Proposed
Assisted Living Residence Regulations to be Published
Written By: Attorney Jeffrey A.
Marshall, CELA*
One
way to limit expensive skilled nursing facility usage is to
encourage the use of potentially less expensive assisted
living care.
Historically, Pennsylvania assisted
living homes have been prohibited from serving people who need
a nursing facility level of care.
Medicaid-funded care has only been available under a
home waiver program or in a skilled nursing institution.
This has meant that some care recipients were forced
into a more expensive nursing home even if their needs could
have been met in a less expensive assisted living setting.
Pennsylvania attempted to close this gap
with Act 56 of 2007, which created a new class of assisted
living providers. They will be able to serve residents with
higher care needs including some who would qualify for
Medicaid-funded nursing home care.
Unlike personal care homes, this new Assisted Living
Residence (ALR) provider class will be able to deliver some
health care services to their residents.
Moreover, they are intended to provide
their residents with a more private home-like feel than a
nursing facility, including such amenities as separate
bedrooms, bathrooms and kitchen facilities.
Consumers will have more direct control over their
care.
Act 56 directed DPW to develop
regulations for ALRs. Proposed
regulations have been drafted and will be published in the
Pennsylvania Bulletin on August 8, 2008.
A regulatory analysis form submitted by
the Department of Public Welfare states that the “proposed
regulation establishes the minimum standards for licensure of
assisted living residences to allow individuals to age in
place. The regulation protects consumers' health and safety,
privacy and autonomy while at the same time balancing
providers' concerns related to liability and individual
choice.”
“The establishment of Assisted Living
Residence licensure will provide Pennsylvania's citizens with
another choice when they consider their long-term care service
needs. An individual that chooses to reside in an assisted
living residence will have the opportunity to age in place and
could delay or prevent the need for placement in a nursing
facility.”
Eventually, DPW intends to use Medicaid
funds to subsidize the cost of care for a limited number of
assisted living residents.
The Office of Long Term Living expects to submit an
assisted living waiver to CMS sometime before the end of this
year. The hope is
that Medicaid will spend less on assisted living care than
would be paid to a nursing facility.
Only facilities that seek to operate as
assisted living residences will be affected by the regulation.
It is anticipated that 100 assisted living residences will be
licensed in FY 2009-2010; 150 assisted living residences in FY
2010-2011; 200 assisted living residences in FY 2011-2012; and
250 assisted living residences in FY 2012-2013.
The anticipated effective date for the
proposed ALR regulation is July 1, 2009.
Interested persons may submit written comments, suggestions or
objections regarding the proposed rulemaking to the following:
Office of Long Term Living
Attention: Gail Weidman
PO Box 2675
Harrisburg, PA 17105
within 30 calendar days after the date of publication of the proposed
rulemaking in the Pennsylvania Bulletin.
An
early copy of the proposed ALR regulation is available on
Marshall, Parker & Associates’ website at
http://www.paelderlaw.com/pdf/proposed_ALR_regs_PA.pdf
.
The August 8th
edition of the Pennsylvania Bulletin will be available on and after that date
at www.pabulletin.com.
Attorney
Marshall can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
New
VA Rules Impose Continuing Education Requirement on Agents and
Attorneys
Written
By: Attorney Jeffrey A. Marshall, CELA*
A
new Veteran’s Administration (VA) rule that took effect on
June 23rd establishes new accreditation requirements for
lawyers who represent veterans before the VA.
Accreditation
refers to the authority granted by the VA to representatives,
agents, and attorneys to assist claimants in the preparation,
presentation, and prosecution of claims for VA benefits.
Without
accreditation, an individual may not independently assist
claimants in the preparation, presentation, and prosecution of
claims for VA benefits.
The
new accreditation and fee rules are published at 72 Fed. Reg.
29,852 - 29,880 (May 22,
2008). They
require that in addition to being a member in good standing of
a State bar the lawyer must complete State-bar-approved
continuing legal education (CLE) credits in veterans benefits
law and procedure to maintain accreditation.
(CLE requirements also apply to non-attorneys who act
as agents).
An
initial 3 hours of State-bar-approved CLE in veterans benefits
law and procedure is required for agents and attorneys.
Additionally, to maintain accreditation, agents and
attorneys will be required to periodically complete 3 hours of
State-bar-approved CLE in veterans benefits law and procedure.
Agents
and attorneys applying for accreditation must satisfy the
initial CLE requirement during the first year of accreditation
and must satisfy the follow-on CLE requirement every 2 years
thereafter. Upon completion of the initial and follow-on CLE
requirements, agents and attorneys must certify in writing to
the VA that they have completed qualifying CLE and provide the
date and time of the CLE and identification of the CLE
provider.
For
attorneys, the initial accreditation process consists of
filing an application with the VA General Counsel,
self-certification of admission information concerning
practice before any other court, bar, or State or Federal
agency, and a determination of character and fitness. The
General Counsel will presume an attorney’s character and
fitness to practice before VA based on State bar membership in
good standing unless the General Counsel receives credible
information to the contrary.
As
a further condition of initial accreditation, both agents and
attorneys are required to complete 3 hours of qualifying
continuing legal education (CLE) during the first 12-month
period following the date of initial accreditation by VA.
The CLE course must be approved for a minimum of 3
hours of CLE credit by any State bar association and, at a
minimum, must cover the following topics: representation
before VA, claims procedures, basic eligibility for VA
benefits, right to appeal, disability compensation (38 U.S.C.
Chapter 11), dependency and indemnity compensation (38 U.S.C.
Chapter 13), and pension (38 U.S.C. Chapter 15).
To
maintain accreditation, agents and attorneys are required to
complete an additional 3 hours of qualifying CLE on veterans
benefits law and procedure not later than 3 years from the
date of initial accreditation and every 2 years thereafter.
The
new rule also covers the issue of attorney’s fees.
Attorney
Marshall can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
New
Hospice Rules Become Final
Written
By: Attorney Jeffrey A. Marshall, CELA*
In
the first major overhaul of regulations governing the hospice
industry since 1983, CMS has updated its Medicare Conditions
of Participation to include explicit language on patient
rights that had not existed under the previous regulations.
Specifically, the rule says, patients who choose hospice, or
palliative care over curative treatment are entitled to such
things as:
-Participation
in their treatment plan
-The right to effective pain management
-The right to refuse treatment and
-The right to choose his or her own physician
In addition to the new patient rights’
section, the final regulation, which will take effect in
December 2008, updates a number of other hospice rules.
In 2006 there were approximately 4500
hospices nationwide. About
1.3 million people received hospice services in 2006, more
than twice as many as did a decade earlier. Medicare
spent about $10 billion on hospice care in 2007, up from about
$3 billion in 2000.
The new rule was published in the Federal
Register on June 5, 2008 and is available online at http://edocket.access.gpo.gov/2008/pdf/08-1305.pdf
Attorney
Marshall can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
Attorney
Marshall on Faculty of Elder Law Institute
Written
By: Melissa Bottorf, Director of Marketing & Public
Education
On July 24th and 25th, the Pennsylvania
Bar Institute hosted the 11th Annual Elder Law
Institute at the Harrisburg Hilton.
Over 350 attorneys attend the Institute which has
become known as one of the best elder law conferences in the
nation. For the 8th consecutive year, Jeff Marshall
kicked off the Institute’s opening session by co-presenting
with fellow Certified Elder Law Attorney, Robert
Clofine. Their session, entitled “The
Year in Review,” updated attendees on the latest
developments and most relevant case law affecting elderly
clients in Pennsylvania.
Attorney Marshall also moderated the
Institute’s closing session entitled “The
Gray(ing) Areas of Medicaid.”
The session enabled attendees to ask their most
perplexing questions about Medicaid Planning to a panel of the
state’s leading elder law experts.
Written materials from this year’s
Institute are available for purchase on PBI’s website at www.pbi.org.
Melissa
can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
Learn
How to Protect Your Assets from Long Term Care Costs at our
FREE Community Workshop in Williamsport
Saturday,
August 2, 2008
10:00
AM until 12:00 PM
Holiday
Inn Downtown
100
Pine Street in Williamsport
Saturday,
August 9, 2008
10:00
AM until 12:00 PM
Scranton
Hilton & Convention Center
100
Adams Avenue in Scranton
(validated parking available in the
Medallion Parking Garage beside the Hilton-BUT NOT in the
Casey Garage)
Reserve
your seat by calling 1-800-401-4552 or visit our registration
page online.
