Reverse Mortgage: Useful Retiree Tool or Bad Move?

By Fredrick P. Niemann, Esq., a NJ Elder Care Attorney

I think reverse mortgages can be a very useful tool for some clients and their families.  Here’s an article that I recently reviewed which gives you a simple snapshot of the product and how it works.

CNBC Article

If you have any questions regarding a reverse mortgage, please contact Fredrick P. Niemann, Esq., NJ Elder Care Attorney, toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.

 

Program of All-inclusive Care for the Elderly (PACE)

By Fredrick P. Niemann, Esq. of Hanlon Niemann, a Freehold, NJ Elder Care Attorney

What is PACE?

PACE stands for Program of All-inclusive Care for the Elderly. It is an innovative Medicare program that provides individuals age 55 and older comprehensive medical and social services provided by a team of professionals in a community-based center and in their homes, helping program participants delay or avoid long-term nursing home care. The PACE center serves as the hub for medical care, rehabilitation, social activities and dining.

Eligibility to participate in PACE

To participate, an individual must be 55 years of age or older, require nursing home level of care but be able to live safely in the community at time of enrollment with the services of PACE.

What services are provided through PACE?

PACE provides all the services covered by Medicare and Medicaid, without the limitations normally imposed by these programs. It also provides any other services deemed necessary by the team that allows participants to remain in the community. Services provided by PACE include, but are not limited to, primary care (including doctor, dental and nursing services), prescription drugs, adult day health care, home and personal care services, nutrition services, and hospital and nursing home care if and when needed. Transportation to and from the center and all off-site medical appointments is also provided.

Who pays for PACE?

PACE agencies receive Medicare and Medicaid funds each month to ensure participant care, whether services are provided in the home, community or in a nursing home setting.

To discuss your NJ elder care matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com. Please ask us about our video conferencing consultations if you are unable to come to our office.

When Can Medicare Stop Paying for Skilled Care and Rehabilitation

By Fredrick P. Niemann, Esq. of Hanlon Niemann, a Freehold, NJ Medicaid Attorney

Often times families and patients are told by representatives of a nursing home or outpatient Medicare provider that Medicare will not pay for continued rehab, therapy or care because the patient is not improving. But is this policy legal? The short answer is no!

The Medicare Policy Manuals have been revised. These changes must be followed in NJ. The revisions have been published by the Centers for Medicare Medicaid Services (CMS). The changes in policy pertain to care in Inpatient Rehabilitation Facilities (IRF), Skilled Nursing Facilities (SNF), Home Health care (HH), and Outpatient Therapies (OPT). Translated, it means nursing homes and outpatient visitations at home and/or health care facilities.

The Transmittal from Medicare announces the new policy revisions as follows:

Abolition of the No Improvement Standard

The “No Improvement Standard” is not to be applied in determining Medicare coverage for maintenance claims that require skilled care. Medicare has long recognized that even in situations where no improvement is possible, skilled care may nevertheless be needed for maintenance purposes (i.e., to prevent or slow a decline in condition).

In truth, this policy is the required legal Medicare standard. Medicare coverage of skilled services is based on the “unique medical condition of the individual beneficiary”); (prohibiting the use of utilization screens or “rules of thumb” to make coverage decisions); 42 C.F.R. § 409.44(b)(3)(iii) (providing that the determination of whether a skilled service is reasonable and necessary “must be based solely upon the beneficiary’s unique condition and individual needs without regard to whether the illness, or injury is acute, chronic, terminal, or expected to last a long time”); 42 C.F.R. §409.32(c) “Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve current capabilities.”; “Rules of thumb” in the Medicare medical review process are prohibited… Medical denial decisions must be based on a detailed and thorough analysis of the beneficiary’s total condition and individual need for care.

Patients should discuss with their health care providers the Medicare maintenance standard and whether it is applicable to them. Health care providers should apply the maintenance standard and provide medically necessary nursing services or therapy services, or both, to patients who need them to maintain their function, or prevent or slow their decline. Under the maintenance standard articulated in the settlement, the important issue is whether the skilled services of a health care professional are needed, not whether the Medicare beneficiary will “improve.”

CMS has issued a Fact Sheet outlining the “new policy”. You can use this fact sheet now as evidence that skilled maintenance services are coverable for skilled nursing facility care, outpatient therapy, and home health care.

For people needing assistance with appeals, the Center for Medicare Advocacy has self-help materials available. This information can help individuals understand proper coverage rules and learn how to contest Medicare denials for outpatient, home health, or skilled nursing facility care.

To discuss your NJ Medicaid, Medicare and Elder Care matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com. Please ask us about our video conferencing consultations if you are unable to come to our office.

 

Guardianship Commissions in New Jersey

By Fredrick P. Niemann, Esq. of Hanlon Niemann, a Freehold, NJ Guardianship Attorney

Questions often come up concerning compensation available to a Guardian if appointed by the Superior Court of New Jersey. The following blog discusses the commission schedule which a Guardian is entitled to receive under New Jersey Law.   It is as follows:

(1)     One half (1/2%) percent (.5) on the total value of the corpus each year; corpus is defined as the economic fair market value of all property owned by the incapacitated

(2)     Six (6%) percent of all income received annually; if $100,000.00 of income is received the Executor’s commission is six (6%) percent.

(3)     Upon the termination of the Guardianship caused by restoration to full functioning or death of the Ward; the Guardian is entitled to a two (2%) percent termination commission on the total value of the entirety of the incapacitated estate.

I hope that this helps you get a better idea of the economic compensation scheduled for Guardians who serve in New Jersey.

To discuss your NJ Guardianship matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com. Please ask us about our video conferencing consultations if you are unable to come to our office.

Hold on a Minute: Non-Probate Assets Can be Recaptured to Pay New Jersey Inheritance Death Taxes

By Fredrick P. Niemann, a New Jersey Estate Administration and Probate Attorney

I recently received a question from a client concerning the liability to pay New Jersey Death Taxes. Apparently, the decedent signed a Will which provided that all inheritance and death taxes would be paid from the residuary estate. The residuary estate is the entirety of the estate but excludes non-probate assets.   Probate assets are those assets owned by an individual at death without a beneficiary designation.   Non-probate assets are assets that name a beneficiary upon death or are jointly owned with another person.

Unfortunately in this case, the residuary estate did not contain sufficient funds to cover New Jersey Transfer Inheritance Taxes. Located inside the Will was a specific bequest of probate assets to be paid to a named beneficiary.   If this specific bequest was not paid, however, then there would be sufficient funds to pay New Jersey Death Taxes. The question presented was whether the Executor could withhold the payment of the specific bequest to cover the shortfall in New Jersey Death Taxes. My answer to the client was direct and simple, yes. Both probate and non-probate assets are subject to payment of New Jersey Death Tax and Inheritance Taxes regardless of provisions in the Will.   The Executor of the estate was told he should apply the specific bequest proceeds to satisfy death taxes and any leftover funds could then be paid over to the beneficiary.   I would note, however, that the payment of taxes should be apportioned based on the percentage of inheritance received by both the beneficiary of the specific bequest as well as the residuary beneficiaries.

Have probate and estate questions? Need answers? Then contact Fredrick P. Niemann, Esq., a New Jersey attorney, welcomes inquiries regarding Estate Administration and Probate of estate matters throughout all 21 counties of the State of New Jersey.  Please call me toll-free at 855-376-5291 or email me at fniemann@hnlawfirm.com.