Talk With Your Clinton, Flowood and Metro Jackson Area Elder Lawyer about Recent Medicare Changes

Recent changes to Medicare are giving elder lawyers and their clients some new options, and you may want to meet with your Mississippi attorney to see if they apply to you.  A class-action lawsuit was brought, and the proposed settlement has some big implications for those with disabilities and chronic conditions.

For decades, standard Medicare practice was to not provide skilled nursing and therapy for those whose conditions were unlikely to improve.  This has caused considerable problems for those with chronic or terminal conditions or with disabilities who would still have benefited from these services.  Now, home health care, outpatient therapy, and skilled nursing are much more likely to be covered for a chronic illness or disability.

The class-action suit was brought by a large group of people, with plaintiffs including organizations such as the National Multiple Sclerosis Society, the Parkinson’s Action Network, Paralyzed Veterans of America, and others.  As a result of the outcome, it appears that more than 10,000 individuals who had claims denied earlier may be able to have those same claims reviewed again with different results.

According to the agreement, Medicare will begin to cover these services when they “maintain the patient’s current condition or prevent or slow further deterioration.”  This is great news for those whose condition isn’t expected to improve but who still require assistance to improve their quality of life.

According to the New York Times, this change has potential to help those with:

  • Alzheimer’s
  • Multiple Sclerosis
  • Parkinson’s
  • Spinal Cord Injuries
  • Stroke
  • Traumatic Brain Injury

Elder lawyers in Clinton, Flowood and Metro Jackson Area  and the rest of the country see this as a positive change for clients who were often denied care because they simply couldn’t afford it and Medicare wouldn’t cover their needs.  There is still a potential for Medicare contractors to use more restrictive guidelines that could deny coverage for therapy or skilled nursing if the patient isn’t showing improvement.

The proposed changes are geared toward those in the traditional Medicare program, as well as to those with private Medicare Advantage.  Most Medicare recipients are 65 and older, which is why a skilled elder lawyer in Clinton, Flowood and Metro Jackson Area keeps abreast of these kinds of changes that might affect clients.

Clinton Elder Lawyer’s Advice: Create a Personalized Healthcare Directive

When a Clinton elder lawyer’s clients enter a hospital or other medical facility, they have the peace of mind that comes from knowing their healthcare wishes will be made clear to the staff.  This is because the attorney and the client were able to sit down and go through various situations and scenarios to put together a personalized healthcare directive.  When you don’t have one of these in place, the hospital will likely ask you to use their forms to create something similar.

While it’s better to fill out their form than to have no healthcare directive at all, it’s important to remember that it will not be personalized to fit your needs.  When the hospital or other institution puts their forms together, they do so for a wide, unknown audience.  The topics covered will be those which the hospital (or its lawyers) find important, rather than those which are meaningful to you and your family.

Basically, this document is where you name the person that you want to make medical decisions should you become unable to do so yourself.  Oftentimes, this person is a spouse, but if you are unmarried or simply want to appoint someone else, then a healthcare directive is especially important.  Remember that if you don’t assign the role, the legal system will do so for you, choosing a “close” blood relative, such as your adult children (or your parents, for younger folks) to make the medical decisions you are unable to make at the time.

Provide Guidance about Your Wishes

Your Hinds County elder lawyer will not only have you appoint someone, he or she will also help you to make many medical decisions in advance.  By recognizing potential medical situations and declaring your wishes, you can lessen the burden for the individual who will ultimately be responsible for your care.  For example, what are your feelings about life-sustaining measures such as feeding tubes and respirators?  Are there situations in which you would want these used and/or situations where you would not?

This is also a good place to make any religious or cultural restrictions known.  For example, some groups do not agree to have blood transfusions performed.  If this is the case for you, then your healthcare directive would be the place to make it known.  Ideally, you would discuss your thoughts and decisions with the person you have named so that he or she is aware of your feelings and can use that understanding to guide him or her if other circumstances were to happen.  Obviously, your healthcare proxy won’t cover every potential situation, so it’s beneficial for the appointed person to have a good understanding of your beliefs in order to make decisions which are in alignment with what your wishes would be.

Important to Remember

If you have gone through the effort to work with your Hinds County elder lawyer to create your personalized health care directive, make sure that it isn’t undone by filling in one of the generic healthcare proxy forms at the hospital.  If you use their form, you can negate the one you created with your attorney.

Making Long-Term Care Insurance a Part of Your Estate Plan in Clinton

Working with a trust and estates attorney in Clinton is an excellent way to prepare for the future and to protect the assets you want to pass on to your loved ones after you’re gone.  A qualified Hinds County lawyer will be able to offer you valuable advice, not only on setting up a will or trust, but also on creating other important documents, such as medical directives and powers of attorney.

One area that often gets overlooked in the estate planning process is long-term care insurance.  There are different reasons why it gets ignored:

  • I’m too young to think about long-term care (whether you’re 40, 50, 60, or more)
  • I already have medical insurance, isn’t that good enough?
  • I don’t want the added expense of long-term care insurance
  • I have enough money set aside for nursing home or other long-term care

Some or all of these justifications may be true, but it really does make sense to at least discuss the risks with your Clinton trust and estates attorney.  For example, were you aware it is estimated that 60% of people over the age of 65 will need some kind of long-term care in their life?  Also, how confident are you that your health insurance will pay for long-term care?  You will definitely want to double-check that, as most private insurance, as well as Medicare, do not cover most long-term care services.

Keep in mind, too, long-term care isn’t just for the elderly.  Many younger people involved in accidents or who are diagnosed with a particular disease or illness will also require long-term care.  In many cases, this type of care will take place in a hospital or rehabilitation center, and it’s important to know where the money will come from to pay the expenses.

Of course, that’s not to say that everyone needs long-term care insurance.  Again, your Hinds County estate planning attorney can help you assess your risks and determine the right course of action.

What Long-Term Care Insurance Does

Long-term care is certainly beneficial in paying for nursing home expenses, but it doesn’t necessarily exclude other types of care settings.  It may be used to pay for in-home care, for example, or to help with the costs of adult day care or assisted living facilities.

Basically, long-term care insurance comes into play when an individual has lost the ability to take care of two or more of their own daily activities. These are usually defined as:

  • Bathing
  • Continence
  • Dressing
  • Eating
  • Toileting
  • Transferring

There are some other impairments which can trigger the need for long-term care, even if the person involved is still able to function in all of the ways listed above.  For example, a person with Alzheimer’s may still require long-term care, even if he or she is able to perform all six of the daily activities.

Of course, long-term care isn’t just about daily activities.  It can also be used to pay for health care and rehab costs recommended by a physician. Physical or speech therapy may be covered, as well as the need for professional care by a registered nurse.

Your trust and estates attorney in Clinton will work with you to help answer the most important questions in purchasing a long-term care insurance product.  Based on knowledge of the Hinds County area, the lawyer can guide you as you determine where in the community you might be most interested in receiving care and help base estimated coverage needs on this and other criteria.


Reducing Medicare Recovery Reporting Threshold will Raise and Cost Millions

One of the most annoying aspects of settling small personal injury settlements today is the reporting requirement of the Medicare Secondary Payer Act, which is designed to ensure that Medicare gets reimbursed for past payments that it has made on plaintiff's behalf, and that Medicare's future interst in future claims arising from the injury are protected.  The RAND Institute for Civil Justice recently published "Recovery Under the Medicare Secondary Payer Act: Impact of Reporting Thresholds." The study concludes that CMS can recover $1 billion per year from auto accidents – the most-common type of claim – and that retaining the already very low $5,000 reporting threshold would reduce recoveries by 2.4 percent while reducing the number of claims that must be reported by 43 percent.  The monetary cost to CMS of retaining the $5,000 threashold is estimated at $24 million, but that does not compute the added administrative cost to parties.  The $24 million in lost recovery to CMS equates to 123,000 cases whith a threashold of less than $5,000.  If one assumes that dealing with release letters rom CMS adds an additional 2 hours of time for plaintiff counsel and two hours for defense counsel, at an average rate of $200 per hour, the administrative burden to parties would equal an added $98.4 million of private administrative cost.  Even if one assumes that the vast majority of these small claims involve insurance and legal staff only, assuming a rate of $20.00 per hour and 4 hours combined time, would equal almost $10 million.  And that does not even consider the delays that will result in settling these very small claims.  Most such claims settle within 14 days of injury, but CMS reporting requirement will delay such settlements by months.