with a nasty surprise. Here’s the problem: Medicare covers nursing home stays for the first 20 days, so long as the patient was first admitted to a hospital as an inpatient for at least three days. But a lot of people who spend three days in a hospital later discover that they were never actually “admitted.” Rather, they were merely kept in the hospital “under observation.” As a result, the nursing home stay afterward isn’t covered.

Hospitals have increasingly been choosing not to admit patients and to place them under observation instead due in part to pressure from Medicare to reduce costs. As of 2011, some 1.6 million seniors per year were being treated under observation, a dramatic increase from past years.

Frequently, patients have no idea that they haven’t actually been admitted. They’re given a bed and a wristband, nurses and doctors come to see them, they get treatment and tests, and they fill out a meal chart just as if there had been a formal admission.

Patients who discover after the fact that they have been denied Medicare because of this problem usually have little recourse. As long as Medicare pays for the hospital stay – which it usually does on an outpatient basis – there’s no way to appeal because there has been no denial of coverage. And the denial of coverage for the nursing home stay is technically proper if the patient wasn’t admitted to the hospital for three days.

The new federal law is called the NOTICE Act (which stands for Notice of Observation Treatment and Implication for Care Eligibility). It requires hospitals to notify patients who are under observation for more than 24 hours of their outpatient status within 36 hours, or upon discharge if that occurs sooner. The notification must explain that because the patient hasn’t been admitted, their hospital stay won’t count toward the three-day requirement, and so Medicare won’t pay for a subsequent nursing home stay.

The NOTICE Act will go into effect on August 6, 2016.

In the meantime, if you’re in the hospital and a nursing home stay is likely, it’s a good idea to ask whether or not you’ve been formally admitted.

In keeping with the “new” theme, we also wanted to introduce a new resource that our office recently developed. “How to Avoid Going Broke in a Nursing Home” is a booklet that gives families a broad overview of Medicaid benefits and a little bit of what exactly our firm does to help protect assets. It is written in layman’s words (not attorney-speak!) so it is a little more easily understood than a lot of other information out there. Within the booklet, we discuss:

• the differences between Medicare and Medicaid
• the basic rules of qualifying for Medicaid
• assets that are considered available for Medicaid
• planning strategies you can use to protect your assets
• the differences between traditional estate planning and Medicaid planning

The link to access the electronic version of the booklet is below. We hope that you enjoy and welcome your feedback!

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I always wanted to have my own business, but I did not know what exactly I wanted to do. I was nudged by my older brother to learn a technical skill - hence my accounting degree from St. Bonaventure University (which ultimately lead me to get my CPA license). While attending St. Bonaventure I was again nudged by my business law professor who suggested that I should go to law school. After 4 years of college, I had no interest in continuing with formal schooling so I got a job instead. A few years later, however, and I decided I was ready to tackle law school. I attended University of Buffalo Law School and after graduation, I started working with a law firm in Elmira, New York. My duties included preparing estate plans and working with small businesses. I was lucky enough to really enjoy these areas and my CPA background really helped in these areas as well. However, my desire to have my own business did not go away. After several years I parted ways with my old firm and struck out on my own...READ MORE

Although the holidays are over, it is the only time I get one of my favorite cookies that my mother-in-law makes; Saltine Toffee Cookies. These are typically made with Saltine crackers (and some recipes call for unsalted variety), but I am sure they would work with your favorite cracker as well.

Ingredients:

• 
  
• 4 Ounces of Saltine Crackers
• 1 Cup of Butter
• 1 Cup of Brown Sugar
• 2 Cups (or one bag) of Semi Sweet Chocolate Chips
• 3/4 Cup of Chopped Nuts

Instructions:

1. Preheat the oven to 400 degrees.

2. Line a cookie sheet with saltine crackers in a single layer (about a sleeve or slightly more depending on the size).

3. In a saucepan combine the sugar and butter and bring to a boil on medium heat. Boil for 3 minutes stirring constantly then immediately pour over saltines and spread to cover them completely.

4. Bake at 400 degrees for 5 to 6 minutes.

5. Remove from oven and sprinkle with chocolate chips immediately. Let sit for five minutes then spread the melted chocolate and top with chopped nuts.

6. Allow to cool completely then break into pieces and enjoy.

7. You can also be creative and try different flavors of chips (peanut butter or butterscotch, etc) and toppings instead of nuts.