Stefans Law Group by cjleclaire
Elder Care and Medicaid Planning Attorney
Aug 27, 2013 | 1184 views | 0 0 comments | 0 0 recommendations | email to a friend | print | permalink

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MEDICARE’S 100 DAYS OF REHABILITATION “IMPROVEMENT STANDARD” DEFEATED IN RECENT COURT
by cjleclaire
May 13, 2014 | 5522 views | 0 0 comments | 196 196 recommendations | email to a friend | print | permalink

A loved one is brought from the hospital to a rehabilitation facility to receive nursing care and physical therapy treatment.  Medicare is covering this cost.  After a month of being provided with such care, the facility tells the family that their loved one is going to be denied Medicare coverage going forward because his condition is “no longer improving.”  The family is faced with paying the private pay rate of a nursing home to the tune of $350.00 per day, or taking their loved one home when they are not ready because they cannot afford to pay this astronomical cost.  Does this situation sound familiar to you?

There has been a recent trend amount nursing and rehabilitation facilities and agencies to deny Medicare services to patients because their conditions had not been “improving” during rehabilitative services.  This “improvement standard” of assessing whether or not a patient should receive 100 days of Medicare has never been supported by Medicare regulations, and recently, the standard was successfully challenged in federal court.

What is being done to stop the practice of wrongfully denying Medicare coverage?

There is good news for Medicare beneficiaries who are wrongfully denied the full 100 days of Medicare coverage they are entitled to by the nursing or rehabilitation facility they are receiving care from.  A recent court decision Jimmo v Sebelius helps to ensure that Medicare coverage is available for skilled services to maintain an individual’s condition, regardless of whether the condition improves.

In Jimmo v. Sebelius, the lead Plaintiff, Glenda Jimmo, was denied Medicare coverage for home health aides before her 100 days of Medicare were up due to her condition being “unlikely to improve.”  The Court held that this “improvement standard” was improper, and that facilities or agencies must instead base Medicare eligibility decisions on whether a person demonstrates a reasonable and necessary need for a skilled care to maintain a beneficiary’s condition or to slow its decline.

What Medicare programs does Jimmo v. Sebelius apply to?

The standard of Medicare facilities must use, as directed by the Court, applies to both Medicare Advantage as well as the traditional Medicare program.

What Medicare services does Jimmo v. Sebelius apply to?

It applies to any beneficiary who requires skilled services to maintain one’s condition or prevent or slow its deterioration regardless of the underlying illness, disability or injury; Further, it applies to skilled maintenance services provided in all three care settings under Medicare Home Health, outpatient therapy and skilled nursing facility benefits.

What if my Medicare coverage was denied years ago?  Is coverage under Jimmo v. Sebelius retroactive?

Medicare denials under these circumstances can be reviewed from January 18, 2011 going forward. The Jimmo settlement also establishes a process of "re-review" for Medicare beneficiaries who received a denial of skilled nursing facility care, home health care, or out-patient therapy services.

If you or loved one have been denied Medicare services because of a medical condition that has not “improved,” call  Stefans Law Group, PC at 516-692-2744 and speak to one of our attorneys  for legal assistance and professional guidance on your rights, and obtaining Medicare and Medicaid benefits you may be entitled to.

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NEW YORK ESTATE TAX CHANGES: PROPER PLANNING IS MORE IMPORTANT THAN EVER BEFORE!
by cjleclaire
Apr 29, 2014 | 3845 views | 0 0 comments | 157 157 recommendations | email to a friend | print | permalink
Posted on April 29, 2014 by Donna Stefans

Here at Stefans Law Group, we like to keep our clients informed of the legislative changes that will affect their families. As of April 1, 2014 the New York Estate Tax exemption was raised from $1million to $2,062,500. This is great news! However, lack of planning could have your family paying hundreds of thousands in estate tax.

On April 1, 2014, Forbes.com released an article “The New New York Estate Tax Beware A 164% Marginal Rate” reflecting the New York State’s new changes and advising individuals to watch out for big traps in the new law. Here is some of the important information from that article:

 Exemption Schedule:

DATE OF DEATH

EXEMPTION AMOUNT

April 1, 2014 to April 1, 2015

                       $2,062,500.00

April 1, 2015 to April 1, 2016

                       $3,125,000.00

April 1, 2016 to April 1, 2017

                       $4,157,500.00

April 1, 2017 to April 1, 2019

                       $5,250,000.00

The “Cliff”

As of April 1st of this year, if you or your family member dies with just five percent (5%) more than the exemption amount, you face a “cliff”. This cliff, as the article explains is that you are going to be taxed on the full value of your estate, not just the amount over the exemption. Prior to April 1, 2014, New York would only have placed an estate tax on the estate’s value exceeding the one million dollar exemption. Now, if the estate exceeds the exemption by 5%, the entire estate is taxable to New York, with no exemption at all!

Look-back and Portability:

In addition to the changes indicated above, the article references a new three-year look-back for taxable gifts. This is very important for individuals to know! As of April 1, 2014 any gifts made within that three year time period will be added back into the taxable estate. The federal portability provision allows the surviving spouse to add the unused portion of his/her deceased spouse’s exemption to his/her own. This election is made on the first-to-die’s estate. New York did not add this to its legislation. Therefore, the State not exactly matching up to the federal law.

Like many things in life, if you start planning now for your future you can avoid those traps in the New York State laws. At Stefans Law Group PC, we provide services in Elder Law and Medicaid Planning, Estates and Trusts, Probate, Guardianship, and Tax Planning.  We welcome the opportunity to sit with you and discuss your long-term planning needs. Contact us today at (516) 692-2744 to schedule an appointment to create a proper asset protection plan for you. You can also read further as to how to better protect your family from facing the “cliff” and other financial issues at Stefanslawgroup.com

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Senior Living & Care... What To Do With So Many Choices? What Does It All Mean?
by cjleclaire
Dec 02, 2013 | 7036 views | 0 0 comments | 191 191 recommendations | email to a friend | print | permalink

Author:StefansLawGroup

As we age we will find ourselves either making or assisting in complex and important decisions about where we, a family member or even a friend should be living. Changes in physical functioning, mental capabilities, life interests, financial situation, and social supports all affect what type of place is appropriate, and most importantly, where an individual may ultimately live being content and the happiest.

Often times, many do not know how to begin  this process and some of terms may be daunting and confusing. To assist with this, below are some terms frequently used with information about each.

  • CCRC- Continuing Care Retiring Community. Combine independent living and nursing in a single setting. Normally requiring an entry fee, offering a living unit, meals, and health care, up to the nursing level.
  • Retirement-Independent living with amenities such as meals, transportation and activities usually included in a monthly fee.
  • Assisted Living- A combination of housing, personalized supportive services and health care, designed to meet the needs of those needing help with the activities of daily living.
  • Residential Care Adult Care Facilities- Usually single family homes licensed to provide assistance with medications, bathing and dressing.
  • Alzheimer’s- Communities offering specialized programs for residents suffering from Alzheimer’s disease or other forms of memory loss. These programs can be offered by Residential, Assisted Living or Nursing facilities.
  • Nursing/Rehab- Communities licensed to provide health care and services involved in managing complex and potentially serious medical problems.
  • Sub-Acute- Communities licensed to provide care that falls between acute care and traditional skilled nursing home care, usually after or instead of hospitalization.
  • Home Care- Includes providers of licensed health care services in the home and companies that provide non-medical assistance with such tasks as bathing, dressing, meal preparation and transportation.
  • Hospice- Hospice care may be provided in the home or a senior care community. Services can include pain management and a variety of emotional, spiritual and physical support issues.
  • Day Care- Various programs provide a range of geriatric day services, including social, nutrition, nursing, and rehab.
  • Products and Services- Financial, health-related and other valuable products and services designed to meet the varying needs of mature adults.

Stefans Law Group, PC can provide the legal assistance and professional guidance to assist you through these instrumental times. Take a few minutes to find out how we can help you at Stefans  Law Group. We welcome the opportunity to discuss any questions you may have regarding these topics and your estate planning needs. Contact us today at (516) 692-2744 to schedule an appointment to discuss how you can begin preparing for you and your family today!

 

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Quick and Easy Access: My Social Security Account!
by cjleclaire
Sep 11, 2013 | 9141 views | 0 0 comments | 138 138 recommendations | email to a friend | print | permalink

9 MILLION.  That is the number of benefit verification letters the Social Security Administration (SSA) processed in the last year.  While they were processing, you were waiting…and waiting.  But the wait is finally over!  SSA has launched an online service called my Social Security account to ensure that the over 60 million Social Security beneficiaries and Supplemental Security Income (SSI) recipients have the ability to immediately request and receive their benefit verification letter.

The new site is a valuable resource for anyone over the age of 18, especially those who need quick and instantaneous access to their Social Security information. My Social Security account allows a Social Security beneficiary or a SSI recipient to quickly retrieve their benefit verification letter that may assist them in obtaining other benefits. Recipients no longer have to wait in lines at the SSA office or remain on hold for long periods of time.  And they especially do not have to wait around for the mailman to deliver their benefit letter.  My Social Security account gives immediate access to information for faster results.

The SSA’s launch of their online service not only cuts down on wait time but it also boosts people’s confidence in the SSA. Social Security beneficiaries and SSI recipients are able to handle their own requests without having to spend all day speaking with a SSA employee hoping they get what they need.  The quicker and easier it is to do something, the happier and less stressed people are.  My Social Security account provides people with the immediate results they are looking for in the comfort of their home.

What if you are not receiving Social Security benefits or SSI? There is no need to worry because my Social Security account provides access to any individual over the age of 18.  An individual can sign up for my Social Security account and immediately take advantage of the online service to get their personalized Social Security statement.

My Social Security account is designed to provide faster service to a greater number of people. The SSA has developed this site to provide people with efficient assistance without sacrificing customer service. This valuable resource will cut down on wait time and speed up results.

Now you can spend your days doing something you enjoy instead of waiting for the SSA!

Receive the information you need and the sound advice you seek to make important financial decisions about your elder care & social security benefits, special needs or Medicaid planning by scheduling a confidential consultation with a full service law firm that will tailor its representation to meet all your health care, estate planning and elder care needs. Call us toll free at (800) 882-3625 or, if you prefer, fill out our intake form and we will contact you. Let our family help your family.

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It’s Not Easy Being a Trustee
by cjleclaire
Aug 29, 2013 | 4780 views | 0 0 comments | 44 44 recommendations | email to a friend | print | permalink

Some estate plans may require extra attention and protection for special needs family members. An important option to consider is the creation of a Special Needs Trust (SNT). A SNT is a unique trust that gives special needs family members the ability to have funds (placed in trust for their benefit), without jeopardizing government benefits. The trust is specifically worded so that the trustees may only supplement, but not pay for, what government benefits would cover.

The trustees who manage these trusts are sometimes responsible for more than they realize. They have an obligation when it comes to following the rules of a particular trust, and acting in the best interest of the beneficiary.

In the article below, a corporate trustee was found to have misspent almost $200,000 because they failed to adhere to the trust, and adequately investigate whether there were government benefits available for those things the money was spent on

Elder Law and Special Needs Estate Planning attorneys at the Stefans Law Group, P.C., have the experience and the know-how to help you create and manage a SNT, and to help you avoid potential problems down the road. Call (516) 692 – 2744, and make an appointment with us today so we can discuss your needs.

Please read the article below to find out what happened to one trustee when they mistakenly spent trust funds on behalf of the trust beneficiary.

Trustee Must Reimburse SNT for Excessive Distributions

A New York trial court requires a trustee to reimburse a special needs trust for nearly $180,000 that was misspent on private caregivers, cab rides, and medications that could have been obtained from government sources.  Liranzo v. LI Jewish Education / Research (N.Y. Sup. Ct., Kings Cty., No. 28863/1996, June 25, 2013).

Eirol Liranzo was injured as a child.  In 2003, $422,012.54 remaining from the settlement of his personal injury lawsuit was placed into a special needs trust for his benefit.  The trustees were authorized to spend not less than $1,500 a month on Eirol's living expenses, but the trust also specifically stated that the trustees must make a good-faith effort to determine whether Medicaid would cover home health care services prior to expending trust funds for that purpose.  The trust also required the trustees to take Eirol's eligibility for government benefits into account before making discretionary payments to him or his family.

By 2009, only $3,253.03 remained in the trust.  When BNY Mellon, the trustee, filed an order requesting that the court approve its account and release it as trustee, the court opened an investigation.  The independent examiner discovered that BNY Mellon had paid for $118,064.50 worth of home health care without making an inquiry into whether Eirol could qualify for Medicaid payments for his care.  BNY Mellon had also paid for $56,320 worth of cab fares for Eirol's family and had made payments to the family that rendered Eirol ineligible for SSI and Medicaid.

The Supreme Court of New York, Kings County, rules that BNY Mellon must repay the trust for $176,905.99 that it improperly spent while it was trustee.  The court finds that "it is clear that the trustee relegated [its duties] to others, failing to make the necessary inquiries to ensure the longevity of the Trust Fund.  It is clear to the Court that BNY breached its duty under the Trust agreement and failed to properly administer the Trust."

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Documenting Your Finances is the Best Medicine to Avoid Problems With Medicaid
by cjleclaire
Aug 27, 2013 | 4247 views | 0 0 comments | 63 63 recommendations | email to a friend | print | permalink

It’s easy (and very important) to keep detailed records of expenses for your family member who are approaching the sunset years of their lives. Whether it be assisting with grocery shopping, or providing a home for your aging loved ones, documentation of costs and reimbursements must be maintained in order to pass a possible later Medicaid inspection.

While many of us generously and willingly give this support, the Medicaid penalty and look-back period for skilled nursing facilities is five years! That means that Medicaid can look at the last five years, and based on whatever proof you might have, make a decision as to what might be a gift and what might be a reimbursement for a loan (see the article below).

As part of any Medicaid plan, we constantly encourage our clients to develop a financial recording strategy that works best for them, as long as it clear and consistent. For example, we recommend using a computer spreadsheet program. This allows you to keep everything neat and organized, and it will even do the math for you! But remember to keep all receipts and bank records.

If you don’t prefer a computer, another great alternative is a black and white composition notebook. This keeps everything at your fingerprints, and you can’t rip the pages out (plus you can staple receipts and other documents as needed).

Whether you have a good system in place, or you just realized you might be running into a problem, the Stefans Law Group, P.C. is ready to help you with all aspects of Elder Care and Medicaid Planning. Give us a call at (516) 692 – 2744 to make an appointment with our Elder Law attorney and Geriatric Case Manager.

In the meantime, read below to see what happens when one family failed to keep the proper documentation.

Medicaid Applicant's Son Failed to Prove Father's Gift Was Reimbursemen

A New York appeals court holds that a Medicaid applicant's son did not prove that his father who transferred money to him before entering a nursing home was reimbursing him for expenses or had a history of giving, so the father is subject to a penalty period. Donvito v. Shah (N.Y. Sup. Ct., App. Div., 4th Dept., No. 663, 12-02248, July 19, 2013).

Nicholas Donvito gave $54,162.05 to his son and his son's family between June 2007 and August 2008. The last transfer was for $6,500 and took place one month after Mr. Donvito suffered a stroke. Mr. Donvito entered a nursing home in October 2008. Two years later he applied for Medicaid. The state imposed a seven-month penalty period due to the transfers.

Mr. Donvito's son appealed the penalty period, arguing the last transfer was reimbursement for purchases he made on his father's behalf. He also argued his father had a history of giving money and was not motivated by a desire to qualify for Medicaid. The hearing officer affirmed the state's decision, and Mr. Donvito's son appealed.

The New York Supreme Court, Appellate Division, rules that the penalty period is valid. According to the court, Mr Donvito's son did not offer any proof, such as receipts or credit card bills, that he purchased items for his father. In addition, the court finds that with respect to the other transfers, Mr. Donvito's son did not establish that Mr. Donvito was not motivated, at least in part, by a desire to qualify for Medicaid.

For the full text of this decision, go to:

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