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/

Tuesday, July 17, 2018

Life Insurance Trust

A number of opportunities are available for estate planning with life insurance. Many different types of life insurance products are on the market today, including "Term Insurance", "Universal Life Insurance", "Split Dollar Insurance" and "Whole Life Insurance". Depending upon the particular situation, one or more of these products may have a valuable place in your estate plan. "Split Dollar Insurance" provides that a portion of the cost is paid by a business entity, the other portion is paid by another person (e.g., the insured). Payment of a potion of the premiums by the business creates taxable income to the employee-insured. The beneficiary can be the insured, his estate, the business or family members. These policies are useful to provide cash on the death of the insured which can then be available to fund buy-sell agreement in which the employee pays for the term portion of a policy, while the corporation pays for the whole life or investment portion. With each of these products, it is possible to establish an irrevocable life insurance trust during your lifetime so that in the event you die more than three years after the creation of the trust, the insurance proceeds can be excluded from both your taxable estate and from the taxable estate of your surviving spouse. An insurance trust might provide that upon your death, the proceeds from your life insurance policies are to be collected by your Trustees (one of whom can be your spouse) and all of the income from the trust is to be paid to your spouse for life. The Trustees (other than your spouse) could have the right to invade the principal of the trust for your spouses benefit. Upon the death of your spouse, the assets could pass to your successor beneficiaries, such as your children, either outright or in further trust. To the extent that the value of the trust increases during the term of the trust, all of the trust assets, including the appreciation, will pass to the ultimate beneficiaries. If you are presently discussing the possibility of purchasing life insurance, consideration should be given to whether the policy should be owned by an individual or by a trust, as well as the selection of the beneficiaries.
A number of advantages and disadvantages of insurance trusts should be considered.
Advantages
(a) If you die more than three years after the creation of the trust and its funding, the assets in the trust are excluded from your estate.
(b) The trust will provide liquidity to help pay the estate taxes and administration expenses that may be payable on your other assets.
Disadvantages
(a) The trust is irrevocable and the provisions of the trust (including ownership of the policy by the trust), cannot be changed even if circumstances change.
Grantor Retained Income Trust ("Grit")
This type of trust involves a current gift by you to a trust wherein the "Grantor" (you) retains an income interest for a specified number of years (the "Term") and at the expiration of the term, one or more named beneficiaries receive the assets in the trust, either outright or in further trust. The IRS actuarial tables, which presently assume a 10% return on trust investments, are used to value the remainder interests for gift tax purposes.

Life Insurance

If you own life insurance on your own life, you may either
(a) designate one or more beneficiaries to receive the insurance proceeds upon your death, or
(b) make the proceeds payable to your probate estate or to a trust created by you during your lifetime or by your will.

If the insurance proceeds are payable to your estate, they will be distributed as part of the general estate in accordance with the terms of your will or, if you die without a will, the distribution will be according to the applicable laws of intestate succession. If the proceeds are payable to a trust, they will be held and distributed in the same manner as other trust assets and may also be free of creditors claims. Insurance proceeds that are payable directly to a minor child will generally necessitate the court appointment of a legal guardian or conservator. This can be avoided by having a trust designated as beneficiary or a custodial account under the state-transfers-to-minors law.
Insurance plays an important role in estate planning and should be coordinated with all other aspects of your estate plan. The laws pertaining to the taxability of insurance proceeds are complex, however, so it is important that all matters pertaining to life insurance be carefully reviewed with your attorney and insurance advisor.

Friday, July 06, 2018

ABA Summer ReportElder Law Committee Annual 2018 GP Solo Division

ABA Summer ReportElder Law Committee Annual 2018 GP Solo Division

COUNCIL AGENDA REPORT FORM 

COMMITTEE REPORTS
Division Number and Name: Division 3: Practice Specialty


Division Director Name: Daniel Tann

Reporting Board or Committee: ABA Elder Law Committee


Completed By: Kenneth Vercammen Co-Chair, Edison, NJ

1.  What has your board or committee done since its last report (e.g., conference call, meetings, use of discussion lists, planning for CLE programs, publications and articles, collaboration with other boards, committees, or sections)?
-      Sent email to members with Committee Report and information on upcoming ABA Aging conference calls
-      -Publicized program Protecting Your Assets Against Long-Term Care and Nursing Home Expenses April 26 2018    9:45 AM to 10:45 AM with speakers James and Matt Davidson Moderator Kenneth Vercammen, Esq. at the ABA-GPSoloand Group Legal Services Association (Formerly API) Spring Conference & Assisted GLSA Group Legal at New Orleans meeting April 2018 with other programs
-      Added Spring Committee report to Estate Planning blog and forwarded to all committee members
-Published article in GP Solo 
-       
-      -Helped publicize Solo Division’s book “Wills and Estate Administration Practice” approx 240 pages to help raise revenue for section- Sale of book continue to be good



What is the status of your board or committee’s business plan for the year (e.g., participation of board or committee members, goals achieved, and new goals)?
Participate in Quarterly ABA Law and Aging Networking Call
July 9, 2018
2:00 - 3:00 PM Eastern time
Call in number:
866-646-6488
Conference code: 864 935 2408
Please send me any items you would like to add to the agenda (David.Godfrey@Americanbar.org)
Our goal is to provide a forum for ABA Entities to talk about programs, publications, or policy in age related issues:
         ABA Policy Proposals in development for ABA Annual Meeting
         Upcoming training on age related topics or issues
         Publications
         Other planned programing on age related topics or issues
Offered to do program if there is a Solo day in Chicago 2018
-Ken V will participate in future quarterly ABA Commission on Law and Aging networking. These calls are open to ABA staff and Members with an interest in developing programing, policy or publications on issues relating to aging and law.  Please share this message with colleagues who may want to participate and encourage people to email me to be added to the invitation list (david.godfrey@americanbar.org<mailto:david.godfrey@americanbar.org>.)
Help publicize ABA Estate Planning, Probate and Trust and Elder Law Joint Committee Meeting Friday, Estate Planning and Elder Law Joint Committee Meetings have been scheduled for Friday August 3, at 4:00 pm – 5:00 pm round table discussion. Free to attendees
at the ABA Annual Meeting Swissotel Chicago    
Ideas to be discussed:
-BUILDING THE MILLION DOLLAR ESTATE PLANNING PRACTICE
 A Lawyer’s Guide toCreating a Winning Estate Planning Practice 

Ethically Building Your Practice using free and low-cost online methods
1.      Website specific http://www.njwillsprobatelaw.com
2.      Blog https://njprobate.blogspot.com  
3.      Facebook Law Office
4.      LinkedIn- post articles, events
5.      Google+ aka Google Plus
6.      Twitter
7.      YouTube
8.      Avvo Legal rating
9.      JD Supra
10.  Justia Lawyer Directory:
11.  Yelp for Business Owners
Attend October 2018 Charleston meeting and help out
-Future to do: Schedule Committee meeting at ABA Mid year 2019 in Las Vegas
- Future to do: Schedule Committee meeting at Spring 2019 meeting in New York


2.  Does your board or committee need any assistance from the Director, Staff, Division Officers, or Council? If yes, please explain:

Yes we need help setting up future programs and meetings.
-The Committee anticipates guidance, support and/or involvement from our Division Director regarding publicizing the Wills and Estate Administration book



ACTION ITEMS
List any action items to be presented to Council. These are items that require discussion, reporting, and/or decision-making on the part of the Council (e.g. a request for support of matters appearing before the House of Delegates, revisions of Division policies, and requests for use of extraordinary Division resources).

INFORMATIONAL ITEMS
List any informational items to be represented to Council. These items are matters for the Council’s information and do not require action.

Wednesday, June 20, 2018

Wills & Power of Attorney Seminar

Wills & Power of Attorney Seminar
Piscataway Library Kennedy Branch
October 11 at 7pm
500 Hoes Lane Piscataway NJ 08854
Piscataway J.F. Kennedy Memorial Library
Open to the public. You do not need to be a resident.

SPEAKER: Kenneth Vercammen, Esq. Edison, (Author- ABA’s “Wills and Estate Administration book”)
The January 1, 2018 New Estate Tax law changes administration of estates and trusts in New Jersey.
Main Topics:
1. NJ Estate Tax eliminated as of January 1, 2018 & Veterans Tax credit
2. 2018 changes in Federal Estate and Gift Tax
3. The new Digital Fiduciary Act & New law permits Executor to resign if all parties consent
4. Power of Attorneys
5. Living Will
6. Administering the Estate/ Probate/Surrogate
COMPLIMENTARY MATERIAL: Brochures on Wills, Probate and Administration of an Estate, Power of Attorney, Living Wills, Real Estate Sales for Seniors, and Trusts.
Piscataway Library Kennedy Branch
Brought to you by the Piscataway Public Library Foundation
Register at the Kennedy Library Information Desk or by calling 732-463-1633x6
FB
Can’t attend? We can email you materials Send email to VercammenLaw@Njlaws.com


Free Will Seminars and Speakers Bureau for Groups
SPEAKERS BUREAU
At the request of senior citizen groups, unions, and Middlesex County companies and organizations, the " Speakers Bureau " is a service designed to educate citizens about how laws affect their lives and how the judicial system operates. We have attorneys available to speak to businesspersons, educational, civic and social organizations on a wide range of topics during business hours. If your organization in Central NJ would like to schedule a Will & Estates seminar, call Kenneth Vercammen’s Law Office at 732-572-0500 or email Vercammenlaw@njlaws.com

10 years ago the AARP Network Attorneys of the Edison/Metuchen/Woodbridge area several years ago established a community Speakers Bureau to provide educational programs to AARP and senior clubs, Unions and Middlesex County companies. Now, Ken Vercammen, Esq. and volunteer attorneys of the Middlesex County Estate Planning Council have provided Legal Rights Seminars to hundreds of seniors, business owners and their employees, unions, clubs and non-profit groups
Details on free programs available

These quality daytime educational programs will educate and even entertain. Clubs and companies are invited to schedule a free seminar. The following Seminars are now available:
1. WILLS & ESTATE ADMINISTRATION-PROTECT YOUR FAMILY AND
MAKE PLANNING EASY
2. POWER OF ATTORNEY to permit family to pay your bills if you are temporarily disabled and permit doctors to talk with family
All instructors are licensed attorneys who have been in practice at least 25 years. All instructors are members of the American Bar Association, New Jersey
State Bar Association, and Middlesex County Bar Association. All programs include free written materials.

You don't have to be wealthy or near death to do some thinking about a Will. Here is your opportunity to listen to an experienced attorney who will discuss how to distribute your property as you wish and avoid many rigid provisions of state law.

Topics discussed include: Who needs a Will?; What if you die without a Will (intestacy)?; Mechanics of a Will; "Living Will"; Powers of Attorney; Selecting an executor, trustee, and guardian; Proper Will execution; Inheritance Taxes, Estate Taxes $14,000 annual gift tax exclusion, Bequests to charity, Why you need a "Self-Proving" Will and Estate Administration/ Probate.

Sample materials: Hand-outs on Wills, Living Wills/Medical Advance Directive, Power of Attorney, Probate and Administration of an Estate, Real Estate, Working with your Attorney, Consumers Guide to New Jersey Laws, and Senior Citizen Rights.

SPEAKERS BUREAU

At the request of senior citizen groups, unions, and Middlesex County companies and organizations, the " Speakers Bureau " is a service designed to educate citizens about how laws affect their lives and how the judicial system operates. We have attorneys available to speak to businesspersons, educational, civic and social organizations on a wide range of topics during business hours.

In today's complex world, few people can function successfully and safely without competent legal advice. In order to insure your estate plans are legally set up, you need to know exactly where you stand so that you can avoid possibly catastrophic mistakes impacting both you and your family.

About the speaker: Kenneth A. Vercammen is a trial attorney in Edison, NJ. We is the author of the American Bar Association’s book “Wills and Estate Administration”
He is co-chair of the ABA 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. He is a member of the AARP and often lectures to groups on the importance of an up to date Will, Power of Attorney and Living Will.
KENNETH VERCAMMEN & ASSOCIATES, PC
ATTORNEY AT LAW
2053 Woodbridge Ave.
Edison, NJ 08817
(Phone) 732-572-0500
(Fax) 732-572-0030
www.njlaws.com

Tuesday, June 12, 2018

Happy Hour & Networking Social

Happy Hour & Networking Social
July 13, 2018
    Professionals, Attorneys, Friends, Runners, Law Enforcement invited to Happy Hour & Networking Social
July 13, 2018   Friday
at Bar Anticipation
703 16th Ave. Lake Como/ Belmar, NJ 07719
   Free !    
5:30-7:55PM Hot & Cold Buffet
   The reduced price Happy Hour is 6-7PM is $2.00 House Drinks, House Wine Bud/BudLt draft 
   Co-sponsored by NJ State Bar Association Municipal Court Section & several other organizations
      Outdoor bands, prize giveaways. Bring your friends. Pass this along. Please bring a canned food donation for a community food bank, continuing to provide food and help to individuals in need.
      Email Ken Vercammen's Law Office so we can put your name on the VIP list for wristbands.     VercammenLaw@Njlaws.com
https://www.facebook.com/events/433925550366495/
   If your group, non-profit or organization wishes to co-sponsor the networking happy hour, please contact
KENNETH VERCAMMEN, Esq.
2053 Woodbridge Ave. Edison, NJ 08817  
732-572-0500 VercammenLaw@Njlaws.com

    Bar Anticipation is 5 blocks from the Belmar Train Station and 8 blocks from the Ocean boardwalk

2018 Happy Hour Co-Sponsors as of 5/11/18
NJ State Bar Association Municipal Court Section
Young Lawyers Division YLD
Criminal Law Section
Business Law Section
Construction Law Section
Elder and Disability Law Section
Minorities in Legal Profession Section (MIPS)
Entertainment, Arts and Sports Law Section
Federal Practice and Procedure Section
Insurance Defense Special Committee
Insurance Law Section
Labor and Employment Law Section
Lawyers In Transition Special Committee
Local Government Law Section
NJSBA Dispute Resolution Section
Paralegal Special Committee
Consumer Protection Committee
Diversity Committee
Morris County Bar
 NJ Defense Association
Paralegal Association of NJ
Lakewood Chamber of Commerce
Central Jersey Professionals Networking Group
ABA Estate, Probate & Trust Committee
ABA Elder Law Committee
ABA Criminal Law Committee
Retired Police & Fire Middlesex Monmouth Local 9
Middlesex Estate Planning Council
Edison Elks BPOE

Friday, April 20, 2018

Wills, Estate Planning & Probate Seminar Sayreville Senior Center May 1

 Wills, Estate Planning & Probate Seminar 
423 Main Street
Sayreville NJ 08872    
open to the public

Open to the public. You do not need to be a resident.

SPEAKER: Kenneth Vercammen, Esq. Edison, (Author- ABA’s “Wills and Estate Administration book”)

Main Topics:
 1. NJ Estate Tax eliminated on Estates as of January 1, 2018 & Veterans Tax credit
2. 2018 changes in Federal Estate and Gift Tax  
    3. The new Digital Fiduciary Act & New law permits Executor to resign if all parties consent
4. Power of Attorneys      
5.  Living Will            
6.  Administering the Estate/ Probate/Surrogate
      
        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.
 For information Call Sayreville Senior Center 732-390-7059Jen Krushinski  
jkrushinski@sayreville.com
You don’t have to be a Sayreville resident to attend. https://www.facebook.com/events/1812208865746499/
For materials if you can’t attend, email vercammenlaw@njlaws.com


Speaker: Kenneth A. Vercammen is a trial attorney in Edison, NJ. He is Author of the American Bar Association book “Wills and Estate Administration”. He is co-chair of the ABA 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.comwhich includes many articles on Estate Planning, Probate and Wills. He is a member of the AARP and often lectures to groups on the importance of an up to date Will, Power of Attorney and Living Will.

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

Wednesday, April 04, 2018

nursing home medicaid payment denied where applicant did not provide documents W.S., Petitioner-Appellant, v. DIVISION OF MEDICAL ASSISTANCE

W.S.,

        Petitioner-Appellant,

v.

DIVISION OF MEDICAL ASSISTANCE
AND HEALTH SERVICES and
ATLANTIC COUNTY BOARD OF
SOCIAL SERVICES,

     Respondents-Respondents.
_______________________________

              Submitted February 28, 2018 – Decided March 20, 2018

              Before Judges Manahan and Suter.

              On appeal from the Department of Human
              Services, Division of Medical Assistance and
              Health Services.

 NOT FOR PUBLICATION WITHOUT THE
                      APPROVAL OF THE APPELLATE DIVISION
     This opinion shall not "constitute precedent or be binding upon any court."
      Although it is posted on the internet, this opinion is binding only on the
        parties in the case and its use in other cases is limited. R. 1:36-3.




                                       SUPERIOR COURT OF NEW JERSEY
                                       APPELLATE DIVISION
                                       DOCKET NO. A-2815-16T4

PER CURIAM W.S. appeals from the January 17, 2017 final decision of the New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS). A fair hearing was held before the Administrative Law Judge (ALJ), who, in his initial decision, reversed the Atlantic County Board of Social Services' (ACBSS) denial of W.S.'s Medicaid application. ACBSS filed exceptions to the ALJ's decision. The Director of the DMAHS, reversed the ALJ's decision and entered a final agency decision upholding the denial of W.S.'s Medicaid application. In essence, the Director held that despite given the opportunity to provide financial documents necessary for a determination of eligibility for Medicaid benefits, the documents were not provided. W.S. argues that ACBSS should have allowed more time to provide the information and should have provided assistance in obtaining the information. We conclude that controlling law compels us to affirm. We review an agency's decision for the limited purpose of determining whether its action was arbitrary, capricious or unreasonable. "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 and Health Servs., 434 N.J. Super. 250, 261 (App. Div. 2014) (quoting Russo v. Bd. of Trs., Police & 2 A-2815-16T4 Firemen's Ret. Sys., 206 N.J. 14, 27 (2011)). "The burden of demonstrating 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)). "Medicaid is a federally-created, state-implemented program that provides 'medical assistance to the poor at the expense of the public.'" Matter of Estate of Brown, 448 N.J. Super. 252, 256, (App. Div.) (quoting Estate of DeMartino v. Div. of Med. Assistance & Health Servs., 373 N.J. Super. 210, 217 (App. Div. 2004)), certif. denied, In re Estate of Brown, 230 N.J. 393 (2017); see also 42 U.S.C. § 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). In New Jersey, the Medicaid program is administered by DMAHS pursuant to the New Jersey Medical Assistance and Health Services Act, N.J.S.A. 30:4D-1 to -19.5. The county welfare boards, such as ACBSS, evaluate eligibility. One of the objectives of Medicaid is to provide "medical assistance to needy persons who are institutionalized in nursing homes as a result of illness or other incapacity." R.S., 434 N.J. 3 A-2815-16T 4 Super. at 258 (quoting M.E.F. v. A.B.F., 393 N.J. Super. 543, 545 (App. Div. 2007)). "DMAHS provides institutional level Medicaid benefits to individuals residing in nursing homes pursuant to the Medicaid Only program, N.J.A.C. 10:71-1.1 to -9.5." Brown, 448 N.J. Super. at 257. "[A]n applicant seeking such benefits must have financial eligibility as determined by the regulations and procedures." Ibid.; see also N.J.A.C. 10:71-1.2(a). "[T]o be financially eligible, the applicant must meet both income and resource standards." Ibid.; N.J.A.C. 10:71-3.15. Through its regulations, DMAHS establishes "policy and procedures for the application process." N.J.A.C. 10:71-2.2(b). The county welfare boards exercise "direct responsibility in the application process to . . . [r]eceive applications." N.J.A.C. 10:71-2.2(c)(2). The regulations establish timeframes to process an application, with the "date of effective disposition" being the "effective date of the application" where the application has been approved. N.J.A.C. 10:71-2.3(b)(1). "The process of establishing eligibility involves a review of the application for completeness, consistency, and reasonableness." N.J.A.C. 10:71-2.9. "The maximum period of time normally essential to process an application for the aged is [forty-five] days." N.J.A.C. 10:71-2.3(a). New Jersey regulations recognize: 4 A-2815-16T4 there will be exceptional cases where the proper processing of an application cannot be completed within the [45-day] period. Where substantially reliable evidence of eligibility is still lacking at the end of the designated period, the application may be continued in pending status. In each such case, the CWA [(county welfare agency)] shall be prepared to demonstrate that the delay resulted from one of the following: . . . . (2) A determination to afford the applicant, whose proof of eligibility has been inconclusive, a further opportunity to develop additional evidence of eligibility before final action on his or her application; [N.J.A.C. 10:71-2.3(c).] This was the fourth application by W.S. for Medicaid. The applications were filed by Hammonton Center as his "Authorized Representative" (AR) of W.S. Prior applications were submitted in February, May and November, 2015. The instant application was received on February 1, 2016 and was denied for failure to provide information needed to make a determination on June 21, 2016. At the time of the denial, bank statements from an ING Direct account remained outstanding. Statements from this account were requested by ACBSS commencing with the first application. On April 27, 2016, an ACBSS caseworker acknowledged receipt of a fax from the AR's attorney, which informed the ACBSS that it had not obtained the requested documents. The caseworker advised 5 A-2815-16T4 the AR that the documentation was necessary to make an eligibility determination and suggested searching for the documents with the financial institution by using the wife's account number. On June 2, 2016, the caseworker sent the AR a letter stating that the application would be denied on June 20, 2016, if the account statements were not provided by that date. On June 20, 2016, the attorney for the AR sent an email to the caseworker requesting an extension because they still had not obtained the records. The request was denied and the application was denied on June 21, 2016. ACBSS had the discretion, pursuant to N.J.A.C. 10:71-2.3(c), to extend the deadline even further and could have placed W.S.'s application in pending status. ACBSS, however, did not use the forty-five day standard set out in N.J.A.C. 10:71-2.3(a) as a basis for denying eligibility. See 42 C.F.R. § 435.912(g)(2) (2013). Instead, ACBSS gave the AR one-hundred-eighty days to procure the requested verification documents. ACBSS has the obligation to address Medicaid applications timely. See N.J.A.C. 10:71-2.2(c)(5). During a Medicaid application process, the CWA, ACBSS here, is responsible for assisting an applicant "in exploring their eligibility for assistance," N.J.A.C. 10:71-2.2(c)(3), and making known to the applicant "the appropriate resources and services 6 A-2815-16T4 both within the agency and the community, and, if necessary, assist in their use." N.J.A.C. 10:71-2.2(c)(4). The applicant must "[c]omplete, with assistance from the CWA if needed, any forms required by the CWA as a part of the application process," N.J.A.C. 10:71-2.2(e)(1), and "[a]ssist the CWA in securing evidence that corroborates his or her statements." N.J.A.C. 10:71-2.2(e)(2). The applicant is "the primary source of information," but the CWA is responsible for making "the determination of eligibility and to use secondary sources when necessary, with the applicant's knowledge and consent." N.J.A.C. 10:71-1.6(a)(2). "The CWA shall verify the equity value of resources1 through appropriate and credible sources. . . . If the applicant's resource statements are questionable, or there is reason to believe the identification of resources is incomplete, the CWA shall verify the applicant's resource statements through one or more third parties." N.J.A.C. 10:71-4.1(d)(3). The applicant is responsible for cooperating fully with the verification process if the CWA has to contact the third party in reference to verifying resources. N.J.A.C. 10:71-4.1(d)(3)(i). "If necessary, the applicant shall 1 A resource is "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). 7 A-2815-16T4 provide written authorization allowing the CWA to secure the appropriate information." Ibid. N.J.A.C. 10:71-2.10 discusses collateral investigation: (a) "Collateral investigation" shall refer to contacts with individuals other than members of applicant's immediate household, made with the knowledge and consent of the applicant(s). (b) The primary purpose of collateral contacts is to verify, supplement or clarify essential information. Here, ACBSS did not attempt to procure the missing documentation. However, nothing in N.J.A.C. 10:71-4.1(d)(3) places a burden on ACBSS to acquire the required documents, but rather states only that if an applicant's identification of resources is incomplete, ACBSS must verify the resource statements through a third party. Although ACBSS is responsible for assisting an applicant, the regulations did not create an affirmative duty upon ACBSS to procure all documents necessary to complete the application, especially when W.S. had a representative. "An administrative agency's interpretation of statutes and regulations within its implementing and enforcing responsibility is ordinarily entitled to our deference." N.J. Div. of Child Prot. & Permanency v. V.E., 448 N.J. Super. 374, 390 (App. Div. 2017) (quoting Wnuck v. N.J. Div. of Motor Vehicles, 337 N.J. Super. 52, 56 (App. Div. 2001)). "Deference to an agency decision 8 A-2815-16T4 is particularly appropriate where interpretation of the Agency's own regulation is in issue." R.S., 434 N.J. Super. at 261 (quoting I.L. v. N.J. Dep't of Human Servs., Div. of Med. Assistance & Health Servs., 389 N.J. Super. 354, 364 (App. Div. 2006)). Here, the DMAHS rendered its final decision after interpreting its own regulations. We may reverse only upon a showing that the DMAHS acted arbitrarily, capriciously, or unreasonably. Denying an application that did not have the information necessary to verify eligibility after giving several adjournments is not arbitrary, capricious or unreasonable because Medicaid applications must be processed promptly and Medicaid is intended to be a resource of last resort, reserved for those who have a proven financial or medical need for assistance. See N.E. v. N.J. Div. of Med. Assistance & Health Servs., 399 N.J. Super. 566, 572 (App. Div. 2008). Affirmed.

Saturday, March 31, 2018

Pending Bill” “Aid in Dying for the Terminally Ill Act,”

Pending Bill” “Aid in Dying for the Terminally Ill Act,”
   The Assembly Judiciary Committee reports favorably and with committee amendments Assembly Bill No. 1504.
      As amended by the committee, this bill 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 bill, “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 bill, the patient is required to make two oral requests and one written request to the patient’s attending physician for the medication.  The bill 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 bill’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 bill.  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 bill’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 bill requires a valid written request for medication to be in a form that is substantially similar to the form set forth in the bill.  The bill 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 bill 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 bill’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 bill 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 bill 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 bill 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 bill’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 bill have been satisfied.
      A patient's request for, or the provision of, medication in compliance with the bill 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 bill 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 bill’s provisions, except to communicate the patient’s own health care decisions to a health care provider upon the patient’s request.  The bill 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 bill, 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 bill’s provisions.  An obligation owing under a contract, will, insurance policy, annuity, or other agreement executed before the bill’s effective date will not be affected by a patient’s request, or rescission of a request, for medication under the bill.
      Any person who, without the patient’s authorization, willfully alters or forges a request for medication pursuant to the bill, 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 bill, 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 bill does not impose any limit on liability for civil damages in association with the negligence or intentional misconduct of any person.
      The amended bill 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 bill, including the act of being present when a qualified terminally ill patient takes the medication prescribed to the patient under the bill’s provisions.  As amended, the bill 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 bill.  Any action undertaken in accordance with the bill will not be deemed to constitute patient abuse or neglect, suicide, assisted suicide, mercy killing, euthanasia, or homicide under any State law, and the bill expressly exempts actions taken pursuant to the bill 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 bill 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 bill 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 bill.
      The bill 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 bill 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 bill 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 bill may not be dispensed by mail or other form of courier.   Not later than 30 days after the dispensation of medication under the bill, 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 bill, 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 bill’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 bill.  Any action taken by a health care professional or facility to carry out the provisions of the bill is to be voluntary.  If a health care professional is unable or unwilling to participate in a request for medication under the bill, 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 bill was pre-filed for introduction in the 2018-2019 session pending technical review.  As reported, the bill 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 bill.
      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 bill 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 bill.  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 bill provides for such referrals when the attending or consulting physician thinks the patient may lack the capacity to make health care decisions.  The bill 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 bill 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 bill 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 bill.  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 bill.
      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 bill 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 bill will not constitute abuse or neglect of an elderly person.
      The committee amendments provide that the immunities and protections established under the bill do not apply to acts or omissions that constitute gross negligence, recklessness, or willful misconduct.