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. He is author of the ABA's book "Wills and Estate Administration. Kenneth Vercammen & Associates,
2053 Woodbridge Avenue - Edison, NJ 08817
(732) 572-0500 More information at www.njlaws.com/

Friday, April 26, 2019

Municipal Court 101

NJSBA Annual Meeting
Program pickup is at Borgata Hotel 1 Borgata Way, Atlantic City, NJ 08401

Municipal Court 101
Wednesday 4:30 p.m. - 6:00 p.m. - Central Ballroom A/B

Speakers: Kenneth A. Vercammen, Esq., Law Offices of Kenneth Vercammen
Joshua H. Reinitz, Esq., Iacullo Martino, LLC
Hon. Ashlie C. Gibbons J.M.C., Pascack Joint Municipal Court
Ronald P. Mondello, Esq., GRM Legal Works, LLC
Peter H. Lederman, Esq., Davison, Eastman, Munoz, Lederman, & Paone
Description:
This is an introduction to municipal court for recently admitted attorneys or for anyone who. is new to the practice are or wants a refresher. Experienced practitioners and judges will discuss important procedures, practical information and practice tips.

https://tcms.njsba.com/PersonifyEbusiness/MeetingsEvents/2019AnnualMeetingandConvention/EducationalAgenda.aspx

Law Student free (must register by phone or faxed in registration form)

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https://www.facebook.com/events/2468366823197365/

Monday, April 22, 2019

Rule 4:86-2. Guardianship Complaint requirements; Accompanying Documents; Alternative Affidavits or Certifications

Rule 4:86-2. Guardianship Complaint requirements; Accompanying Documents; Alternative Affidavits or Certifications
(a) Complaint. The allegations of the complaint shall be verified as prescribed by R. 1:4-7. The complaint shall state:
(1) the name, age, domicile and address of the plaintiff, of the alleged incapacitated person and of the alleged incapacitated person’s spouse, if any;
(2) the plaintiff’s relationship to the alleged incapacitated person;
(3) the plaintiff’s interest in the action;
(4) the names, addresses and ages of the alleged incapacitated person’s children, if any, and the names and addresses of the alleged incapacitated person’s parents and nearest of kin, meaning at a minimum all persons of the same degree of relationship to the alleged incapacitated person as the plaintiff;
(5) the name and address of the person or institution having the care and custody of the alleged incapacitated person;
(6) if the alleged incapacitated person has lived in an institution, the period or periods of time the alleged incapacitated person has lived therein, the date of the commitment or confinement, and by what authority committed or confined; and
(7) the name and address of any person named as attorney-in-fact in any power of attorney executed by the alleged incapacitated person, any person named as health care representative in any health care directive executed by the alleged incapacitated person, and any person acting as trustee under a trust for the benefit of the alleged incapacitated person.
(b) Accompanying Documents. The complaint shall have annexed thereto:
(1) An affidavit or certification stating the nature, description, and fair market value of the following, in such form as promulgated by the Administrative Director of the Courts:
(A) all real estate in which the alleged incapacitated person has or may have a present or future interest, stating the interest, describing the real estate fully and stating the assessed valuation thereof;
(B) all the personal estate which he or she is, will or may in all probability become entitled to, including stocks, bonds, mutual funds, securities and investment accounts; money on hand, annuities, checking and savings accounts and certificates of deposit in banks and notes or other indebtedness due the alleged incapacitated person; pensions and retirement accounts, including annuities and profit
sharing plans; miscellaneous personal property; and the nature and total monthly amount of any income which may be payable to the alleged incapacitated person; and
(C) the encumbrance amount of any debt including any secured associated debt related to the real estate or personal estate of the alleged incapacitated person;
(2) Affidavits or certifications of two physicians having qualifications set forth in N.J.S.A. 30:4-27.2t, or the affidavit or certification of one such physician and one licensed practicing psychologist as defined in N.J.S.A. 45:14B-2, in such form as promulgated by the Administrative Director of the Courts. Pursuant to N.J.S.A. 3B:12- 24.1(d), the affidavits or certifications may make disclosures about the alleged incapacitated person. If an alleged incapacitated person has been committed to a public institution and is confined therein, one of the affidavits or certifications shall be that of the chief executive officer, the medical director, or the chief of service providing that person is also the physician with overall responsibility for the professional program of care and treatment in the administrative unit of the institution. However, where an alleged incapacitated person is domiciled within this State but resident elsewhere, the affidavits or certifications required by this rule may be those of persons who are residents of the state or jurisdiction of the alleged incapacitated person’s residence. Each affiant shall have made a personal examination of the alleged incapacitated person not more than 30 days prior to the filing of the complaint, but said time period may be relaxed by the court on an ex parte showing of good cause. To support the complaint, each affiant shall state:
(A) the date and place of the examination;
(B) whether the affiant has treated or merely examined the alleged incapacitated individual;
(C) whether the affiant is disqualified under R. 4:86-3;
(D) the diagnosis and prognosis and factual basis therefor;
(E) for purposes of ensuring that the alleged incapacitated person

is the same individual who was examined, a physical description of the person examined, including but not limited to sex, age and weight;
(F) the affiant’s opinion of the extent to which the alleged incapacitated person is unfit and unable to govern himself or herself and to manage his or her affairs and shall set forth with particularity the circumstances and conduct of the alleged incapacitated person upon which this opinion is based, including a history of the alleged incapacitated person’s condition;
(G) if applicable, the extent to which the alleged incapacitated person retains sufficient capacity to retain the right to manage specific areas, such as residential, educational, medical, legal, vocational or financial decisions; and
(H) an opinion on whether the alleged incapacitated person is capable of attending or otherwise participating in the hearing and, if not, the reasons for the individual’s inability; and
(3) A Case Information Statement in such form as promulgated by the Administrative Director of the Courts. Said Case Information Statement shall include the date of birth and Social Security number of the alleged incapacitated person.
(c) Alternative Affidavits or Certifications.
(1) If the plaintiff cannot secure the information required in paragraph (b)(1), the complaint shall so state and give the reasons therefor, and the affidavit or certification submitted shall in that case contain as much information as can be secured in the exercise of reasonable diligence.
(2) In lieu of the affidavits or certifications provided for in paragraph (b)(2), an affidavit or certification of one affiant having the qualifications as required therein shall be submitted, stating that he or she has endeavored to make a personal examination of the alleged incapacitated person not more than 30 days prior to the filing of the complaint but that the alleged incapacitated person or those in charge of him or her have refused or are unwilling to have the affiant make such an examination. The time period herein prescribed may be relaxed by the court on an ex parte showing of good cause.
Note: Source — R.R. 4:102-2; former R. 4:83-2 amended and rule redesignated June 29, 1990 to be effective September 4, 1990; paragraphs (b) and (c) amended July 14, 1992 to be effective September 1, 1992; paragraph (b) amended July 13, 1994 to be effective September 1, 1994; paragraphs (a), (b), and (c) amended July 12, 2002 to be effective September 3, 2002; paragraphs (b) and (c) amended July 28, 2004 to be effective September 1, 2004; paragraphs (a), (b) and (c) amended July 9, 2008 to be effective September 1, 2008; caption amended, and paragraphs (a), (b) and (c) amended and captions added August 1, 2016 to be effective September 1, 2016.

Rule 4:86-1. Action for Guardianship

4:86-1. Action; Records; Guardianship Monitoring Program
(a) Every action for the determination of incapacity of a person and for the appointment of a guardian of that person or of the person’s estate or both, other than an action with respect to a veteran under N.J.S.A. 3B:13-1 et seq., or with respect to a kinship legal guardianship under N.J.S.A. 3B:12A-1 et seq., shall be brought pursuant to R. 4:86-1 through R. 4:86-8 for appointment of a general, limited or pendente lite temporary guardian.
(b) Judiciary records of all actions set forth in R. 4:86-1(a) shall be maintained by the Surrogate and shall be accessible pursuant to R. 1:38-3(e).
(c) Each vicinage shall operate a Guardianship Monitoring Program through the collaboration of the Superior Court, Chancery Division, Probate Part; the County Surrogates; and the Administrative Office of the Courts, Civil Practice Division.
(1) The functions of guardianship support and monitoring shall be established by the Administrative Director of the Courts. Such functions shall include guardianship training and review of inventories and periodic reports of financial accounting filed by guardians as required by R. 4:86-6(e).
(2) Post-adjudicated case issues identified through monitoring may be forwarded for further action by the Superior Court, Chancery Division, Probate Part and/or the Administrative Office of the Courts.
(3) Case monitoring issues referred to the attention of the Superior Court, Chancery Division, Probate Part shall be promptly reviewed and such further action taken as deemed appropriate in the discretion of the court.
(4) Quasi-judicial immunity shall be extended to Judiciary staff, County Surrogates, County Surrogate staff, and volunteers performing monitoring responsibilities in the Guardianship Monitoring Program.

3B:1-2 Definitions I to Z. 3B:1-2. "Incapacitated individual" means an individual who is impaired by reason of mental illness or intellectual disability to the extent that the individual lacks sufficient capacity to govern himself and manage his affairs.

3B:1-2 Definitions I to Z.

3B:1-2. "Incapacitated individual" means an individual who is impaired by reason of mental illness or intellectual disability to the extent that the individual lacks sufficient capacity to govern himself and manage his affairs.

The term incapacitated individual is also used to designate an individual who is impaired by reason of physical illness or disability, chronic use of drugs, chronic alcoholism, or other cause (except minority) to the extent that the individual lacks sufficient capacity to govern himself and manage the individual's affairs.

The terms incapacity and incapacitated refer to the state or condition of an incapacitated individual as hereinbefore defined.

"Intellectual disability" means a significant subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior which are manifested during the development period.

"Issue" of an individual means a descendant as defined in N.J.S.3B:1-1.

"Joint tenants with the right of survivorship" means co-owners of property held under circumstances that entitle one or more to the whole of the property on the death of the other or others, but excludes forms of co-ownership in which the underlying ownership of each party is in proportion to that party's contribution.

"Local administration" means administration by a personal representative appointed in this State.

"Local fiduciary" means any fiduciary who has received letters in this State and excludes foreign fiduciaries who acquire the power of local fiduciary pursuant to this title.

"Minor" means an individual who is under 18 years of age.

"Nonresident decedent" means a decedent who was domiciled in another jurisdiction at the time of his death.

"Parent" means any person entitled to take or who would be entitled to take if the child, natural or adopted, died without a will, by intestate succession from the child whose relationship is in question and excludes any person who is a stepparent, resource family parent, or grandparent.

"Per capita." If a governing instrument requires property to be distributed "per capita," the property is divided to provide equal shares for each of the takers, without regard to their shares or the right of representation.

"Payor" means a trustee, insurer, business entity, employer, government, governmental agency or subdivision, or any other person authorized or obligated by law or a governing instrument to make payments.

"Person" means an individual or an organization.

"Per Stirpes." If a governing instrument requires property to be distributed "per stirpes," the property is divided into as many equal shares as there are: (1) surviving children of the designated ancestor; and (2) deceased children who left surviving descendants. Each surviving child is allocated one share. The share of each deceased child with surviving descendants is divided in the same manner, with subdivision repeating at each succeeding generation until the property is fully allocated among surviving descendants.

"Personal representative" includes executor, administrator, successor personal representative, special administrator, and persons who perform substantially the same function under the law governing their status. "General personal representative" excludes special administrator.

"Representation; Per Capita at Each Generation." If an applicable statute or a governing instrument requires property to be distributed "by representation" or "per capita at each generation," the property is divided into as many equal shares as there are: (1) surviving descendants in the generation nearest to the designated ancestor which contains one or more surviving descendants; and (2) deceased descendants in the same generation who left surviving descendants, if any. Each surviving descendant in the nearest generation is allocated one share. The remaining shares, if any, are combined and then divided in the same manner among the surviving descendants of the deceased descendants, as if the surviving descendants who were allocated a share and their surviving descendants had predeceased the designated ancestor.

"Resident creditor" means a person domiciled in, or doing business in this State, who is, or could be, a claimant against an estate.

"Security" includes any note, stock, treasury stock, bond, mortgage, financing statement, debenture, evidence of indebtedness, certificate of interest or participation in an oil, gas, or mining title or lease or in payments out of production under the title or lease, collateral, trust certificate, transferable share, voting trust certificate or, in general, any interest or instrument commonly known as a security or as a security interest or any certificate of interest or participation, any temporary or interim certificate, receipt or certificate of deposit for, or any warrant or right to subscribe to or purchase, any of the foregoing.

"Stepchild" means a child of the surviving, deceased, or former spouse who is not a child of the decedent.

"Successor personal representative" means a personal representative, other than a special administrator, who is appointed to succeed a previously appointed personal representative.

"Successors" means those persons, other than creditors, who are entitled to real and personal property of a decedent under a decedent's will or the laws governing intestate succession.

"Testamentary trustee" means a trustee designated by will or appointed to exercise a trust created by will.

"Testator" includes an individual and means male or female.

"Trust" includes any express trust, private or charitable, with additions thereto, wherever and however created. It also includes a trust created by judgment under which the trust is to be administered in the manner of an express trust. "Trust" excludes other constructive trusts, and it excludes resulting trusts, guardianships, personal representatives, trust accounts created under the "Multiple-party Deposit Account Act," P.L.1979, c.491 (C.17:16I-1 et seq.), gifts to minors under the "New Jersey Uniform Gifts to Minors Act," P.L.1963, c.177 (C.46:38-13 et seq.), or the "New Jersey Uniform Transfers to Minors Act," R.S.46:38A-1 et seq., business trusts providing for certificates to be issued to beneficiaries, common trusts, security arrangements, liquidation trusts, and trusts for the primary purpose of paying debts, dividends, interest, salaries, wages, profits, pensions or employee benefits of any kind, and any arrangement under which a person is nominee or escrowee for another.

"Trustee" includes an original, additional or successor trustee, whether or not appointed or confirmed by court.

"Ward" means an individual for whom a guardian is appointed or an individual under the protection of the court.

"Will" means the last will and testament of a testator or testatrix and includes any codicil and any testamentary instrument that merely appoints an executor, revokes or revises another will, nominates a guardian, or expressly excludes or limits the right of a person or class to succeed to property of the decedent passing by intestate succession

3B:12-24.1 Determination by the court of need for guardianship services, specific services.

3B:12-24.1 Determination by the court of need for guardianship services, specific services.

12. Determination by the court of need for guardianship services, specific services.

a.General Guardian. If the court finds that an individual is incapacitated as defined in N.J.S.3B:1-2 and is without capacity to govern himself or manage his affairs, the court may appoint a general guardian who shall exercise all rights and powers of the incapacitated person. The general guardian of the estate shall furnish a bond conditioned as required by the provisions of N.J.S.3B:15-1 et seq., unless the guardian is relieved from doing so by the court.

b.Limited Guardian. If the court finds that an individual is incapacitated and lacks the capacity to do some, but not all, of the tasks necessary to care for himself, the court may appoint a limited guardian of the person, limited guardian of the estate, or limited guardian of both the person and estate. A court, when establishing a limited guardianship shall make specific findings regarding the individual's capacity, including, but not limited to which areas, such as residential, educational, medical, legal, vocational and financial decision making, the incapacitated person retains sufficient capacity to manage. A judgment of limited guardianship may specify the limitations upon the authority of the guardian or alternatively the areas of decision making retained by the person. The limited guardian of the estate shall furnish a bond in accordance with the provisions of N.J.S.3B:15-1 et seq., unless the guardian is relieved from doing so by the court.

c.Pendente lite; Temporary Guardian. 

(1)Whenever a complaint is filed in the Superior Court to declare a person incapacitated and appoint a guardian, the complaint may also request the appointment of a temporary guardian of the person or estate, or both, pendente lite. Notice of a pendente lite temporary guardian application shall be given to the alleged incapacitated person or alleged incapacitated person's attorney or the attorney appointed by the court to represent the alleged incapacitated person.

(2) Pending a hearing for the appointment of a guardian, the court may for good cause shown and upon a finding that there is a critical need or risk of substantial harm, including, but not limited to: 

(a)the physical or mental health, safety and well-being of the person may be harmed or jeopardized;

(b)the property or business affairs of the person may be repossessed, wasted, misappropriated, dissipated, lost, damaged or diminished or not appropriately managed; 

(c)it is in the best interest of the alleged incapacitated person to have a temporary guardian appointed and such may be dealt with before the hearing to determine incapacity can be held, after any notice as the court shall direct, appoint a temporary guardian pendente lite of the person or estate, or both, of the alleged incapacitated person. 

(3)A pendente lite temporary guardian appointed pursuant to this section may be granted authority to arrange interim financial, social, medical or mental health services or temporary accommodations for the alleged incapacitated person determined to be necessary to deal with critical needs of or risk of substantial harm to the alleged incapacitated person or the alleged incapacitated person's property or assets. The pendente lite temporary guardian may be authorized to make arrangements for payment for such services from the estate of the alleged incapacitated person. 

(4)A pendente lite temporary guardian appointed hereunder shall be limited to act for the alleged incapacitated person only for those services determined by the court to be necessary to deal with critical needs or risk of substantial harm to the alleged incapacitated person.

(5)The alleged incapacitated person's attorney or attorney appointed by the court to represent the alleged incapacitated person shall be given notice of the appointment of the pendente lite temporary guardian. The pendente lite temporary guardian shall communicate all actions taken on behalf of the alleged incapacitated individual to the alleged incapacitated person's attorney or attorney appointed by the court to represent the alleged incapacitated person who shall have the right to object to such actions.

(6)A pendente lite temporary guardian appointment shall not have the effect of an adjudication of incapacity or effect of limitation on the legal rights of the individual other than those specified in the court order.

(7)If the court enters an order appointing a pendente lite temporary guardian without notice, the alleged incapacitated person may appear and move for its dissolution or modification on two days' notice to the plaintiff and to the temporary guardian or on such shorter notice as the court prescribes.

(8)Every order appointing a pendente lite temporary guardian granted without notice expires as prescribed by the court, but within a period of not more than 45 days, unless within that time the court extends it for good cause shown for the same period.

(9)The pendente lite temporary guardian, upon application to the court, shall be entitled to receive reasonable fees for his services, as well as reimbursement of his reasonable expenses, which shall be payable by the estate of the alleged incapacitated person or minor.

(10) The pendente lite temporary guardian shall furnish a bond in accordance with the provisions of N.J.S.3B:15-1 et seq., unless the guardian is relieved from doing so by the court.

d.Disclosure of information. Physicians and psychologists licensed by the State are authorized to disclose medical information, including but not limited to medical, mental health and substance abuse information as permitted by State and federal law, regarding the alleged incapacitated person in affidavits filed pursuant to the Rules Governing the Courts of the State of New Jersey.

e.Court appearance. The alleged incapacitated person shall appear in court unless the plaintiff and the court-appointed attorney certify that the alleged incapacitated person is unable to appear because of physical or mental incapacity.

f.Communication. When a person who is allegedly in need of guardianship services appears to have a receptive or expressive communication deficit, all reasonable means of communication with the person shall be attempted for the purposes of this section, including written, spoken, sign or non-formal language, which includes translation of the person's spoken or written word when the person is unable to communicate in English, and the use of adaptive equipment.

g.Additional subject areas. At the request of the limited guardian, and if the incapacitated person is not represented, after appointment of an attorney for the incapacitated person and with notice to all interested parties, the court may determine that a person is in need of guardian services regarding additional subject areas and may enlarge the powers of the guardian to protect the person from significant harm.

h.Limitations of guardian powers. At the request of the guardian, the incapacitated person or another interested person, and if the incapacitated person is not represented, after appointment of an attorney for the incapacitated person and with notice to all interested parties, the court may limit the powers conferred upon a guardian.

Friday, April 19, 2019

Medicaid did not give full credit for caretaker non medical expenses E.C., Petitioner-Appellant, v. DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES and UNION COUNTY BOARD OF SOCIAL SERVICES,

Medicaid did not give full credit for caretaker non medical expenses
E.C.,
Petitioner-Appellant, 
v. 
DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES and UNION COUNTY BOARD OF SOCIAL SERVICES, 
SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION
DOCKET NO. A-0832-17T4 
Submitted February 7, 2019 – Decided March 25, 2019 
Before Judges Whipple and DeAlmeida. 
On appeal from the New Jersey Department of Human Services, Division of Medical Assistance and Health Services. 
SB2 Inc., attorneys for appellant (Laurie M. Higgins, on the brief). 
Gurbir S. Grewal, Attorney General, attorney for respondent Division of Medical Assistance and Health Services (Melissa H. Raksa, Assistant Attorney 
General, of counsel; Jacqueline R. D'Alessandro, Deputy Attorney General, on the brief). 
PER CURIAM
Plaintiff E.C. appeals from the September 7, 2017 final decision of the 
Division of Medical Assistance and Health Services (DMAHS) adopting the initial decision of an Administrative Law Judge (ALJ) finding E.C. eligible for Medicaid benefits, but assessing a transfer penalty of $81,102.20. We affirm. 
I.
The following facts are derived from the record. On September 10, 2015, 
E.C., then 103 years old and a resident of a nursing home, applied through a representative to the Union County Board of Social Services (the Board) for Medicaid benefits. On April 25, 2016, the Board found E.C. eligible for benefits as of August 1, 2015. However, the Board imposed a period of ineligibility of 334 days, from August 1, 2015 to June 29, 2016, due to E.C.'s transfer of $111,051.01 in assets to her niece, P.R., within the five-year look-back period. 
E.C. requested a fair hearing with respect to the transfer penalty. The matter was transferred to the Office of Administrative Law, where a fair hearing was held before ALJ Joan Bedrin Murray. At the hearing, a representative of the Board testified that after the initial decision, the Board obtained proof that a portion of the $111,051.01 transferred to P.R. was used to pay E.C.'s rent. As a 
A-0832-17T4 
result, the parties stipulated to a reduction in the penalty amount to $84,702.20, adjusting the period of ineligibility to April 29, 2016. 
L.B. testified that she began providing caretaker services to E.C. in 2014 and was paid $150 a week in cash to assist her with housekeeping, meal preparation, bathing, and toileting. According to L.B., in May 2015, E.C. fractured her hip and was admitted to a nursing home. Although the nursing facility provided caregiver services to its residents, L.B. testified that she continued to provide care to E.C. after she was admitted to the facility, and until E.C.'s death in June 2016. L.B. testified that she also received additional funds, the amount of which she approximated, from P.R.'s spouse that she used for grocery shopping, podiatrist visits, and purchasing household items for E.C. L.B. testified that she collected receipts for these purchases and gave those receipts to P.R. No receipts were produced at the hearing. 
After the hearing, P.R. submitted an affidavit stating that she maintained a separate bank account containing funds transferred to her by E.C. She stated that she spent $57,340.89 of E.C.'s funds on E.C.'s behalf. Included with the affidavit was a spreadsheet compiled by counsel that P.R. said represented the purchases she made on behalf of E.C. The post-trial submission did not include bank records for the account or receipts for any purchases. 
A-0832-17T4 
On June 16, 2017, ALJ Murray issued an initial decision affirming the imposition of a transfer penalty, but reducing the amount to $81,102.20. The ALJ found credible L.B.'s testimony that she provided caregiver services to E.C. from December 2014 to May 2015, when E.C. was admitted to the nursing home, receiving $3600 for her work. The ALJ found a lack of credible evidence establishing that the other expenditures about which L.B. testified were made for fair market value, given the absence of receipts. ALJ Murray found that P.R.'s affidavit was not credible, because P.R. could not be cross-examined, and because her statements were not corroborated. Thus, she concluded E.C. had not overcome the presumption that expenditures beyond the $3600 were for the purpose of accelerating E.C.'s Medicaid eligibility. See N.J.A.C. 10:71-4.10(j). 
On September 7, 2017, the Director, DMAHS issued a final agency decision adopting ALJ Murray's initial decision. The Director adopted the ALJ's credibility determinations, and agreed with her observation that the hearing record did not contain credible evidence sufficient to overcome the presumption that the disallowed transfers were made for early qualification for Medicaid. The Director rejected the evidentiary value of P.R.'s affidavit because it was vague and uncorroborated. Finally, the Director rejected E.C.'s argument that because she was in good health prior to the fall that resulted in her being 
A-0832-17T4 
admitted to the nursing facility, it was an error to consider her transfer of assets as an effort to accelerate Medicaid eligibility. See N.J.A.C. 10:71-4.10(k) ("[t]he presence of one or more of the following factors, while not conclusive, may indicate that the assets were transferred exclusively for some purpose other than establishing Medicaid eligibility . . . [t]raumatic onset of disability"). The Director noted E.C.'s advanced age, her receipt of niece's longtime management of her financial affairs as evidence that E.C. was contemplating Medicaid eligibility during the look-back period. 
This appeal followed. E.C. argues that DMAHS should have deducted from the transfer nursing home, and the expenditures made by L.B. on E.C.'s behalf with E.C.'s funds; and (2) $11,924.85 for expenditures by P.R. on behalf of E.C. with E.C.'s funds. In addition, E.C. argues that the ALJ should have considered the sudden onset of her institutionalization as evidence that the 
, it appears that that figure includes the $3600 previously recognized by DMAHS. Therefore, E.C. actually seeks an additional $12,510 deduction. 
The Director's final agency decision refers to 2013, which appears to be a typographical error, in light of L.B.'s testimony that she began providing services to E.C. in 2014. The error is not material to the outcome of this matter. 
A-0832-17T4 
transfers she made during the look-back period were not to accelerate Medicaid eligibility. 
II.
"An administrative agency's decision will be upheld 'unless there is a clear 
showing that it is arbitrary, capricious, or unreasonable, or that it lacks fair support in the record.'" R.S. v. Div. of Med. Assistance & Health Servs., 434 N.J. Super. 250, 261 (App. Div. 2014) (quoting Russo v. Bd. of Trs., Police & Firemen's Ret. Sys., 206 N.J. 14, 27 (2011)). "The burden of demonstrating that the agency's action was arbitrary, capricious or unreasonable rests upon the [party] challenging the administrative action." E.S. v. Div. of Med. Assistance & Health Servs., 412 N.J. Super. 340, 349 (App. Div. 2010) (alteration in original) (quoting In re Arenas, 385 N.J. Super. 440, 443-44 (App. Div. 2006)). "[I]f substantial credible evidence supports an agency's conclusion, a court may not substitute its own judgment for the agency's even though the court might have reached a different result." Greenwood v. State Police Training Ctr., 127 N.J. 500, 513 (1992). 
"Medicaid is a federally-created, state-implemented program that provides 'medical assistance to the poor at the expense of the public.'" In re Estate of Brown, 448 N.J. Super. 252, 256 (App. Div. 2017) (quoting Estate of 
A-0832-17T4 
DeMartino v. Div. of Med. Assistance & Health Servs., 373 N.J. Super. 210, 217 (App. Div. 2004)); see also 42 U.S.C.A. § 1396-1. To receive federal funding the State must comply with all federal statutes and regulations. Harris v. McRae, 448 U.S. 297, 301 (1980). 
Pursuant to the New Jersey Medical Assistance and Health Services Act, N.J.S.A. 30:4D-1 to -19.5, DMAHS is responsible for administering the Medicaid program in our State. Through its regulations, DMAHS establishes "policy and procedures for the application process[.]" N.J.A.C. 10:71-2.2(b). "[T]o be financially eligible, the applicant must meet both income and resource standards." Brown, 448 N.J. Super. at 257; see also N.J.A.C. 10:71-3.15; N.J.A.C. 10:71-1.2(a). 
Because Medicaid funds are limited, only those applicants with income and non-exempt resources below specified levels may qualify for government- paid assistance. To qualify for the Medicaid Only program, an individual applicant may not have resources that exceed $2000. N.J.A.C. 10:71-4.5(c). Resources are defined "as any real or personal property which is owned by the applicant . . . and which could be converted to cash to be used for his or her support and maintenance." N.J.A.C. 10:71-4.1(b). 
A-0832-17T4 
An applicant who transfers or disposes of resources for less than fair market value during a sixty-month look-back period before the individual becomes institutionalized or applies for Medicaid is penalized for making the transfer. 42 U.S.C.A. §1396p(c)(1)(E); N.J.A.C. 10:71-4.10(m)(1). Transfers within the look-back period are presumed to be made to obtain earlier Medicaid eligibility than that to which the applicant would otherwise be entitled. N.J.A.C. 10:71-4.10(i). The presumption may be rebutted with "convincing evidence that the assets were transferred exclusively (that is, solely) for some other purpose." N.J.A.C. 10:71-4.10(j). If the applicant does not overcome the presumption, a transfer penalty denies Medicaid benefits during the period the applicant should have been using the transferred resources for medical care. See W.T. v. Div. of Med. Assistance & Health Servs., 391 N.J. Super. 25, 37 (App. Div. 2007). 
If the applicant transfers any resource within the look-back period, the transfer is reviewed, and the resource's fair market value is ascertained, as is the consideration received for the transferred resource. N.J.A.C. 10:71-4.10(c). The difference between the fair market value of the resource and the compensation received by the applicant is the "uncompensated value." N.J.A.C. 10:71-4.10(c)(2). If the uncompensated value of the transferred resources,
A-0832-17T4 
combined with other countable resources, exceeds the resource limit for Medicaid eligibility, a transfer penalty is assessed. N.J.A.C. 10:71-4.10(m)(1). Having carefully reviewed the record and applicable legal principles, we conclude the agency's decision is supported by substantial credible evidence in the record as a whole, R. 2:11-3(e)(1)(D), and that E.C.'s arguments to the contrary are without sufficient merit to warrant extended discussion in a written opinion. R. 2:11-3(e)(1)(E). Accordingly, we affirm for the reasons set forth in 
DMAHS's final agency decision adopting ALJ Murray's initial decision.
We note only that E.C. argues that because ALJ Murray found L.B. to be credible with respect to the wages she earned while providing services to E.C. prior to her being admitted to a nursing facility, she must find all of L.B.'s testimony regarding her services and expenditures credible. E.C.'s argument overlooks two crucial facts. First, L.B. was specific with respect to the amount she received for her services, allowing ALJ Murray to determine that she received fair market value for her services. There was a lack of specificity, including an absence of receipts, with respect to the expenditures L.B. made on behalf of E.C., making a fair market value determination impossible. Second, it is apparent that ALJ Murray did not find credible L.B.'s testimony that she provided caretaker services to E.C. after she was admitted to a nursing facility. 
A-0832-17T4 
Having listened to and observed L.B. at the hearing, ALJ Murray could accept or reject, in whole or in part, the credibility of L.B.'s testimony. 
Affirmed. 

Sunday, April 14, 2019

"Medical Aid in Dying for the Terminally Ill Act" signed, permits qualified terminally ill patient to self-administer medication to end life in humane and dignified manner

"Medical Aid in Dying for the Terminally Ill Act" signed, permits qualified terminally ill patient to self-administer medication to end life in humane and dignified manner
Governor Murphy on 4/12/2019 signed legislation that will allow terminally ill New Jersey adults to end their lives peacefully, with dignity, and at their own discretion. The law, which was sponsored by Assemblyman John Burzichelli and Senator Nick Scutari, makes New Jersey the eighth state to allow such end-of-life decisions with the assistance of medical professionals. 
“Allowing residents with terminal illnesses to make end-of-life choices for themselves is the right thing to do,” said Governor Murphy. “By signing this law today, we are providing terminally ill patients and their families with the humanity, dignity, and respect that they so richly deserve at the most difficult times any of us will face. I commend Assemblyman Burzichelli for steering us down this long, difficult road, and thank the Legislature for its courage in tackling this challenging issue.”
The law will take effect on August 1, 2019.

“Over the course of seven years, we’ve heard countless heartbreaking stories of terminally ill patients and their families yearning to make a personal choice that simply was not provided for under law,” said Assemblyman John Burzichelli. “The choice for patients, who are critically ill and with a short life expectancy prescribed by their doctors, to determine their final day on this earth with dignity deserved honest and intellectual discussion. I’ve had many, many conversations with religious and non-profit organizations such as Compassion and Choices of New Jersey to get their take on the legislation. I thank all who have contributed over the years to the open dialogue, for and against it, and to the Governor for giving it the attention it deserved. It’s been a long, learned discussion, one that I’m sure will continue as we move forward today.”
“This will provide a humane choice for terminally-ill patients who are experiencing tremendous suffering and pain. It offers the freedom of choice for those with no hope of surviving beyond six months to end their suffering in a dignified way,” said Senate President Steve Sweeney. “It is a very personal decision. I watched someone I loved suffer for the last six months of her life from cancer while her children watched. Her suffering was prolonged to a point where she entered a hospice where her medications were increased until she passed away. I don’t think that was humane for her or for her loved ones. This will offer patients in end-of-life circumstances an option to decide their own fate in their final days.”
“There is no good reason for terminally ill patients to be forced to endure prolonged pain and suffering if they make the choice to end their lives with dignity,” said Senator Nicholas P. Scutari. “This law respects the free will of terminally ill patients and provides a humane and dignified process for those qualified to end their lives. I am very proud of New Jersey to support this law and the compassion it provides to those suffering.”
“There are many strong opinions on this issue, but the truth is, only these patients understand what it is like to know death is approaching,” said Assemblyman Joe Danielsen. “This law will give terminally ill patients the choice to meet their end on their own terms. This is the humane approach. We cannot prevent them from dying, but we can at least provide the option and let them to do it with dignity.”
The “Medical Aid in Dying for the Terminally Ill Act” permits terminally ill, adult patients residing in New Jersey to obtain and self-administer medication to end their lives peacefully and humanely.  A patient’s attending and consulting physicians must determine that the patient has a life expectancy of six months or less, has the capacity to make health care decisions, and is acting voluntarily, in order for the patient to obtain the medication. The law establishes additional procedures and safeguards that patients, physicians, and other health care professionals must follow before a qualifying patient may legally obtain and self-administer the medication.
 The Assembly Judiciary Committee reports favorably and with committee amendments Assembly Law No. 1504.
      As amended by the committee, this law establishes the “Aid in Dying for the Terminally Ill Act,” which will allow an adult New Jersey resident, who has the capacity to make health care decisions and who has been determined by that individual’s attending and consulting physicians to be terminally ill, to obtain medication that the patient may self-administer to terminate the patient’s life.  Under the law, “terminally ill” is defined to mean the patient is in the terminal stage of an irreversibly fatal illness, disease, or condition with a prognosis, based upon reasonable medical certainty, of a life expectancy of six months or less.
      In order for a terminally ill patient to receive a prescription for medication under the law, the patient is required to make two oral requests and one written request to the patient’s attending physician for the medication.  The law requires at least 15 days to elapse between the initial oral request and the second oral request, and between the patient’s initial oral request and the writing of a prescription for the medication.  The patient may submit the written request for medication either when the patient makes the initial oral request, or at any time thereafter, but a minimum of 48 hours are to elapse between the attending physician’s receipt of the written request and the writing of a prescription for medication.
      When a patient makes an initial oral request for medication under the law’s provisions, the attending physician is required to provide the patient with information about the risks, probable results, and alternatives to taking the medication; recommend that the patient participate in a consultation concerning concurrent or additional treatment opportunities, palliative care, comfort care, hospice care, and pain control options; and refer the patient to a health care professional who is qualified to discuss those alternative care and treatment options. The patient may choose, but is not required, to participate in such consultation.  The attending physician is also required to recommend that the patient notify the patient’s next of kin of the request, but medication may not be denied if a patient declines, or is unable to, provide this notification.
      The attending physician is required to refer the patient to a consulting physician for the purpose of obtaining confirmation of the attending physician’s diagnosis.  Both the attending physician and the consulting physician are required to verify that the patient has made an informed decision when requesting medication under the law.  When the patient makes the second oral request, the attending physician is to offer the patient an opportunity to rescind the request.  In addition, the attending physician is required to notify the patient that a request may be rescinded at any time and in any manner, regardless of the patient’s mental state.
      A patient may make a written request for medication, in accordance with the law’s provisions, so long as the patient:  is an adult resident of New Jersey, as demonstrated through documentation submitted to the attending physician; is capable; is terminally ill, as determined by the attending physician and confirmed by the consulting physician; and has voluntarily expressed a wish to receive a prescription for the medication.
      The law requires a valid written request for medication to be in a form that is substantially similar to the form set forth in the law.  The law requires the written request to be signed and dated by the patient and witnessed by at least two individuals who attest, in the patient’s presence, that, to the best of their knowledge and belief, the patient is capable and is acting voluntarily.
      The law requires at least one of the witnesses to be a person who is not:
      (1)  a relative of the qualified patient by blood, marriage, or adoption;
      (2)  at the time the request is signed, entitled to any portion of the patient’s estate upon the patient’s death; 
      (3)  an owner, operator, or employee of a health care facility, other than a long term care facility, where the patient is receiving medical treatment or is a resident.
      The patient's attending physician may not serve as a witness.
      A written request form will be required to include an indication as to whether the patient has informed the patient’s next-of-kin about the request for medication and an indication as to whether concurrent or additional treatment consultations have been recommended by the attending physician or undertaken by the patient.
      If the patient complies with the law’s oral and written request requirements, establishes State residency, and is found by both the attending physician and a consulting physician to be capable, to have a terminal illness, and to be acting voluntarily, the patient will be considered to be a “qualified terminally ill patient” who is eligible to receive a prescription for medication.  The law expressly provides that a person is not be considered to be a “qualified terminally ill patient” solely on the basis of the person’s age or disability or the diagnosis of a specific illness, disease, or condition.
      If either the attending physician or the consulting physician believes that the patient may lack capacity to make health care decisions, the physician will be required to refer the patient to a mental health care professional, which is defined in the amended law to mean a licensed psychiatrist, psychologist, or clinical social worker, for a consultation to determine whether the patient is capable.  If such a referral is made, the attending physician is prohibited from issuing a prescription to the patient for medication under the law unless the attending physician has received written notice, from the mental health care professional, affirming that the patient is capable.
      Prior to issuing a prescription for requested medication, the attending physician is required to ensure that all appropriate steps have been carried out, and requisite documentation submitted, in accordance with the law’s provisions.  The patient's medical record is to include documentation of:  the patient’s oral and written requests and the attending physician’s offer to rescind the request; the attending physician’s recommendation for concurrent or alternative care and treatment consultations, and whether the patient participated in a consultation; the attending physician’s and consulting physician’s medical diagnosis and prognosis, and their determinations that the patient is terminally ill, is capable of making the request, is acting voluntarily, and is making an informed decision; the results of any counseling sessions with a mental health care professional ordered for the patient; and a statement that all the requirements under the law have been satisfied.
      A patient's request for, or the provision of, medication in compliance with the law will not constitute abuse or neglect of an elderly person, and may not be used as the sole basis for the appointment of a guardian or conservator.  The law specifies that a patient’s guardian, conservator, or representative is not authorized to take any action on behalf of the patient in association with the making or rescinding of requests for medication under the law’s provisions, except to communicate the patient’s own health care decisions to a health care provider upon the patient’s request.  The law prohibits any contract, will, insurance policy, annuity, or other agreement from including a provision that conditions or restricts a person’s ability to make or rescind a request for medication pursuant to the law, and further specifies that the procurement or issuance of, or premiums or rates charged for, life, health, or accident insurance policies or annuities may not be conditioned upon the making or rescinding of a request for medication under the law’s provisions.  An obligation owing under a contract, will, insurance policy, annuity, or other agreement executed before the law’s effective date will not be affected by a patient’s request, or rescission of a request, for medication under the law.
      Any person who, without the patient’s authorization, willfully alters or forges a request for medication pursuant to the law, or conceals or destroys a rescission of that request, with the intent or effect of causing the patient's death, will be guilty of a crime of the second degree, which is punishable by imprisonment for a term of five to 10 years, a fine of up to $150,000, or both.  A person who coerces or exerts undue influence on a patient to request medication under the law, or to destroy a rescission of a request, will be guilty of a crime of the third degree, which is punishable by imprisonment for a term of three to five years, a fine of up to $15,000, or both.  The law does not impose any limit on liability for civil damages in association with the negligence or intentional misconduct of any person.
      The amended law provides immunity from civil and criminal liability, from professional disciplinary action, and from censure, discipline, suspension, or loss of any licensure, certification, privileges, or membership for any action that is undertaken in compliance with the law, including the act of being present when a qualified terminally ill patient takes the medication prescribed to the patient under the law’s provisions.  As amended, the law provides that this immunity also applies to any refusal to take actions in furtherance of, or to otherwise participate in, a request for medication made under the law.  Any action undertaken in accordance with the law will not be deemed to constitute patient abuse or neglect, suicide, assisted suicide, mercy killing, euthanasia, or homicide under any State law, and the law expressly exempts actions taken pursuant to the law from the provisions of N.J.S.2C:11-6, which makes it a crime to purposely aid a person in committing suicide.  These immunities will not apply to acts or omissions constituting gross negligence, recklessness, or willful misconduct.  Nothing in the law is to be construed to authorize a physician or other person to end a patient's life by lethal injection, active euthanasia, or mercy killing.
      The law amends section 1 of P.L.1991, c.270 (C.2A:62A-16), which establishes a “duty to warn” when a health care professional believes that a patient intends to carry out physical violence against the patient’s own self or against another person, in order to specify that that “duty to warn” provisions are not applicable when a qualified terminally ill patient requests medication under the law.
      The law requires a patient’s attending physician to notify the patient of the importance of taking the prescribed medication in the presence of another person and in a non-public place.  The law specifies that, if any governmental entity incurs costs as a result of a patient’s self-administration of medication in a public place, the governmental entity will have a claim against the patient’s estate to recover those costs, along with reasonable attorney fees.
      The law authorizes attending physicians, if registered with the federal Drug Enforcement Administration, to dispense requested medication, including ancillary medication designed to minimize discomfort, directly to the patient.  Otherwise, the attending physician may transmit the prescription to a pharmacist, who will dispense the medication directly to the patient, to the attending physician, or to an expressly identified agent of the patient.  Medication prescribed under the law may not be dispensed by mail or other form of courier.   Not later than 30 days after the dispensation of medication under the law, the health care professional who dispensed the medication will be required to file a copy of the dispensing record with the Division of Consumer Affairs (Division) in the Department of Law and Public Safety.
      Any medication prescribed under the law, which the patient chooses not to self-administer, is required to be disposed of by lawful means.  Lawful means includes, but is not limited to, disposing of the medication consistent with State and federal guidelines concerning disposal of prescription medications or surrendering the medication to a prescription medication drop-off receptacle.  No later than 30 days after the patient’s death, the attending physician will be required to transmit documentation of the patient’s death to the Division.  The Division is required, to the extent practicable, to coordinate the reporting of dispensing records and records of patient death with the process used for the reporting of prescription monitoring information.  The Division will be required to annually prepare and make available on its Internet website a statistical report of information collected pursuant to the law’s provisions; information made available to the public will not include personal or identifying information. 
      A health care facility’s existing policies and procedures will be required, to the maximum extent possible, to govern actions taken by health care providers pursuant to the law.  Any action taken by a health care professional or facility to carry out the provisions of the law is to be voluntary.  If a health care professional is unable or unwilling to participate in a request for medication under the law, the professional will be required to refer the patient to another health care provider and provide the patient’s medical records to that provider.
      This law was pre-filed for introduction in the 2018-2019 session pending technical review.  As reported, the law includes the changes required by technical review, which has been performed.

COMMITTEE AMENDMENTS:
      The committee amendments clarify that patients are to be advised of both concurrent and additional treatment opportunities, as well as palliative care, comfort care, hospice care, and pain control, when making a request for aid in dying medication under the law.
      The committee amendments provide that licensed clinical social workers will be permitted to make a determination as to whether a patient has the capacity to make health care decisions; as introduced, the law provided that only licensed psychiatrists and psychologists could make this determination.  The committee amendments additionally add a new definition of “mental health care professional,” which includes licensed psychiatrists, psychologists, and clinical social workers, and add a provision requiring the State Board of Social Work Examiners to adopt rules and regulations to implement the provisions of the law.  The committee amendments remove references concerning the referral of a patient to a mental health care professional if the attending or consulting physician thinks the patient may have a psychiatric or psychological disorder or depression that causes impaired judgment; as amended, the law provides for such referrals when the attending or consulting physician thinks the patient may lack the capacity to make health care decisions.  The law removes a definition of “counseling,” and various references to the term, that are obviated by these amendments.  
      The committee amendments revise the definition of “self-administer” to clarify that the term will not be limited to ingesting the aid in dying medication, but will instead apply to the physical administration of the medication to the patient’s own self.
      The committee amendments remove a provision that would have required that, if the patient is a resident in a long term care facility, a designated staff member of the facility is required to be one of the witnesses to the patient’s written request.  The committee amendments further provide an exception to the prohibition against an owner, operator, or employee of a health care facility from being a witness to the patient’s written request, to provide that this prohibition will not apply when the patient is a resident of a long term care facility.  The law defines “long term care facility” to mean a licensed nursing home, assisted living residence, comprehensive personal care home, residential health care facility, or dementia care home.
      The committee amendments remove certain language concerning when a patient has provided written consent for the patient’s attending physician to contact a pharmacist regarding a prescription for aid in dying medication; the law expressly provides elsewhere that the patient may provide such written consent when completing the written consent form, making the additional reference to the consent redundant. 
      The committee amendments clarify that the means of lawfully disposing of unused aid in dying medication may include disposal consistent with State and federal guidelines concerning the disposal of prescription medications or surrender to a prescription medication drop-off receptacle.
      The committee amendments provide that, in addition to immunity from civil and criminal liability and professional disciplinary action, a person may not be subject to censure, discipline, suspension, or loss of any licensure, certification, privileges, or membership for any action taken in compliance with the law.  The committee amendments further provide that these protections also apply to the refusal to take any action in furtherance of, or to otherwise participate in, a request for medication under the law.
      The committee amendments clarify that, in addition to not constituting patient abuse or neglect, suicide, assisted suicide, mercy killing, or homicide, actions taken in connection with a request for medication under the law will not constitute euthanasia.  
      The committee amendments provide that, in addition to not providing the sole basis for the appointment of a guardian or conservator, a patient’s request for, or the provision of, medication under the law will not constitute abuse or neglect of an elderly person.
      The committee amendments provide that the immunities and protections established under the law do not apply to acts or omissions that constitute gross negligence, recklessness, or willful misconduct.
REQUEST FOR MEDICATION TO END MY LIFE IN A
HUMANE AND DIGNIFIED MANNER

     I, . . . . . . . . . . . . . . . , am an adult of sound mind and a resident of New Jersey.
     I am suffering from . . . . . . . . . . . . . . . , which my attending physician has determined is a terminal illness, disease, or condition and which has been medically confirmed by a consulting physician.
     I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and the feasible alternatives, including 1concurrent or additional treatment opportunities,1 palliative care, comfort care, hospice care, and pain control.
     I request that my attending physician prescribe medication that I may self-administer to end my life in a humane and dignified manner and to contact any pharmacist as necessary to fill the prescription.

INITIAL ONE:

     . . . . I have informed my family of my decision and taken their opinions into consideration.
     . . . . . I have decided not to inform my family of my decision.
     . . . . . I have no family to inform of my decision.
INITIAL ALL THAT APPLY:

     . . . . .My attending physician has recommended that I participate in a consultation concerning 1concurrent or1 additional treatment opportunities, palliative care, comfort care, hospice care, and pain control options, and provided me with a referral to a health care professional qualified to discuss these options with me.
     . . . . .I have participated in a consultation concerning 1concurrent or1 additional treatment opportunities, palliative care, comfort care, hospice care, and pain control options.
     . . .  I am currently receiving palliative care, comfort care, or hospice care.

     I understand that I have the right to rescind this request at any time.
     I understand the full import of this request, and I expect to die if and when I take the medication to be prescribed.  I further understand that, although most deaths occur within three hours, my death may take longer and my physician has counseled me about this possibility.
     I make this request voluntarily and without reservation, and I accept full responsibility for my decision.

Signed:. . . . . . . . . . . . . . .

Dated:. . . . . . . . . . . . . . .

DECLARATION OF WITNESSES

     By initialing and signing below on or after the date the person named above signs, we declare that the person making and signing the above request:

Witness 1        Witness 2
Initials             Initials 
. . . . . . . . .       . . . . . . . . .       
1.  Is personally known to us or has provided proof of identity.
. . . . . . . . .       . . . . . . . . . 
2.  Signed this request in our presence on the date of the person's signature.
. . . . . . . . .       . . . . . . . . .
3.  Appears to be of sound mind and not under duress, fraud, or undue influence.
. . . . . . . . .       . . . . . . . . .
4.  Is not a patient for whom either of us is the attending physician.
. . . . . . . . .       . . . . . . . . .
Printed Name of Witness 1: . . . . . . . . . . . . .
Signature of Witness 1/Date: . . . . . . . . . . . .
Printed Name of Witness 2: . . . . . . . . . . . . .
Signature of Witness 2/Date: . . . . . . . . . . . .