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Affordable Care Act

  • 1.  Affordable Care Act

    Posted 07-25-2014 16:29
    This message has been cross posted to the following Discussions: Forensic and Life Care Planning - IALCP .
    -------------------------------------------
    Based on the results of the Life Care Plan Survey 2009, a majority of respondents do not use negotiated fees and/or an established fee schedule  (thus, the cost of items or services in a life care plan are not reduced because the person "might" have private insurance or "might" get Medicare, etc. as we cannot indicate that it is likely that a plan will pay for a specific service now or in the future).  

    What are your thoughts on this topic/protocol with consideration of the Affordable Care Act? 

    Is it appropriate for a life care planner to report a cost for care, then zero it out or significantly reduce it by saying that money for purchase of private insurance under the Affordable Care Act will take care of it?   

    Thanks!

     



    -------------------------------------------
    Ann T. Neulicht PhD
    (919) 870-6048
    Raleigh, NC
    -------------------------------------------


  • 2.  RE: Affordable Care Act

    Posted 07-25-2014 16:48

    Absolutely not;  From my experience with Medicare Set Aside;  changes are continuous and no collateral source can be relied upon;  even in set

    Aside the private pay cost is used.  We do Life Care Plans for Individuals but the third party payors allow services mostly by statistical analysis;

    Eg if only a small percentage of people will be harmed if they don't have PSA's after a certain age then they are not allowed even if the treator

    Does not agree for a particular patient.  I could write volumes on this subject

     

     

    That the law has already been changed 28 times

     




    Original Message


  • 3.  RE: Affordable Care Act

    Posted 07-25-2014 16:55
    I was asked to look into the Affordable Care Act on a particular case recently.  When I reviewed detailed information about the coverage, I found that private residential rehabilitation programs were not covered.  This would be problematic to say the least, for some individuals with TBI or other significant condition requiring such placement.

    -------------------------------------------
    Carla Seyler
    Rehabilitation Counselor
    carla@seylerfavaloro.com
    New Orleans, LA United States
    -------------------------------------------


    Original Message


  • 4.  RE: Affordable Care Act

    Posted 07-25-2014 16:55
    TOTALLY AGREE, Sharon.

    It is but another collateral souce that can not be relied upon.    


    -------------------------------------------
    Hope Wade, RN, BS, CLNC, CLCP
    President
    hhwrnlegalnurse@aol.com
    Edmond, OK United States
    -------------------------------------------


    Original Message


  • 5.  RE: Affordable Care Act

    Posted 07-25-2014 17:07

    Ann,

    Attached is a brief article I was recently asked to write on the PPACA and Life Care Planning for individuals with acquired brain injury.  The article is directed to a broad audience including clinicians, providers, administrators, attorneys, etc. ; some of who are not fully familiar with Life Care Planning.   I hope this contributes to the discussion.  Comments would be appreciated and appreciation is noted to a number of colleagues who assisted in article development.

    Harvey

     

    ---

    Harvey E. Jacobs, PhD, CLCP  
    Licensed Clinical Psychologist / Certified Life Care Planner
    7400 Beaufont Springs Drive,  # 401 
    North Chesterfield, VA  23225
    Office: (804) 323-5560; Fax: (804) 323-5562; Cell: (804) 814-0609
    harveyjacobs@harveyjacobs.net  Website:  www.harveyjacobs.net


    This message and its attachments are confidential. If you received it in error, please notify the sender immediately by E-mail or phone and destroy the message and its attachments. Thank you.

     

    On 2014-07-25 16:29, Ann Neulicht via IARP Connect wrote:

     
    IARP | Communities | View Discussions | All Discussions | Life Care Planning - IALCP
    Affordable Care Act      
    This message has been cross posted to the following Discussions: Forensic and Life Care Planning - IALCP .
    -------------------------------------------
    Based on the results of the Life Care Plan Survey 2009, a majority of respondents do not use negotiated fees and/or an established fee schedule  (thus, the cost of items or services in a life care plan are not reduced because the person "might" have private insurance or "might" get Medicare, etc. as we cannot indicate that it is likely that a plan will pay for a specific service now or in the future).  

    What are your thoughts on this topic/protocol with consideration of the Affordable Care Act? 

    Is it appropriate for a life care planner to report a cost for care, then zero it out or significantly reduce it by saying that money for purchase of private insurance under the Affordable Care Act will take care of it?   

    Thanks!

     



    -------------------------------------------
    Ann T. Neulicht PhD
    (919) 870-6048
    Raleigh, NC
    -------------------------------------------
    		 
    Be the first person to recommend this.
     
     
     
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    Original Message


  • 6.  RE: Affordable Care Act

    Posted 07-25-2014 17:13

    Apologies to all.  Apparently IARP blocked the attachment containing the article in my previous message.  Please e-mail me at:  harveyjacobs@harveyjacobs.net if you would like a copy.

    Harvey

    ---

    Harvey E. Jacobs, PhD, CLCP  
    Licensed Clinical Psychologist / Certified Life Care Planner
    7400 Beaufont Springs Drive,  # 401 
    North Chesterfield, VA  23225
    Office: (804) 323-5560; Fax: (804) 323-5562; Cell: (804) 814-0609
    harveyjacobs@harveyjacobs.net  Website:  www.harveyjacobs.net


    This message and its attachments are confidential. If you received it in error, please notify the sender immediately by E-mail or phone and destroy the message and its attachments. Thank you.

     

    On 2014-07-25 17:07, Harvey Jacobs via IARP Connect wrote:

     
    IARP | Communities | View Discussions | All Discussions | Life Care Planning - IALCP
    RE: Affordable Care Act      

    Ann,

    Attached is a brief article I was recently asked to write on the PPACA and Life Care Planning for individuals with acquired brain injury.  The article is directed to a broad audience including clinicians, providers, administrators, attorneys, etc. ; some of who are not fully familiar with Life Care Planning.   I hope this contributes to the discussion.  Comments would be appreciated and appreciation is noted to a number of colleagues who assisted in article development.

    Harvey

     

    ---

    Harvey E. Jacobs, PhD, CLCP  
    Licensed Clinical Psychologist / Certified Life Care Planner
    7400 Beaufont Springs Drive,  # 401 
    North Chesterfield, VA  23225
    Office: (804) 323-5560; Fax: (804) 323-5562; Cell: (804) 814-0609
    harveyjacobs@harveyjacobs.net  Website:  www.harveyjacobs.net


    This message and its attachments are confidential. If you received it in error, please notify the sender immediately by E-mail or phone and destroy the message and its attachments. Thank you.

     

    On 2014-07-25 16:29, Ann Neulicht via IARP Connect wrote:

     
    IARP | Communities | View Discussions | All Discussions | Life Care Planning - IALCP
    Affordable Care Act      
     
    This message has been cross posted to the following Discussions: Forensic and Life Care Planning - IALCP .
    -------------------------------------------
    Based on the results of the Life Care Plan Survey 2009, a majority of respondents do not use negotiated fees and/or an established fee schedule  (thus, the cost of items or services in a life care plan are not reduced because the person "might" have private insurance or "might" get Medicare, etc. as we cannot indicate that it is likely that a plan will pay for a specific service now or in the future).  

    What are your thoughts on this topic/protocol with consideration of the Affordable Care Act? 

    Is it appropriate for a life care planner to report a cost for care, then zero it out or significantly reduce it by saying that money for purchase of private insurance under the Affordable Care Act will take care of it?   

    Thanks!

     



    -------------------------------------------
    Ann T. Neulicht PhD
    (919) 870-6048
    Raleigh, NC
    -------------------------------------------
    		 
    Be the first person to recommend this.
     
     
     
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    Original Message

     



    -------------------------------------------
    Ann T. Neulicht PhD
    (919) 870-6048
    Raleigh, NC
    -------------------------------------------
    		 
    Be the first person to recommend this.
     
     
     
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    [Non-text portion of this message removed]



    Original Message------

    Ann,

    Attached is a brief article I was recently asked to write on the PPACA and Life Care Planning for individuals with acquired brain injury.  The article is directed to a broad audience including clinicians, providers, administrators, attorneys, etc. ; some of who are not fully familiar with Life Care Planning.   I hope this contributes to the discussion.  Comments would be appreciated and appreciation is noted to a number of colleagues who assisted in article development.

    Harvey

     

    ---

    Harvey E. Jacobs, PhD, CLCP  
    Licensed Clinical Psychologist / Certified Life Care Planner
    7400 Beaufont Springs Drive,  # 401 
    North Chesterfield, VA  23225
    Office: (804) 323-5560; Fax: (804) 323-5562; Cell: (804) 814-0609
    harveyjacobs@harveyjacobs.net  Website:  www.harveyjacobs.net


    This message and its attachments are confidential. If you received it in error, please notify the sender immediately by E-mail or phone and destroy the message and its attachments. Thank you.

     

    On 2014-07-25 16:29, Ann Neulicht via IARP Connect wrote:

     
    IARP | Communities | View Discussions | All Discussions | Life Care Planning - IALCP
    Affordable Care Act      
    This message has been cross posted to the following Discussions: Forensic and Life Care Planning - IALCP .
    -------------------------------------------
    Based on the results of the Life Care Plan Survey 2009, a majority of respondents do not use negotiated fees and/or an established fee schedule  (thus, the cost of items or services in a life care plan are not reduced because the person "might" have private insurance or "might" get Medicare, etc. as we cannot indicate that it is likely that a plan will pay for a specific service now or in the future).  

    What are your thoughts on this topic/protocol with consideration of the Affordable Care Act? 

    Is it appropriate for a life care planner to report a cost for care, then zero it out or significantly reduce it by saying that money for purchase of private insurance under the Affordable Care Act will take care of it?   

    Thanks!

     



    -------------------------------------------
    Ann T. Neulicht PhD
    (919) 870-6048
    Raleigh, NC
    -------------------------------------------
    		 
    Be the first person to recommend this.
     
     
     
    Discussion Home
    Reply to Discussion
    Reply to Sender
    Post Message
    Forward Message
    Print Message
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    Author's Messages
    Search
    My Subscriptions
     
     
    		 
    You are subscribed to "Life Care Planning - IALCP" as harveyjacobs@harveyjacobs.net. To change your subscriptions, go to My Subscriptions. To unsubscribe from this community discussion, go to Unsubscribe.
     




  • 7.  RE: Affordable Care Act

    Posted 07-25-2014 17:25
    As long as third-party payers have the right to subrogate their past and future expenses in a lawsuit when there is a recovery, then there should be no impact whatsoever on our work as life care planners.  As in the past, this is a collateral source. Carry-on as per usual

    Sent from Walter's iPhone



    Original Message


  • 8.  RE: Affordable Care Act

    Posted 07-28-2014 13:53
    I think the implications for LCP created by the ACA would be a good topic for the next Summit.
    I have certainly been hearing opinions from attorneys on both sides and have been starting to see reductions in some LCPs that I have reviewed.
    Even though ACA mandates some level of coverage, we know that all coverage is not equal and that people can opt out if willing to pay the fine. Plus we don't know whether this will be considered a collateral source that is excluded.
    If we had some truly authoritative information that we could use to base our methodology on, then we could move forward with decisions that we can live with.

    -------------------------------------------
    Karen Preston, FIALCP
    Consultant
    rnsconsult@aol.com
    Sacramento, CA United States
    -------------------------------------------


    Original Message


  • 9.  RE: Affordable Care Act

    Posted 07-28-2014 13:57
    Karen,

    I also understand that we are to base future costs on what is reasonably expected to exist. The ACA is under political attack. To assume it will exist in one, ten or twenty years is not a sound assumption.

    Hope you are well.
    Tony





    Anthony J. Choppa, MEd, CRC, CCM, CDMS
    Rehabilitation Counselor/Case Manager
    OSC Vocational Systems, Inc
    10132 NE 185th 
    Bothell, WA 98011
    425-486-4040 * 5220
    425-486-8701 fax

    Sent from my iPhone



    Original Message


  • 10.  RE: Affordable Care Act

    Posted 07-28-2014 15:42
    Agreed, Tony.
    Since some LCPers are in fact already altering their practices, we are losing uniformity in methodology, hence I think it warrants more discussion as a field. Harvey's article is a start. I'd like to see us be proactive in addressing this so we do not fragment our fundamental methodology.
    I think what makes this feel different is that ACA is a law that affects everyone, it is still new, and there is pressure from customers who may sound authoritative to alter our practice. The individual LCPer may respond to that pressure and could be well served to have the support of the LCP field through a discussion and decisions that can be used to support/defend LCP decisions.

    -------------------------------------------
    Karen Preston, FIALCP
    Consultant
    rnsconsult@aol.com
    Sacramento, CA United States
    -------------------------------------------


    Original Message


  • 11.  RE: Affordable Care Act

    Posted 07-28-2014 15:45
    Karen - I agree about the necessity of addressing this as well as the tendency to look at other issues such as cash discounts. I think it would be a good topic to address as soon as feasible.

    Thanks,Carol



    Original Message


  • 12.  RE: Affordable Care Act

    Posted 07-28-2014 15:55
    I also agree...here in California we also have to deal with the Correnbaum and Howell decision and different judges are interpreting this differently in regard to life care plans. Some uniformity in this area would be nice as well. 

    Addie aadedeji

    Sent from my iPhone



    Original Message


  • 13.  RE: Affordable Care Act

    Posted 07-28-2014 16:43
    Karen - I agree about the necessity of addressing this as well as the tendency to look at other issues such as cash discounts. I think it would be a good topic to address as soon as feasible.

    Thanks,Carol



    Original Message


  • 14.  RE: Affordable Care Act

    Posted 07-28-2014 21:00
    Currently, a number of the individuals for whom LCP's are  written qualify, or may soon do so, for Medicare and/or Medicaid.  Is anyone reducing their cost analysis basis because one of these federal insurance programs may step in, or are you all allowing the attorneys to develop set-aside arrangements?  It seems to be that there are 2 issues - will the ACA stand up after the next election and into the future, and, if so, do the required insurance policies cover items typically covered in an LCP.  Unfortunately, I think the answer to both questions is "No" in many instances, but even if it were "Yes", would it then be reasonable to take the track of an ACA set-aside rather than reducing the cost basis given the questionable future of the law?

    I would love to hear what other people think about this.

    -------------------------------------------
    Leslie Gillespie
    Director
    gillespierehab@aol.com
    Pace, FL United States
    -------------------------------------------


    Original Message


  • 15.  RE: Affordable Care Act

    Posted 07-29-2014 01:37
    Unless a program can guarantee the items in a life care plan, then there is no change to the life care plan components  that are researched by the LCPer  & physician.


    -------------------------------------------
    Ronald Smolarski
    Director
    ron@beaconrehab.com
    Ann Arbor, MI United States
    -------------------------------------------


    Original Message


  • 16.  RE: Affordable Care Act

    Posted 07-29-2014 07:46
    Agreed!

    Kate B. Murphy RN MSN CRRN 
    Sent from my iPhone



    Original Message


  • 17.  RE: Affordable Care Act

    Posted 07-29-2014 14:07

    Life Care Plans are plans of care for individuals with catastrophic injuries and needs which will last throughout their life.  Discounting prices of services and care due to "collateral sources" will not accurately reflect the individual's needs during the course of their lifetime.  These sources often change in terms of scope of coverage of services they pay for, what is paid for today, may not be paid for tomorrow.  The Life Care Plan does not consider what is subsidized and what is not, the plan looks at actual costs of care in the individuals geographic area.

    If I were to go into a nursing home because of an illness my care might be paid for a period of time through Medicare, Medicaid or the PACA, however, if it's now ten years later, who is to say with absolute certitude those same services would be covered at the same rates?

    The nursing home will still want their money and they won't care who the source is.


    -------------------------------------------
    Brian Daly, CRC, CLCP
    bdalyoas@gmail.com
    Clinton, NJ United States
    -------------------------------------------


    Original Message


  • 18.  RE: Affordable Care Act

    Posted 07-29-2014 18:32
    The various comments being made in this thread are all legitimate, BUT what everyone needs to keep in mind is that the issue of collateral sources and ACA are all targets in motion.  Here in CA, several judges are currently ruling that life care planners must provide information on the current collateral sources and this may include MediCare if we have knowledge that MediCare is going to be effect soon.  In addition, they expect us to provide info on what we know about the ACA right now.  IF the LCPer does not provide that information, per the judge's instructions, then the LCPers are being excluded from testifying at the trial all together.  Because of this, our standard of practice on how we make our cost estimates is changing from what has been published by the IALCP to what the CA rulings are as they come up.  It is an extreme source of frustration for most of us in CA and though I have personally been included in the process of writing rebuttals to oppose motions in limine on these issues, the judge makes the final decision based upon how he or she feels is appropriate and we must comply.  Therefore, the profession now has to take this into consideration when analyzing / updating our standards of practice.   

    Lets just say life is getting interesting here in CA.  

    -------------------------------------------
    Tracy Albee
    tracy@medilegalinc.com
    Tracy, CA United States
    -------------------------------------------


    Original Message


  • 19.  RE: Affordable Care Act

    Posted 07-29-2014 19:41

    The judge always make the ultimate decisions.  It is important that standards regarding the costing section of the Life Care Plan are fluid, to comply with  the rules in the specific venue of the case.  It is the attorney's responsibility to make the rules clear to the Life Care Planner.   Standards should not be so specific that the Life Care planner cannot comply with the legal issues and rulings when preparing Life Care Plans for litigation.   The inconsistency among judges, even in the same  venue, is a real challenge.  We must be able to comply with legal rulings to continue to testify.   The attorney can elicit your comments about the unpredictability of future collateral sources in testimony, but you need to be prepared to discuss these issues if the judge allows them during a trial. 

     

    Mona Yudkoff, RN

     

    BalaCare Nursing Solutions

    191 Presidential Blvd.  Suite W-8

    Bala Cynwyd, PA 19004

    610-664-8760

    mona@balacare.com

    www.balacare.com

     




    Original Message


  • 20.  RE: Affordable Care Act

    Posted 07-30-2014 16:24
    Food for thought in response to what Tracy Albee posted about what judges are requiring in California:  Is this perhaps something different from a life care plan, similar to the way a Medicare Set-Aside is different from a life care plan?  Life care planning methodology can be applied to meet the needs of different situations, jurisdictions, funding sources, etc., but the resulting document might be something other than a life care plan.  A modification of a life care plan (perhaps called something like a cost projection) could take into account collateral sources as required, but an actual life care plan should be based on the evaluee's disability-related needs and the actual costs of meeting those needs, right?  What do you think?

    - Chris Reid

    -------------------------------------------
    Christine Reid
    Professor Rehabilitation Counseling
    creid@vcu.edu
    Richmond, VA United States
    -------------------------------------------


    Original Message


  • 21.  RE: Affordable Care Act

    Posted 07-30-2014 17:13

    Thank you Chris for your comments, but yes, these are situations where the plaintiff is catastrophically injured and in need of a full life care plan.  It won't matter to the judges what we call the document, the point they are ruling on is that they do not believe any provider will be paid the full cash price for services, and therefore, the plan should be based on reimbursement, rather than on the billed amount.  So if a physician charges $100, but any particular payor source, such as Medicare or private insurance, agrees to only pay $50.00, then the jury should only award $50.  In my experience so far, we try and explain that the physician may still hold the plaintiff liable for the unpaid amount of the bill, or the additional $50.00, but the Judges don't want to hear about that, saying it is "speculative".  I try to explain that knowing what any particular insurance will pay for any certain CPT code is also speculative, but apparently here in CA, that is often not the case. 

    -------------------------------------------
    Tracy Albee
    tracy@medilegalinc.com
    Tracy, CA United States
    -------------------------------------------


    Original Message


  • 22.  RE: Affordable Care Act

    Posted 07-30-2014 21:57

    Very interesting and somewhat troubling.

    In my humble opinion - I believe this scenario needs to be submitted to the Foundation for LCP for review.

    I can foresee the possible need for Foundation for LCP 'sourced' education to the California Courts.

     

    Rich Shivers

    M.Ed., CRC, CCM, CLCP, LPC, CISM, ABDA/F

    Catastrophic Medical & Rehabilitation Consultant

    Georgia Licensed Catastrophic Supplier #01865C

     

    Cell (404) 273-6771  Fax (800) 517-5594  E-mail: rjshivers@comcast.net

     

    Richard J. Shivers LLC

    Catastrophic Injury Services

    P.O. Box 189

    Clarkston, GA 30021

     

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    Original Message


  • 23.  RE: Affordable Care Act

    Posted 07-28-2014 14:18
    We are working on webinars to keep up with the changes in the ACA and impact to all.  If you have suggestions for experts / speakers knowledgeable in the area, please forward to me. 

    Insurance coverage is only one portion of the act.  Implications for LCP are evolving.  More rapidly are implications for case management with Accountable Care Organizations, Patient Centered Medical Homes Community and Transition services.
    Debbe





    Original Message