Elder Law of Louisville's Blog
Monday, October 4, 2010
Kentucky Medicaid recipients are now eligible for nicotine replacement products and drugs to help them quit smoking, Gov. Steve Beshear announced Monday. “This is a great opportunity for Medicaid recipients to stop smoking or using tobacco,” Beshear said at a news conference in the Capitol. The 2010-12 state budget provides $3 million for the program, which will be matched with $8.4 million in federal funds, Beshear said.
The program, which began Oct. 1, has been sought for years by health advocates. They say it will improve the health of Kentuckians and save money in the long haul because treatment for tobacco-related illness costs the state Medicaid program nearly $500 million a year. Amy Barkley, of the Campaign for Tobacco Free Kids, praised the governor and General Assembly for including funding for the program in a lean state budget. “Providing smoking cessation coverage for Kentucky Medicaid recipients is good economic and health policy,” Barkley said in a news release. “It benefits individual patients and Kentucky businesses while helping to improve the long-term financial prosperity of the state.”
Under the program, Medicaid recipients will be given a tobacco cessation assessment to determine their tobacco usage, willingness to quit and coping skills, as well as any barriers to quitting. Recipients will enroll in a counseling program and select a cessation program. Nicotine replacement products such as gum or patches and tobacco cessation drugs will, if necessary, be prescribed by the recipient's provider.
About one in four Kentucky adults smoke, but the rate is about 40 percent among Medicaid recipients, said Tonya Chang of the American Heart Association. Kentucky Public health Commissioner William Hacker said only 1 to 5 percent of individuals who try to quit on their own succeed. But about 28 percent are successful under the type of comprehensive program now being offered by Medicaid.
Beshear said Kentucky along with West Virginia “still leads the nation in the percentage of adults who smoke. We also are second in the nation in number of pregnant women who smoke.” He also said nearly 8,000 Kentuckians die prematurely each year because of tobacco use. “We cannot, and we must not, ignore these statistics,” he said.
Health and Family Services Secretary Janie Miller said recipients who want to enroll in the program should consult their health care provider.
Courtesy of Courier-Journal.
Saturday, October 2, 2010
Humana and Walmart are offering a 2011 Medicare prescription drug plan that will have the lowest monthly premium of any Medicare drug plan to be sold in the U.S., according to the Centers for Medicare and Medicaid Services. The premium will be $14.80, less than half the nationwide average for Medicare drug plans this year.
Humana said in a statement that the plan will save a typical Medicare beneficiary $450 next year compared with average national costs this year, including premiums and co-payments. Plan members will have in-store co-payments as low as $2 at preferred pharmacies, including those at Walmart stores.
Enrollment in 2011 Medicare prescription plans will begin Nov. 15.
Courtesy of Courier-Journal.
Wednesday, September 29, 2010
Have you Seen the YouToons Explain the Health Reform Law?
Health Reform Hits Main Street, a new animated short video from the Kaiser Family Foundation, features the YouToons explaining the health reform law to an American public still confused by how it works. Have you seen it? The short movie has three major sections: explaining problems in the current health care system, short-term changes that will take place between now and 2014, and major provisions that will take effect in 2014. View it online and share it with colleagues, friends and family:
Friday, September 24, 2010
Republican Senate candidate Rand Paul said Thursday that Medicare recipients may have to “bear more of the burden” to shore up the health program's finances as rising numbers of seniors rely on its benefits. While accepting a business group's endorsement in Louisville, Paul told reporters that dealing with looming Medicare shortfalls will require a bipartisan solution. But he options could include higher premiums.
“Nobody wants that,” Paul said during a question-and-answer session. “I don't want higher premiums. But I also don't want the system to be bankrupt where we can't pay for Medicare at all.” Trustees who oversee Medicare have projected the Medicare hospital trust fund would be exhausted in 2029.
During an interview earlier Thursday on WHAS-AM in Louisville, Paul, a Bowling Green eye doctor, was asked what cuts could be made to such popular programs as Medicare. “You want to have more participation by the person who's receiving the entitlement,” Paul replied. “By that I mean that they need to be more involved with some sort of economic transaction every time they use their entitlement, and that means they have to bear more of the burden.”
Paul said later that the problem is purely demographic, caused by surging numbers of retirees compared to the number of people in the workforce. “We have to address it head on and not put our head in the sand and say we'll just keep borrowing money,” he said. Paul has previously stressed that he would not change Medicare rules for retirees or people nearing retirement.
The campaign of his Democratic opponent, Attorney General Jack Conway, seized on Paul's comments to question his commitment to the government health program for seniors. Conway spokesman John Collins said Paul wants to “force seniors to pay more for basic health care, and put more money into his own pocket” as a doctor who has Medicare patients. “It's just another example of him being out of step with Kentucky values.”
Meanwhile, Paul picked up an endorsement from the National Federation of Independent Business, marking his second business endorsement in days. Last week, the U.S. Chamber of Commerce announced that it backs Paul and launched a $500,000 ad campaign in Kentucky that accuses Conway of supporting Medicare cuts by backing the federal health care overhaul.
Conway has denounced the chamber ad as a scare tactic. “If seniors ought to be scared by any candidacy, they ought to be scared by Rand Paul's for a number of reasons. He's called Medicare socialism, essentially,” Conway said in an interview Wednesday.
Couresty of the Courier-Journal.
Wednesday, September 22, 2010
The Center for Medicare Advocacy has launched a campaign to end what they call an unfair standard for covering Medicare beneficiaries whose conditions may not show improvement. They are looking for stories that will help make the case for needed changes in the interpretation of the law. If you can provide information on individuals whose Medicare coverage is denied because an underlying condition will not improve or they have plateaued or they are not likely to improve or they need maintenance services only, please have these individuals contact the Center at
http://www.eSurveysPro.com/Survey.aspx?id=17fcaba0-9586-48d9-a3e0-755ae53f3b2e or contact the Center at (860) 456-7790 or send email email@example.com.
The law/regs are very clear that restoration/improvement is not the test for whether skilled nursing should continue:
42 C.F.R. § 409.32 Criteria for skilled services and the need for skilled services.
(a) To be considered a skilled service, the service must be so inherently complex that it can be safely and effectively performed only by, or under the supervision of, professional or technical personnel.
(b) A condition that does not ordinarily require skilled services may require them because of special medical complications. Under those circumstances, a service that is usually nonskilled (such as those listed in
§409.33(d)) may be considered skilled because it must be performed or supervised by skilled nursing or rehabilitation personnel. For example, a plaster cast on a leg does not usually require skilled care. However, if the patient has a preexisting acute skin condition or needs traction, skilled personnel may be needed to adjust traction or watch for complications. In situations of this type, the complications, and the skilled services they require, must be documented by physicians' orders and nursing or therapy notes.
(c) The restoration potential of a patient is not the deciding factor in determining whether skilled services are needed. Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve current capabilities. For example, a terminal cancer patient may need some of the skilled services described in §409.33.
Somehow, the universal standard has evolved to be that the skilled nursing patient must be improving in order to be eligible for ongoing skilled nursing such as physical/speech/occupational therapy. This makes no sense that I can see considering rehab facilities are paid more when a resident remains on Medicare. In any case, it is great to see this issue receiving attention. I hope that more and more the industry will apply the correct standard so that people will be that much more likely to receive the 100 days to which they are likely entitled.
Wednesday, September 22, 2010
(CBS/AP) For seniors worried about the high cost of private health insurance plans arranged through Medicare, the Obama administration has a rare upbeat message: Your premiums may be going down.
The average monthly premium in so-called Medicare Advantage plans will dip to about $35, a roughly 50-cent or 1 percent cut. About 11 million seniors - one-fourth of beneficiaries - are signed up in the plans, and Medicare projects enrollment to increase by 5 percent in 2011.
The fate of the plans has been a source of concern because the new health care law cuts payments to the private insurance companies that operate them. However, payment rates are frozen for 2011 and significant reductions are still a couple of years away.
Administration officials say the program is strong, and they expect it to stay that way in the future. "The plans know in advance what the law says for the future, and despite that they remain very strongly committed to the program," said Jonathan Blum, head of the Medicare division that oversees the plans. "We believe that the program will be stronger and provide better value."
Nonetheless, averages are just that. Some seniors will see higher premiums, while others will see a drop. Because of that, advocates encourage Medicare beneficiaries to shop around each year during open enrollment season, which starts Nov. 15.
Courtesy of CBS News.
Tuesday, September 21, 2010
Kentucky Medicaid Commissioner Elizabeth Johnson has resigned her position as head of the nearly $6 billion health care plan for about 800,000 low-income and disabled Kentuckians.
The resignation was announced Tuesday by the Cabinet for Health and Family Services in a statement that said Johnson, a lawyer, was leaving to practice law in Lexington.
The resignation comes as the state Medicaid program faces a growing deficit of nearly $500 million and criticism by some lawmakers and advocates that the administration of Gov. Steve Beshear isn’t moving fast enough to find solutions.
Deputy commissioner Neville Wise will serve as acting commissioner. The cabinet said in a statement that it plans to conduct a national search for a new commissioner.
Courtesy of Courier-Journal.
Friday, September 17, 2010
A disabled woman, Barbara Algeier, sued a company running public buses for disabled individuals after being injured when the lift was lowered too far, causing her wheel chair to drop. She broke her leg in 9 places. The bus driver called company officials, but never called an ambulance. The disabled woman laid on the ground, screaming for 45 minutes in 25 degree weather until the company officials completed their investigation and then called an ambulance.
Ms. Algeier, 69, suffered from multiple sclerosis. Despite her disabilities, she was able to live fairly independently prior to the accident. After the accident she was no longer able to care for herself. Ms. Algeier alleged in her suit the company was negligent in the hiring of drivers. The bus driver in her accident was a recovering alcoholic. Under company policy, he should not have been hired. A jury awarded her $4.2 million, $4.1 million for pain and suffering and about $75,000 for medical ex
Thursday, September 16, 2010
On Tuesday, October 5, Louisville Metro TRIAD will host the 10th annual Senior Day Out at the Kentucky International Convention Center in downtown Louisville, Kentucky. This event provides Louisville area seniors with valuable information and services. I will be volunteering at the Metro Louisville Aging in Place booth from 9-10 am.
At this year's event, seniors will receive free health screenings, information from local business and service providers, a complimentary lunch, door prizes and more. Guests will enjoy live entertainment as well as Bingo.
Senior Day Out is hosted by Louisville Metro TRIAD, a grassroots partnership between local law enforcement, representatives of senior groups, service providers and community volunteers with a mission to inform and protect Kentucky Seniors.
Senior Day Out is scheduled for Tuesday, October 5 at the Kentucky International Convention Center. Registration begins at 8:00 am followed by activities, guest speakers and informational booths. Entertainment and Bingo continue until 1:30 pm.
Courtesy of Wave3 News. http://www.wave3.com/Global/story.asp?S=12781618
Thursday, September 16, 2010
WALSH & WILSON, PLLC is a proud sponsor of the Candidate Roundtable Discussion hosted by the Metro Louisville Aging in Place Council on Friday, October 8, 2010 from 8:45 am to 12:00 pm at Kaden Tower's Civic Center (6100 Dutchman's Lane) in Louisville, KY. A total of 23 candidates in the upcoming election for US Congress, Metro Mayor, County Attorney, Sheriff, PVA, and the Metro Council will answer questions relating to issues important to helping Louisville's seniors stay at home as long as possible. Registration and seating is free, but limited. Light refreshments will be served. Contact Ms. Lynn Harrelson at (502) 386-4806 or LHarrelsonKY@aol.com for registration.
Topics will include: transportation, health, financial challenges, awareness and availability of resources.
The candidates include:
For US Congress: Toddy Lally (R) and John Yarmuth (D) (through his representative, Marty Meyer)
For Mayor: Greg Fischer (D), Hal Heiner (R) and Jackie Green (I)
Sheriff: John Aubrey (D), Don Fitsgerald (I) and Mike Roberts (R)
County Attorney: Mike O'Connell (D)
PVA: Corey Koellner (R) and Tony Lindauer (D)
5th District: Cheri Bryant Hamilton (R)
6th District: Deonte Hollowell (I), David James (D) and Candace Jaworski (R)
9th District: Patrick Joseph Duerr (R)
13th District: Renay Davis (R) and Vicki Aubrey Welch (D)
15th District: Jody Harral (R)
17th District: Glen E. Stuckel (R) and William D. Cohen (D)
19th District: Jerry T. Miller (R)
25th District: David Yates (D)
The goals of the Metrol Louisville Aging in Place Council are to promote aging in place by encouraging seniors, recent retirees and baby boomers to be proactive in planning for their future, continuing health, well being and independence.
Both Eileen and I are proud members of this Council. We will be volunteering at the event, so please track us down and say hi!
Thursday, September 16, 2010
Louisville, Kentucky is home to an unprecedented lawsuit. A high school football coach and 5 assistant coaches were sued for wrongful death by the parents of a player who died of heat stroke during practice. The head coach was also charged criminally, but was later acquitted. It was the first time ever in the country that a high school or college coach was charged criminally for causing a player's heat-related death. The parents and coaches settled the wrongful death civil lawsuit today, with the parents receiving $1.75 million. They say the money will be used to finance the Max Gilpin Beat the Heat Foundation.
This case is interesting to me because of what could have happened. Had Max Gilpin, the student, survived he likely would have suffered life long mental and/or physical disabilities. His parents would be using the settlement money not to finance a non-profit organization, but to fund a special needs trust. The trust would allow Max to receive state disability benefits while maintaining some access to the money for extra niceties. It means the family would not have to exhaust every penny of that settlement paying for medical expenses before getting state benefits.
A special needs trust can pay for anything related to the beneficiary's disabilites, except food, shelter, clothing or medical expenses already covered by the state benefits. The special needs trust would allow the money to sit untouched and grow. Or, it allows the family to spend the money on medical expenses not paid for by the state benefits, extending the life of the settlement funds. Or, it allows the family to spend the money on some niceties. Some examples include retro fitting the house to be handicap accessible, purchasing a vehicle to transport Max, or paying for in-home care services. Trust money could also be used to pay for companionship services to give Max's parents a break, to purchase specialized computers, televisions, telephones or other equipment, or even pay to send Max on vacation with a caregiver. The list is almost endless.
Regardless of whether disabilities are present at birth or are the result of an accident, a special needs trust is a form of asset protection. It allows the disabled individual to obtain government benefits to pay for the bulk of the medical expenses, leaving the trust assets free to pay for other things or to sit there as a safety net. If you are disabled or have a loved one with disabilities, you should consult with a special needs attorney to see if this type of trust is right for you.
The attorneys of Elder Law of Louisville (formerly Walsh & Wilson, PLLC) assist clients in Louisville, Kentucky and surrounding counties of Jefferson, Oldham, Shelby, Spencer, and Bullitt. Our Office also serves Southern Indiana and the towns of New Albany, Jeffersonville, and Clarksville.