Kenneth Vercammen, Esq is Chair of the ABA Elder Law Committee and presents seminars to attorneys and the public on Wills, Probate and other legal topics related to Estate Planning and Elder law. Kenneth Vercammen is a Middlesex County trial attorney who has published 130 articles in national and New Jersey publications. He was awarded the NJ State State Bar Municipal Court Practitioner of the Year. He was a speaker at the 2012 ABA Annual Meeting attended by 10,000 attorneys and professionals.

Kenneth Vercammen & Associates, P.C.

2053 Woodbridge Avenue - Edison, NJ 08817
(732) 572-0500
http://www.njlaws.com/

Sunday, February 22, 2015

Estate Planning & Probate Seminar North Brunswick Chapter #3885 of AARP March 2, 2015

Press Release: Estate Planning & Probate Seminar
 North Brunswick Chapter #3885 of AARP
March 2, 2015 at 1:15 Monday  
North Brunswick Senior Center, 15 Linwood Place, North Brunswick, NJ 08902    [Materials distributed at 12:15]

SPEAKER: Kenneth Vercammen, Esq. Edison, NJ
                (Author- Answers to Questions About Probate)

     The new NJ Probate Law made a number of substantial changes in Probate and the administration of estates and trusts in New Jersey.
Main Topics:
1.  Estate Planning
2.  Medicaid
3.  Probate and Duties of Executor

      COMPLIMENTARY MATERIAL: Brochures on Wills, "Answers to Questions about Probate" and Administration of an Estate, Power of Attorney, Living Wills, Real Estate Sales for Seniors, and Trusts.
       
Can’t attend?  We can email you materials Send email to VercammenLaw@Njlaws.com

Kenneth A. Vercammen is a trial attorney in Edison, NJ. He is co-chair of the Probate & Estate Planning Law Committee of the American Bar Association Solo Small Firm Division.  He is a speaker for the NJ State Bar Association at the annual Nuts & Bolts of Elder Law & Estate Administration program.
He was Editor of the ABA Estate Planning Probate Committee Newsletter. Mr. Vercammen has published over 150 legal articles in national and New Jersey publications on litigation, elder law, probate and trial topics. He is a highly regarded lecturer on litigation and probate law for the American Bar Association, NJ ICLE, New Jersey State Bar Association and Middlesex County Bar Association. His articles have been published in noted publications included New Jersey Law Journal, ABA Law Practice Management Magazine, and New Jersey Lawyer. He established the NJlaws website www.njlaws.com which includes many articles on Estate Planning, Probate and Wills.


KENNETH  VERCAMMEN & ASSOCIATES, PC
ATTORNEY AT LAW
2053 Woodbridge Ave.
Edison, NJ 08817
(Phone) 732-572-0500
 (Fax)    732-572-0030
www.njlaws.com
www.CentralJerseyElderLaw.com




How to file a Medical Emergency Report (Police) when elderly at fault for an accident

Police and physicians 

Did you know that motor vehicle crashes are the number one cause of injury-related deaths in people aged 65-74? Did you know that many seniors and others with special medical conditions are unable or unwilling to decide for themselves whether it is safe for them to drive? Or that their families are often afraid to take away the keys? It's true, and that's why police and physicians often play a leading role in protecting these individuals from the perils of unsafe driving. The following information is intended to help you in this ambitious goal. 
Physicians 
By regularly assessing their patients' fitness to drive, medical professionals can better identify drivers at increased risk for crashes, help them enhance their driving safety, and ease the transition to driving retirement if and when it becomes necessary. 

Physician reports due within 24 hours
New Jersey law (N.J.S.A. 39:3-10.4) requires physicians to report patients to the Motor Vehicle Commission within 24 hours after determining that the patient experiences:
  • recurrent convulsive seizures
  • recurrent periods of unconsciousness or impairment; or
  • loss of motor coordination due to conditions such as, but not limited to, epilepsy in any of its forms, which persist or recur despite medical treatment
How to file a Medical Emergency Report (Physicians)
The Medical Review Unit greatly appreciates the support of the New Jersey medical community in this effort and tries to simplify the process for you:
  • If you believe that one of your patient's is no longer fit to driver, please fill out MVC's Form MR-4: Medical Emergency Report [612k pdf]. If you are unable to download the form or have any questions about its contents, please call (609) 292-7500 ext. 5032 
  • You may also receive the "Medical Emergency Report" from individuals who have been reported to the MVC by law enforcement or family members, and have been sent the forms in the mail. Please note that this form must be returned within 45 days in order to avoid license suspension 
  • Completed forms may be returned via fax: (609) 292-7504, orUS mail to: Medical Fitness Review Unit, P.O Box 173, Trenton, NJ 08666-0173 
  • The American Medical Association provides helpful information in its Physicians Guide to Assessing and Counseling Older Drivers
  • The physician’s findings in the "Medical Emergency Report" determine the next steps in the medical review process, which may range from indefinite license suspension to a restricted license, to no action required. Many times, additional information or tests are required 
  • In instances where a seizure disorder, syncope condition or recurrent loss of motor coordination has been identified, a 15-day direct order may be issued according to NJAC 13:19-5.2 
  • Approximately 55% of cases are referred to doctors on MVC's Medical Advisory Panel. These doctors review information and test results provided by the driver’s personal physician—the Medical Advisory Panel does not perform examinations or communicate directly with drivers. This process takes approximately 3-4 weeks 

Police
 Few people are more qualified to make a judgment about a person's fitness to drive than a police officer. Every day, officers encounter drivers that are medically impaired during standard traffic stops and at the scene of accidents. At times, police officers may also be approached by individuals who are concerned about the driving skills of a family member. MVC greatly appreciates the support of police officers in this effort.

How to file a Medical Emergency Report (Police) when elderly at fault for an accident

from http://www.state.nj.us/mvc/Licenses/medical_physicians.htm
Here is an explanation of how MVC's medical review process works when a police officer is involved: 
  • If a police officer believes that an individual may not be medically fit to drive, they should fill out MVC's Form MR-5: Driver Examination/Medical Evaluation Request [609k pdf]. If you are unable to download the form from this website, or if you have any questions about the medical review process, please contact us at (609) 292-7500 ext. 5032 
  • Completed forms may be returned via fax: (609) 292-7504, orUS mail to: Medical Fitness Review Unit, P.O Box 173, Trenton, NJ 08666-0173 
  • MVC appreciates the professional insight of police officers in reporting their concerns about driving behavior. The drivers you report will be required to undergo a thorough medical review to determine their fitness to drive. This may result in a re-examination of their driving abilities 
  • If a police officer wishes to receive updates on the status of a driver who they reported to MVC, please call (609) 292-7500 ext. 5032. Unfortunately, a medical review can often be a long, drawn-out process. MVC appreciates your commitment to these cases and will make every effort to keep you updated 
  • Approximately 55% of cases are referred to doctors on MVC's Medical Advisory Panel. These doctors review information and test results provided by the driver’s personal physician­. The Medical Advisory Panel itself does not perform examinations or communicate directly with drivers. This process takes approximately 3-4 weeks 
  • In instances where a seizure disorder, syncope condition or recurrent loss of motor coordination has been identified, a 15-day direct order may be issued according to NJAC 13:19-5.2 

Medical review process of MVC

Medical review process of MVC

from http://www.state.nj.us/mvc/Licenses/medical_review_process.htm
Medical review is conducted on a case-by-case basis and can be a complex process. The following information provides you a general overview of how the process works: 
  • After receiving information about a motorist, MVC may send them a letter stating that a medical review is required. The letter includes medical forms that must be completed by a physician 
  • The motorist must visit a physician and return the forms within 45 days. Failure to return the medical forms on time will result in a license suspension
  • The physician's findings will determine the next steps in the Medical Review process, which may range from indefinite license suspension to a restricted license, to no action required. Many times, additional information or tests are required before the medical review can continue and a decision can be made 
  • In instances where a seizure disorder, syncope condition or recurrent loss of motor coordination has been identified, a 15-day direct order may be issued according to NJAC 13:19-5.2 
  • Approximately 55% of cases are referred to doctors on MVC's Medical Advisory Panel. These doctors review information and test results provided by the driver’s personal physician—the Medical Advisory Panel does not perform examinations or communicate directly with drivers. This process takes approximately 3-4 weeks 
  • The medical review may result in:
    • Restricted driving privileges 
    • Suspension of driving privileges 
    • Re-exam 
    • Regular monitoring and reporting of medical conditions 
    • You can appeal the administrative action by submitting a written hearing request in accordance with NJAC 13:19-1.1, however, if a direct order of suspension has been issued, a hearing request will not stop the impending suspension. (NJAC 13:19-5.2)

Problems with senior's driving -Reporting a concern

Problems with senior's driving -Reporting a concern 

from http://www.state.nj.us/mvc/Licenses/reporting_concern.htm
Serious concerns about an individual's driving skills can be reported to MVC's Medical Review Unit using the process described below. The Medical Review Unit screens and establishes cases based on referrals from medical professionals, police, courts, social workers and family members. Physicians are required by law to notify MVC if patient suffers from a recurrent seizure, recurrent periods of unconsciousness or for impairment or loss of motor coordination due to conditions such as, but not limited to, epilepsy. (NJSA 39:3-10.4). Anonymous reports cannot be accepted. 

The American Medical Association (AMA) 1999 ethical guidelines states that all physicians are ethically responsible for notifying their state Motor Vehicle Department if they believe a patient may not be able to drive safely. 

In order to report a concern:
  • Write a letter detailing the motorist's medical condition and as much of the following information as possible: name and address, driver license number and date of birth. Include your full name and address, your relationship to the driver and your observations regarding the person’s driving safety 
  • Fax the letter to (609) 292-7504. Or mail it to: Medical Review Unit, NJMVC, P.O. Box 173 , Trenton , NJ 08666-0173
  • Questions may be directed to (609) 292-7500 x5032

Contact the Medical Review Unit 

If you have questions regarding medical review that you would like to discuss before filing a report, please contact us by phone or fax. You may also wish to consult with a driver rehabilitation specialist, the driver's physician or eye care specialist. 

By phone
(609) 292-7500 ext. 5032

By fax
(609) 292-7504

Sunday, February 01, 2015

42 CFR § 483.75 Administration.

42 CFR § 483.75 Administration.
A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.
(a) Licensure. A facility must be licensed under applicable State and local law.
(b) Compliance with Federal, State, and local laws and professional standards.The facility must operate and provide services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards and principles that apply to professionals providing services in such a facility.
(c) Relationship to other HHS regulations. In addition to compliance with the regulations set forth in this subpart, facilities are obliged to meet the applicable provisions of other HHS regulations, including but not limited to those pertaining to nondiscrimination on the basis of race, color, or national origin (45 CFR part 80); nondiscrimination on the basis of handicap (45 CFR part 84); nondiscrimination on the basis of age (45 CFR part 91); protection of human subjects of research (45 CFR part 46); and fraud and abuse (42 CFR part 455). Although these regulations are not in themselves considered requirements under this part, their violation may result in the termination or suspension of, or the refusal to grant or continue payment with Federal funds.
(d) Governing body.
(1) The facility must have a governing body, or designated persons functioning as a governing body, that is legally responsible for establishing and implementing policies regarding the management and operation of the facility; and
(2) The governing body appoints the administrator who is—
(i) Licensed by the State where licensing is required; and
(ii) Responsible for management of the facility.
(e) Required training of nursing aides—
(1) Definitions. 
Licensed health professional means a physician; physician assistant; nurse practitioner; physical, speech, or occupational therapist; physical or occupational therapy assistant; registered professional nurse; licensed practical nurse; or licensed or certified social worker.
Nurse aide means any individual providing nursing or nursing-related services to residents in a facility who is not a licensed health professional, a registered dietitian, or someone who volunteers to provide such services without pay. Nurse aides do not include those individuals who furnish services to residents only as paid feeding assistants as defined in § 488.301 of this chapter.
(2) General rule. A facility must not use any individual working in the facility as a nurse aide for more than 4 months, on a full-time basis, unless:
(i) That individual is competent to provide nursing and nursing related services; and
(ii)
(A) That individual has completed a training and competency evaluation program, or a competency evaluation program approved by the State as meeting the requirements of §§ 483.151-483.154 of this part; or
(B) That individual has been deemed or determined competent as provided in § 483.150 (a) and (b).
(3) Non-permanent employees. A facility must not use on a temporary, per diem, leased, or any basis other than a permanent employee any individual who does not meet the requirements in paragraphs (e)(2) (i) and (ii) of this section.
(4) Competency. A facility must not use any individual who has worked less than 4 months as a nurse aide in that facility unless the individual—
(i) Is a full-time employee in a State-approved training and competency evaluation program;
(ii) Has demonstrated competence through satisfactory participation in a State-approved nurse aide training and competency evaluation program or competency evaluation program; or
(iii) Has been deemed or determined competent as provided in § 483.150 (a) and (b).
(5) Registry verification. Before allowing an individual to serve as a nurse aide, a facility must receive registry verification that the individual has met competency evaluation requirements unless—
(i) The individual is a full-time employee in a training and competency evaluation program approved by the State; or
(ii) The individual can prove that he or she has recently successfully completed a training and competency evaluation program or competency evaluation program approved by the State and has not yet been included in the registry. Facilities must follow up to ensure that such an individual actually becomes registered.
(6) Multi-State registry verification. Before allowing an individual to serve as a nurse aide, a facility must seek information from every State registry established under sections 1819(e)(2)(A) or 1919(e)(2)(A) of the Act the facility believes will include information on the individual.
(7) Required retraining. If, since an individual's most recent completion of a training and competency evaluation program, there has been a continuous period of 24 consecutive months during none of which the individual provided nursing or nursing-related services for monetary compensation, the individual must complete a new training and competency evaluation program or a new competency evaluation program.
(8) Regular in-service education. The facility must complete a performance review of every nurse aide at least once every 12 months, and must provide regular in-service education based on the outcome of these reviews. The in-service training must—
(i) Be sufficient to ensure the continuing competence of nurse aides, but must be no less than 12 hours per year;
(ii) Address areas of weakness as determined in nurse aides' performance reviews and may address the special needs of residents as determined by the facility staff; and
(iii) For nurse aides providing services to individuals with cognitive impairments, also address the care of the cognitively impaired.
(f) Proficiency of Nurse aides. The facility must ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care.
(g) Staff qualifications.
(1) The facility must employ on a full-time, part-time or consultant basis those professionals necessary to carry out the provisions of these requirements.
(2) Professional staff must be licensed, certified, or registered in accordance with applicable State laws.
(h) Use of outside resources.
(1) If the facility does not employ a qualified professional person to furnish a specific service to be provided by the facility, the facility must have that service furnished to residents by a person or agency outside the facility under an arrangement described in section 1861(w) of the Act or (with respect to services furnished to NF residents and dental services furnished to SNF residents) an agreement described in paragraph (h)(2) of this section.
(2) Arrangements as described in section 1861(w) of the Act or agreements pertaining to services furnished by outside resources must specify in writing that the facility assumes responsibility for—
(i) Obtaining services that meet professional standards and principles that apply to professionals providing services in such a facility; and
(ii) The timeliness of the services.
(i) Medical director.
(1) The facility must designate a physician to serve as medical director.
(2) The medical director is responsible for—
(i) Implementation of resident care policies; and
(ii) The coordination of medical care in the facility.
(j) Laboratory services.
(1) The facility must provide or obtain laboratory services to meet the needs of its residents. The facility is responsible for the quality and timeliness of the services.
(i) If the facility provides its own laboratory services, the services must meet the applicable requirements for laboratories specified in part 493 of this chapter.
(ii) If the facility provides blood bank and transfusion services, it must meet the applicable requirements for laboratories specified in part 493 of this chapter.
(iii) If the laboratory chooses to refer specimens for testing to another laboratory, the referral laboratory must be certified in the appropriate specialties and subspecialties of services in accordance with the requirements of part 493 of this chapter.
(iv) If the facility does not provide laboratory services on site, it must have an agreement to obtain these services from a laboratory that meets the applicable requirements of part 493 of this chapter.
(2) The facility must—
(i) Provide or obtain laboratory services only when ordered by the attending physician;
(ii) Promptly notify the attending physican of the findings;
(iii) Assist the resident in making transportation arrangements to and from the source of service, if the resident needs asistance; and
(iv) File in the resident's clinical record laboratory reports that are dated and contain the name and address of the testing laboratory.
(k) Radiology and other diagnostic services.
(1) The facility must provide or obtain radiology and other diagnostic services to meet the needs of its residents. The facility is responsible for the quality and timeliness of the services.
(i) If the facility provides its own diagnostic services, the services must meet the applicable conditions of participation for hospitals contained in § 482.26 of this subchapter.
(ii) If the facility does not provide its own diagnostic services, it must have an agreement to obtain these services from a provider or supplier that is approved to provide these services under Medicare.
(2) The facility must—
(i) Provide or obtain radiology and other diagnostic services only when ordered by the attending physician;
(ii) Promptly notify the attending physician of the findings;
(iii) Assist the resident in making transportation arrangements to and from the source of service, if the resident needs assistance; and
(iv) File in the resident's clinical record signed and dated reports of x-ray and other diagnostic services.
(l) Clinical records.
(1) The facility must maintain clinical records on each resident in accordance with accepted professional standards and practices that are—
(i) Complete;
(ii) Accurately documented;
(iii) Readily accessible; and
(iv) Systematically organized.
(2) Clinical records must be retained for—
(i) The period of time required by State law; or
(ii) Five years from the date of discharge when there is no requirement in State law; or
(iii) For a minor, three years after a resident reaches legal age under State law.
(3) The facility must safeguard clinical record information against loss, destruction, or unauthorized use;
(4) The facility must keep confidential all information contained in the resident's records, regardless of the form or storage method of the records, except when release is required by—
(i) Transfer to another health care institution;
(ii) Law;
(iii) Third party payment contract; or
(iv) The resident.
(5) The clinical record must contain—
(i) Sufficient information to identify the resident;
(ii) A record of the resident's assessments;
(iii) The plan of care and services provided;
(iv) The results of any preadmission screening conducted by the State; and
(v) Progress notes.
(m) Disaster and emergency preparedness.
(1) The facility must have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather, and missing residents.
(2) The facility must train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures.
(n) Transfer agreement.
(1) In accordance with section 1861(l) of the Act, the facility (other than a nursing facility which is located in a State on an Indian reservation) must have in effect a written transfer agreement with one or more hospitals approved for participation under the Medicare and Medicaid programs that reasonably assures that—
(i) Residents will be transferred from the facility to the hospital, and ensured of timely admission to the hospital when transfer is medically appropriate as determined by the attending physician; and
(ii) Medical and other information needed for care and treatment of residents, and, when the transferring facility deems it appropriate, for determining whether such residents can be adequately cared for in a less expensive setting than either the facility or the hospital, will be exchanged between the institutions.
(2) The facility is considered to have a transfer agreement in effect if the facility has attempted in good faith to enter into an agreement with a hospital sufficiently close to the facility to make transfer feasible.
(o) Quality assessment and assurance.
(1) A facility must maintain a quality assessment and assurance committee consisting of—
(i) The director of nursing services;
(ii) A physician designated by the facility; and
(iii) At least 3 other members of the facility's staff.
(2) The quality assessment and assurance committee—
(i) Meets at least quarterly to identify issues with respect to which quality assessment and assurance activities are necessary; and
(ii) Develops and implements appropriate plans of action to correct identified quality deficiencies.
(3) A State or the Secretary may not require disclosure of the records of such committee except in so far as such disclosure is related to the compliance of such committee with the requirements of this section.
(4) Good faith attempts by the committee to identify and correct quality deficiencies will not be used as a basis for sanctions.
(p) Disclosure of ownership.
(1) The facility must comply with the disclosure requirements of §§ 420.206 and 455.104 of this chapter.
(2) The facility must provide written notice to the State agency responsible for licensing the facility at the time of change, if a change occurs in—
(i) Persons with an ownership or control interest, as defined in §§ 420.201 and 455.101 of this chapter;
(ii) The officers, directors, agents, or managing employees;
(iii) The corporation, association, or other company responsible for the management of the facility; or
(iv) The facility's administrator or director of nursing.
(3) The notice specified in paragraph (p)(2) of this section must include the identity of each new individual or company.
(q) Required training of feeding assistants. A facility must not use any individual working in the facility as a paid feeding assistant unless that individual has successfully completed a State-approved training program for feeding assistants, as specified in § 483.160 of this part.
(r) Facility closure-Administrator. Any individual who is the administrator of the facility must:
(1) Submit to the Secretary, the State LTC ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties, written notification of an impending closure:
(i) At least 60 days prior to the date of closure; or
(ii) In the case of a facility where the Secretary or a State terminates the facility's participation in the Medicare and/or Medicaid programs, not later than the date that the Secretary determines appropriate;
(2) Ensure that the facility does not admit any new residents on or after the date on which such written notification is submitted; and
(3) Include in the notice the plan for the transfer and adequate relocation of the residents of the facility by a date that would be specified by the State prior to closure, including assurances that the residents would be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident.
(s) Facility closure. The facility must have in place policies and procedures to ensure that the administrator's duties and responsibilities involve providing the appropriate notices in the event of a facility closure, as required at paragraph (r) of this section.
[56 FR 48877, Sept. 26, 1991, as amended at 56 FR 48918, Sept. 26, 1991; 57 FR 7136, Feb. 28, 1992; 57 FR 43925, Sept. 23, 1992; 59 FR 56237, Nov. 10, 1994; 63 FR 26311, May 12, 1998; 68 FR 55539, Sept. 26, 2003; 74 FR 40363, Aug. 11, 2009; 76 FR 9511, Feb. 18, 2011]