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Medicaid Rule Change Strengthens Home- and Community-Based Care

By Hook Law Center

Millions of low- and fixed-income Americans depend on Medicaid for health care. Many are fortunate enough to receive that care in their homes or at nearby facilities. Unfortunately, some have no choice but to receive treatment in nursing homes and in other institutional settings that may be nowhere near their homes, friends and family. Such situations are widely recognized to be less conducive to a patient’s overall well-being.

The Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees those programs, recently announced new rules to strengthen the Community Living Initiative — a program launched in 2009 to develop strategies to increase Medicaid recipients’ opportunities for care in home- and community-based settings (HCBS).

The new rules set definitions for HCBS and specify that Medicaid will support HCBS programs that offer an alternative to care in institutional settings and that take into account a patient’s quality of life. States will be granted a transitional period during which they can ensure their HCBS programs meet requirements. During this period, states will be provided with technical assistance.

The new rules give states more options for expanding HCBS and for targeting specific segments of the population. They also streamline regulatory and documentation procedures for more efficient operations.

The elderly, ill, disabled and low-income populations are all vulnerable to marginalization. Institutionalized care, while necessary and beneficial for some, can be a prime example of such marginalization when not medically necessary. Those who will become able to receive care in their homes and communities because of these changes stand to benefit immensely from the CMS’s new rules.

Posted on Friday, February 28th, 2014. Filed under Medicaid.

Four Legal Documents for Managing an Incapacitated Parent’s Affairs

By Hook Law Center

When an elderly parent becomes incapacitated or terminally ill, the management of the parent’s financial and medical affairs often falls to one of the children. By having the proper legal documents in place, you can help ensure that this process goes smoothly. They help to keep an already difficult situation from becoming much worse because of legal hassles. Following are four key documents you should have in place before your parent falls ill. Your elder law attorney’s guidance is crucial; he or she can ensure that these documents are properly created to withstand legal challenges.

Durable power of attorney: Using this document, an individual (like your parent) grants another (like you) the legal authority to manage his or her financial affairs. Unlike a regular power of attorney, a durable power of attorney remains in effect if the grantor becomes incapacitated.

Health care proxy: This document grants a person the authority to make medical decisions on another’s behalf. It is sometimes called a “power of attorney for health care.” You should discuss what constitutes an acceptable quality of life (one that is worth prolonging) for your parent. For instance, if a feeding tube became necessary to keep your parent alive, would he or she want that? Doctors may balk at carrying out a health care proxy’s instructions if another family member disagrees. As such, it is important for your parent to keep other family members informed about the decisions you have discussed.

Medical information release: Patients use this form to give their doctors permission to share their medical records with third parties. These forms can be obtained from the doctors themselves. There is no widely accepted standard form. As an alternative, an experienced elder law attorney, such as those at Hook Law Center, can draft one for your parent. The releases designed at Hook Law Center are called Authorizations for the Release of Protected Health Information, and they comply with the federal law protecting patient privacy (Health Insurance Portability and Privacy Act (HIPPA)). An attorney-drafted document can apply to any doctor/health professional who is treating your parent. In many cases, multiple doctors will be involved in a patient’s treatment. In an emergency, there may not be time for your parent to give individual authorizations to each doctor/health professional involved.

Living will: A living will specifies what medical treatments a person is willing to accept if he or she becomes incapacitated and cannot communicate his or her wishes. Common inclusions and exclusions include the use of resuscitation, feeding tubes and mechanically assisted breathing. The laws concerning living wills vary from state to state, and the documents often contain language that is too broad to apply to many medical conditions. Consult with your elder law attorney to decide whether your parent should have a living will in addition to a health care proxy.

Posted on Saturday, February 15th, 2014. Filed under Estate Planning, Long-Term Care.
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