual would be eligible for home health coverage, but under CMS's new definition of homebound, she and many like her, will not be considered homebound – and will lose access to Medicare coverage for home health care. This is an illegal and unaccept able result .
CMS should not implement its new home bound policy. It is inconsistent with, and more restrictive than, the Medicare law. It will undermine the intent of the Medicare statute. Furthermore , it will result in many older and disabled Americans losing home health care – the very care that allows them to live at home and to stay out of costly institutions.
Pro t ect io n Act o f 2000 (BIPA), Pub. L. No . 106- 554(Dec. 21, 2000).
4  Rev, 172, Is s ued: 10- 18- 13, Ef f ect ive: 11- 19- 13, Implement at io n: 11- 19- 13, No t yet available o n t he o nline vers io n o f t he Medicare Benef it Po licy Manual, Pub. 100- 02, Ch. 7, § 30.1.1.
 76 Fed. Reg. 68526, 68599 (No v. 4, 2011).
Claims, OEI- 01- 08- 00390 (March 2012).
Gail Willingham, works with Jessica Bras on advanced math as she tutors children at Miami Beach Senior High School through a program called AVID.
As the U.S. economy continues to recover from the recession, more senior citizens are entering the workforce today compared to 2010, according to a new Gallup poll released in October. Senior Americans aged 65 and older in the workforce increased from 22 percent in 2010 to 25 percent in 2013.
Clyde Fleming is one of them. After spending more than 30 years working for Jackson Health System as an administrator, he recently joined the workforce again after having been retired for five years.
But the former healthcare executive wasn’t pounding the pavement answering help wanted ads when he decided to join the professional ranks. Instead, a friend told Fleming about ReServe, a nonprofit program that matches seniors aged 55 and older with jobs.
Fleming considered trying to find a job through traditional means.
Seniors face very real barriers to entering the workforce, according to Christine McMahon, president and CEO of Fedcap, the organization that operates ReServe.
Fedcap was founded in 1935 to help people who, at the time, weren’t often considered for gainful employment including the disabled and the elderly. Based in New York, Fedcap operates seven ReServe chapters in the United States including Boston, Newark and Miami.
In addition to ReServe, Fedcap, a not-for-profit, also runs several other programs to help youth and veterans, primarily in New York, New Jersey and Washington, D.C. find meaningful employment. FedCap operates ReServe and receives funding for the program from foundations like the United Way and the MetLife Foundation, among a host of others.
Since its inception in 2005, ReServe has matched 3,000 seniors to jobs around the nation. The Miami chapter was launched in 2012. And to date, 37 seniors have been matched through the program with positions, primarily in the not-for-profit sector.
ReServe works directly with employers to present the best candidates for a position.
“We charge employers $15 per hour of which the employee receives $10 per hour. Participants are on the ReServe payroll, so we take care of taxes and other costs associated with bringing on a new employee, so we eliminate those costs for the employer,” McMahon said. Fleming, who joined ReServe earlier this year, is a manager for the Alliance for Aging, where he is working on a yearlong assignment to develop a program that educates seniors about how to avoid being exploited financially.
For Gail Willingham, a native Miamian, ReServe offered flexibility: She was able to give back to children and earn money, and she also had time to pursue her love of acting.
For many seniors in the ReServe program, earning a paycheck is secondary to helping the community through their work.
Kelsey Dorsett, a former entrepreneur who lives in Overtown, was looking for volunteer opportunities online when he came across the ReServe program.
Virginia Aponte enjoys sharing her career experiences seniors on the hunt for employment.
A New York resident who worked in publishing for Random House and in television for NBC before moving to Miami, Aponte worked in human resources for the Coconut Grove Playhouse until it closed in 2006. Today, she is a program manager at ReServe in Miami helping other seniors like her find work.
There are plans in the works to reach beyond the Miami area with ReServe, according to McMahon, the head of Fedcap.
Congress mandated the federal Long-Term Care Commission to address a very complex subject in an impossibly short time. As events turned out, the Commission had only three months to conduct hearings and make recommendations once it was fully organized. By comparison, a federal advisory commission created around the same time to review rules on the use of electronic devices on airplanes needed nine months (including a three-month extension) to report its recommendations.
Proposed an improved focus on quality across settings of LTSS – with particular attention to home and community-based services. It suggested the promotion of services for persons with functional limitations in the least restrictive setting appropriate to their needs – building a system, including Medicaid, with options for people who would prefer to live in the community.
Advocated for new models of public payment that pay for post-acute and long-term services and supports on the basis of the service rather than the setting.
Suggested integration of LTSS with health care services in a person- and family-centered approach.
Proposed non-specific improvements in the working conditions for care workers.
These recommendations can serve as a basis to educate the public and policy makers.
Strengthening of a public support program.
It is undisputed that most Americans are unprepared for paying for long-term services and supports if such care is needed. It is also undisputed that many people either cannot afford or are medically unqualified for long-term care insurance. The Commission did not advance the discussion on this vital topic far enough. It should have provided more direction in this critical area.
Finally, the Commission proposed a national advisory committee to continue its work. We support this. Although the Commission provided a template for public dialogue, it was unable to come to a consensus on the most important issues of financing and the balance between public and private roles. The momentum it has created should continue for this issue to be resolved so the elderly and disabled can receive long-term services and supports with dignity and financial security.
· The Veteran must have served at least 90 days of active duty.
· At least one day out of the 90 days of active duty must have been during war time (there are defined dates for the beginning and end of World War II, the Korean War, and the Vietnam Conflict; the Gulf War, which began on August 2, 1990, is not concluded yet, and its ending date will be set by Presidential Proclamation at the appropriate time).
· The Veteran must have received a discharge other than dishonorable.
· The claimant and household must have limited income and assets.
· The claimant must have a permanent and total disability at the time of application (note that a surviving spouse can qualify for a basic low income pension without being disabled, but the Veteran must be disabled—although the disability does not have to be related to war time or military service).
· The disability must have been caused without the willful misconduct of the claimant and must not have been due to the abuse of alcohol or drugs.
· Be blind or have very poor vision.
Applying for these supplemental benefits is not a quick or simple process, and if you decide to apply, you may want to enlist the help of a Veterans’ assistance organization or a specially-trained individual. Note that whoever assists with the application cannot charge a fee for that service. However, if the individual or organization performs other services, fees may be chargeable for those other services.
To find professionals across America who can help you plan for and/or deal with your family’s elder care matters, go to: ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

References: § 501
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