Medi-Cal Planning from Start to Finish

 

Kirsten Howe

Kirsten Howe

Attorney at Absolute Trust Counsel
67 articles 

In this series of posts we will focus on Medi-Cal for our over-65 clients who need assistance with long-term care. We will take you through the laws and what we do for our clients, from the initial meeting until we receive that eligibility letter, to help them qualify, apply for and receive Medi-Cal, for long-term care.

The Initial Appointment – Gathering Information

Every client’s case is different, of course, but our over-65 clients come to discuss Medi-Cal planning with us for a few common reasons. In our initial meeting we must uncover what exactly their situation is so that we can recommend solutions. One common scenario is our client has recently discovered he has a degenerative illness, such as Alzheimer’sdisease, and he and his wife are worried about their future, worried about spending all their savings at the rate of $10,000 or more per month for the husband’s long-term care. The client may be unmarried with a similar diagnosis and not wanting to burden her children if she runs out of money paying long-term care expenses.

A third scenario involves a client already in a nursing home, already paying unbelievable amounts of money for care every month, and the spouse or other family members are in a panic. Each of these cases presents us with a different set of possible solutions to explore and we must ask lots of questions, including:

What Kind of Care is Needed?

Medi-Cal provides a wide variety of services that fall under the umbrella of long-term care. For those who would otherwise require nursing-home level care but prefer to and are able to remain in their homes with the available support, Medi-Cal has a number of Home and Community Based Services (HCBS). Which programs are available varies by county. Some programs directly provide support through agencies that contract with the county. Some programs allow the Medi-Cal recipient to hire caregivers they select themselves, which could be friends or family members. For some of our clients, remaining in their home is just not possible. Medi-Cal also provides support to those in need of nursing-home level care in nursing homes.

What Planning Do We Have or Can We Do?

One very important preliminary step is to make sure we have the legal ability to do planning, now and in the future. As long as our client has the mental capacity to do the necessary planning, everything is fine. However, if our client no longer has the mental capacity necessary to understand the work we do and to participate in the planning, we check documents- trusts and power of attorney- to see if someone else has been granted the power to do planning.

Medi-Cal planning often requires our clients to give away their property. This power to give away property is often not included in trusts and powers of attorney. Two very common misconceptions: husbands and wives can do just about anything with each other’s property, especially in a community property state like California; and all powers of attorney are the same. The law, however, is that without your written authorization nobody, not even your spouse, can legally give your property away to anyone, including themselves. To do so without proper authority could be considered theft and elder financial abuse and it would not be recognized as a completed gift for Medi-Cal eligibility purposes.

What we need to see is a written power of attorney that authorizes someone else to give away our client’s property in order to qualify for Medi-Cal. This is not a power that is granted in most powers of attorney. If the client has a trust, then his trust must also authorize his trustee to give away his property, which, again, is not a common trust provision. If our client has not given these powers to anyone and still has the capacity to do so, creating an appropriate power of attorney and trust language is usually one of the most urgent items for us to do. If our client does not have capacity some planning options will not be available.

Most clients who are considering applying for Medi-Cal are also interested in avoiding Estate Recovery. As we will discuss in more detail in a later post, payments made by Medi-Cal on behalf of the recipient can be recovered from his probate estate upon his death. The need to create an estate plan that avoids probate is obvious here. When our client has capacity or another person has legal authority through a power of attorney, we will want to create a revocable living trust and make sure it owns all appropriate assets.

In our next post we continue to explore the preliminary questions we cover in our first meeting with our clients.

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Medical and Medicare-Paid Pharma and Cancer genetic tests

For Medical and Medicare Paid Pharma and Cancer genetic tests in the USA , contact Connie at motherhealth@gmail.com or text 408-854-1883

Medicare coverage of genetic services. Under Medicare’s guidelines, BRCA1 and BRCA2 genetic testing is covered for people with: A personal history of breast cancer, with one or more of the following: … a close relative with a known BRCA1 or BRCA2 gene mutation.

Medicare coverage of genetic services

Under Medicare’s guidelines, BRCA1 and BRCA2 genetic testing is covered for people with:

  1. A personal history of breast cancer, with one or more of the following:
    • diagnosed at or before age 45, with or without family history
    • diagnosed at or before age 50 or two breast primaries, with 1 or more close blood relative(s) with breast cancer diagnosed at or before age 50 or 1 or more close blood relative(s) with ovarian cancer/fallopian tube/primary peritoneal cancer
    • two breast primaries when first breast cancer diagnosis occurred prior to age 50
    • diagnosed at any age, with 2 or more close blood relatives with breast and/or epithelial ovarian/fallopian tube/primary peritoneal cancer, at any age
    • close male blood relative with breast cancer
    • personal history of epithelial ovarian/fallopian tube/primary peritoneal cancer
    • of a certain ethnicity associated with higher mutation frequency, (eg, founder populations of Ashkenazi Jewish, Icelandic, Swedish, Hungarian or other) no additional family history required
    • a close relative with a known BRCA1 or BRCA2 gene mutation
  2. Personal history of epithelial ovarian/fallopian tube/primary peritoneal cancer.
  3. Personal history of male breast cancer.

Medicare operates on a regional system in which Medicare Area Contractors (MACs) manage the provision of health services for a specific jurisdiction. In the spring of 2015, four MACs expanded their coverage to better align their services with National Comprehensive Cancer Network (NCCN) guidelines in a number of important areas, including:

  • Expanding coverage of genetic testing for individuals who have or had cancer consistent with hereditary cancer syndromes, including men diagnosed with prostate cancer and men and women diagnosed with pancreatic cancer,
  • Coverage of multigene testing panels if more than one mutation may be indicated, and
  • Clarification of the BRCA testing policy for use of the targeted therapyLynparza (olaparib).

It is important to note that these policy changes apply only to states covered by the four MACs:
Arkansas, Arizona, California, Hawaii, Idaho, Kentucky, Montana, Nevada, North Carolina, North Dakota, Ohio, Oregon, South Carolina, South Dakota, Utah, Virginia, Washington, West Virginia and Wyoming

Medicare does not currently cover the cost of genetic testing in individuals who do not have a personal history of cancer.

Are you a US doctor with more than 10 Medicare patients?

ACO 1Calling all US doctors with at least 10 Medicare patients to join us as ACO participant.

Please join Wellness ACO LLC, a start up ACO health care provider, an organization serving Medicare patients that is seeking doctors with profit sharing.  Must have at least 10 Medicare patients. The government requires 5000 Medicare patients before they give a license.

Let us help the government cut health care costs as a team provider.

Email motherhealth@gmail.com

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An accountable care organization (ACO) is a healthcare organization that ties payments to quality metrics and the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. The ACO adopts alternative payment models (e.g., capitation). The ACO is accountable to patients and third-party payers for the quality, appropriateness and efficiency of its services. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is “an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it”

Hiring all laid off Pharma representative

We are hiring all laid off pharma representative to help your network of doctors use a non-invasive serum equivalent tester similar to pulse oximeter and invented by NIH.

scananti oxidant scan

We do not sell it but we expand our network by bringing in doctors, nurses and health consumers to use this tester to measure the level of anti-oxidants in our serum. Our team lead, Dr Kent Nelson and I are available for training.  There is a 2-day training in Utah scheduled on Sept 14-15.

https://www.linkedin.com/in/kentnelsonrph/

We help doctors increase their income stream and increase better patient health outcome.

Practitioners do not have to use the supplements that is manufactured by the maker of the tester, a bio-photonic scanner.

Email motherhealth@gmail.com for your cell to chat and answer your questions with Kent Nelson. Or you may call/text Ken at 650-861-2070.

Connie Dello Buono 408-854-1883

Distributor ID: USW9578356

To join Now:

 

Hire caregiver, find care home, schedule transport, seek nutrition consult

Call Text 408-854-1883 or (650) 946-3368 or email motherhealth@gmail.com if you need the following in the bay area:

Hire a caregiver

Caregivers for 24-hr care or 4-hr care are trained and monitored by case managers to match your needs and caregiving tasks include: assistance in daily living, medication management, cooking, light housekeeping, massage, help with exercise, driving, companion and other non-medical home care tasks to support your independence and health goals.

Find a care home, assisted living facility, nursing home or a senior care facility

A care home consist of 6 clients with 2-3 caregivers for 24-hr care in a residential facility, mostly non medical care.

An assisted living facility has many perks, a dining, a concierge, a nursing staff and in same facility can combine with a nursing facility. In some assisted living facilities, all the amenities of a senior center, high end apartment and care facility is combined in one place.

Nursing home is staffed with medical staff from nurses to doctors to provide 24/7  medical care.  After staying in this facility with a rehab facility combined, a senior can go home provided an in home caregiver is available for 24-hr care. Some clients in this facility are needing hospice care and are  terminally ill.

Schedule a transport

We can schedule Uber, a non medical transport or a medical transport for you.

Seek nutrition consult

We work with your primary care doctor to know what medications and foods are allowed and add more holistic approach and personalized menu plan and monitoring for your needs.

Buy a health product/tools

We can deliver diapers, lotion, gloves, and other tools such as anti-oxidant scanner, glucose meter and other health care products including tests (blood tests, EXOME DNA tests, Gut Microbiome tests) that you need as a doctor or as a health consumer.

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California Telemedicine Policy

With its first telemedicine parity laws passed in 1996, California has a long history in telemedicine reimbursement and was one of the first states to acknowledge the value of telemedicine.

Like many other U.S. states, California recognizes how important telemedicine is improving healthcare access for patients challenged by distance or mobility.  Pending legislation in California illustrates a movement toward utilizing telemedicine as a way to reach those with special needs and those in need of behavioral health care services.

Parity Law

Yes. California has a telemedicine parity law mandating private payer reimbursement for telemedicine.

Type of Telemedicine Covered

California’s Medicaid program covers live video telemedicine. The state also covers store-and-forward services for Teledermatology, teledentistry, and teleophthalmology.

Covered Health Services

California reimburses for wide variety of evaluative & management health services, and psychiatric services. Check out our Billing Codes section below for more details.

Billing Codes

 

CPT E&M Codess

  • 99201 – 99215 Office or other outpatient visit (new or established patient)
  • 99221 – 99233 Initial hospital care or subsequent hospital care (new or established patient)
  • 99241 – 99275 Consultations:  Office or other outpatient, initial or follow-up inpatient, and confirmatory

CPT Psychiatric Codes

  • 90785 Interactive complexity 90791 Psychiatric diagnostic evaluation
  • 90792 Psychiatric diagnostic evaluation with medical services
  • 90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services
  • 90832 Psychotherapy, 30 minutes with patient and/or family member
  • 90837 Psychotherapy, 60 minutes with patient and/or family member
  • 90839 Psychotherapy for crisis; first 60 minutes
  • 90840 Additional 30 minutes
  • Telehealth originating site facility fee : Q3014 (Once per day, same recipient & provider)
  • Transmission costs for telehealth services via audio/video communication: T1014
  • (Maximum of 90 minutes per day same recipient, same provider)
  • Plus, make sure you use the GT modifier with your CPT code to indicate live video telemedicine. If you’re using a store-and-forward solution, use the GQ modifier.

 

Eligible Healthcare Providers

Medi-Cal does limit which healthcare providers can get reimbursed for telemedicine. Here’s who qualifies:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Registered dietitians or nutrition professionals
  • Nurse midwives
  • Certified registered nurse anesthetists
  • Clinical psychologists
  • Clinical social workers

Online Prescriptions

Providers are prohibited from prescribing or dispensing dangerous drugs or dangerous devices on the Internet without an appropriate prior examination and medical indication.

Informed Patient Consent

Yes. Providers need to get patients’ oral consent before they can start a telemedicine service. Providers also need to document consent in the patient’s medical record.

Cross-State Telemedicine Licensing

There’s no interstate licensing available for California right now. Providers doing telemedicine in California need to have a California license.

Restrictions on Locations

Medi-Cal has no limitations on where the patient or provider has to be during the telemedicine visit. That makes it easy for providers to offer quick, convenient virtual care – and get paid for it.

Other Reimbursable Fees

Medi-Cal reimburses the originating site a facility fee, and pays the originating and distant sites for live video transmission costs.

Reimbursement Rates

Good news! California Medicaid reimburses telemedicine services according to the current physician fee schedule amount for that medical service. So reimbursement rates for a telemedicine service should be the same as the comparable in-person medical service.

Helpful Resources

  • California Telehealth Resource Center
  • Center for Connected Health Policy
  • American Telemedicine Association State Policy Matrix
  • University of California Davis Center for Health and Technology
  • California Office of Health Information Integrity — eHealth (CalOHII)
  • The Medical Board of California: Practicing Medicine Through Telehealth Technology
  • Centers for Medicare and Medicaid Services: Telemedicine
  • ————-

Dear Readers,

We are inviting doctors and investors to join us in a telemedicine health application, being developed by Motherhealth to fill in the gaps in the current mobile health apps.

Email motherhealth@gmail.com to join.

Regards,

Connie Dello Buono

http://www.motherhealth.net

San Jose CA 95124