Thursday, August 5, 2010

Our Pledge

At the Knudsen Law Firm, we know this is what clients want, and we
promise to deliver:

* Value. Whatever the fee arrangement is - alternate, fixed or
hourly - you will get your money's worth.
* Solutions to (and prevention of) problems, i.e., getting you out
of trouble.
* Money. Ways to save it, keep it or make it.
* Expertise in the particular area(s) of law where you need
counsel.
* Attention. You will feel that you are our most important client.

* Communication. Only bats and mushrooms like to be kept in the
dark. You won't be
* To be involved. You will be asked your opinion and have a say
in every decision.
* Timeliness. We will meet every deadline.
* Courtesy and respect. You will be treated as a person, not just
a file.
* No surprises. We will tell you what will happen and prepare you
for what might happen.

* Prompt and understandable billing.

* Prompt answers. To questions - and to any complaints.

* Guidance and counsel. On what you must or should do.
* Responsiveness.
* Advocacy.
* Follow through.

If you do not find that have met or exceeded your expectations in all of
these areas, I want to hear about it. I personally will do what it
takes to make you satisfied.

"We help you deal with it"

Change in Nursing Home Survey Process

Nebraska Implementing QIS Process.

Nebraska is moving toward implementing the QIS (Quality Indicator
Survey) process. Nebraska is part of the second group of states in
which CMS is doing this, along with Colorado and New York. Nebraska
will begin implementing the QIS process beginning August 2010.

Compared to the current, traditional, surveying system which has
information documented on paper throughout the process, each CMS team
member will use a tablet PC to document findings. These findings will
then be electronically synthesized, organized and loaded to the CMS.
When doing onsite preparation, QIS team members will analyze
alphabetical resident censuses with room numbers and units in addition
to a list of new admissions over the last thirty days. There will also
be substantial changes to offsite preparation, the initial tour process,
sample selection, and to various other aspects of the survey process.

QIS surveys will involve two stages. Each stage will involve three
steps. Step one will be "computer generated sampling". Step two will be
"investigation". Step three will be "synthesis". The first stage will
involve a preliminary investigation of regulatory areas. The second
stage will involve an in-depth investigation into deficiencies
identified in stage one.

This system will be implemented in phases across the state, using
"teams" to do one area of the state at a time. This will take two to
two and a half years to implement fully. Because it will be more
objective, driven by MDS data, and feature large sample sizes it will
likely result in a higher rate of deficiencies in place of many "FYI"
comments surveyors presently give.

<http://www.knudsenlaw.com/Att_Bio_JRL.htm>
<http://www.knudsenlaw.com/>

Jeanelle R. Lust

Knudsen, Berkheimer, Richardson & Endacott, LLP

3800 VerMaas Pl

Suite 200

Lincoln NE 68502

402 475 7011

402 440 3731 (M)

402 475 8912 (F)

www.knudsenlaw.com

jlust@knudsenlaw.com

Managing Partner

"We help you deal with it"

Tuesday, May 25, 2010

Lexington Public Schools receives summary judgment

Yesterday Judge Doyle in the District Court of Dawson County issued
summary judgment to the Lexington Public Schools finding the school not
liable for injuries to one of its students. The Lexington Public
Schools was represented by Jeanelle Lust of the Knudsen Law Firm.

The student alleged that she fell into a manhole on Lexington Public
School's property while participating in an out-door gym class. The
school maintained throughout the litigation that it did not know of any
defects or problems with the manhole (or in fact that a manhole was even
on its property). Judge Doyle agreed and dismissed the plaintiff's
case.

<http://www.knudsenlaw.com/Att_Bio_JRL.htm>
<http://www.knudsenlaw.com/>

Jeanelle R. Lust

Knudsen, Berkheimer, Richardson & Endacott, LLP

3800 VerMaas Pl

Suite 200

Lincoln NE 68502

402 475 7011

402 440 3731 (M)

402 475 8912 (F)

www.knudsenlaw.com

jlust@knudsenlaw.com

Managing Partner

"We help you deal with it"

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Wednesday, March 17, 2010

Supreme Court Refuses to Hear Nursing Home Civil Rights Case

By: Laura E. Troshynski

www.knudsenlaw.com <http://www.knudsenlaw.com>

Can alleged inadequate nursing home care lead to a civil
rights lawsuit? According to the United States Court of Appeals for the
Third Circuit, the answer is "yes." In July of 2009, in the case of
John J. Kane Regional Centers-Glen Hazel v. Grammer, the Third Circuit
held that the Federal Nursing Home Reform Amendments (FNHRA) guarantee a
nursing home resident's civil rights. Consequently, according to the
Third Circuit, private civil rights lawsuits may be brought against
nursing homes in the event of alleged wrongful death or inadequate
patient care. Recently, the United States Supreme Court declined to
review the case, allowing the Third Circuit decision to stand.

The Third Circuit's ruling was the result of a claim brought
by Sarah Grammer against a Pittsburgh-area nursing home in which Grammer
alleged that her mother, Melvinteen Daniels, was neglected by the John
J. Kane Regional Center. According to Ms. Grammer, the facility
provided inadequate care which eventually resulted in her mother's
death. Instead of filing a typical negligence claim against the nursing
home, Ms. Grammer chose to sue under the Federal Nursing Home Reform
Amendments. According to Ms. Grammer, the FNHRA guarantee various
patient rights, including the right to quality care. Therefore, Ms.
Grammer contended that the alleged inadequate care received by her
mother constituted a civil rights violation for which she could bring a
civil rights lawsuit under the FNHRA. The nursing home, however,
contended that the FNHRA were simply meant to outline requirements for
Medicaid and Medicare certification.

Initially, the District Court ruled in favor of the nursing
home facility. However, the Third Circuit overturned the District
Court's ruling, holding that the FNHRA creates the right to a private
civil rights lawsuit in the event of inadequate care. Various groups,
including the AHCA, the American Association of Homes and Services for
the Aging, and various individual states petitioned the Supreme Court to
review the holding of the Third District. However, despite this
petition, the Supreme Court refused to hear the case. Therefore, it
appears as if nursing homes throughout the country may be exposed to
potential civil rights lawsuits in the event of alleged inadequate
patient care.

Monday, March 8, 2010

What to do when a Loved One Passes

Although first taken aback by shock and grief, you may be called upon to handle the necessary details surrounding the loss of your loved one and it is important to know what to do.

First, you have to get help and depending on the scenario, local law enforcement may have to be contacted first (i.e. if the death was not attended or due to unknown circumstances.) In most other circumstances various parties must be immediately notified, including:

  • The attending physician, a coroner or medical examiner to officially pronounce the death. If the deceased was in a hospital or other care facility, this is typically arranged by the staff.
  • Family members or a legal representative of the deceased. They will need to locate the deceased's pre-arranged funeral plan, if one exists, for direction in how to proceed with funeral arrangements.
  • A Funeral Director to transfer the body from the place of death to a funeral home or comparable care facility. Funeral directors are available through funeral homes and other funeral service organizations.

In the absence of instructions from the loved one, or a pre-arranged funeral plan, you'll need to make a series of decisions relatively quickly. If there are several family members and friends assembled, make a list of the necessary tasks and delegate responsibility. Organizing a funeral usually entails planning the funeral ceremony and the disposition of the deceased's body, accommodating guests and, usually, arranging for a subsequent gathering.

If it is too difficult or you want it handled by a Funeral Director and one hasn't been pre-selected, you should call a recommended funeral home, cremation service or other service provider that will handle all the funeral arrangements. Funeral directors help you plan the funeral ceremonies and then direct the ceremonies in accordance with your wishes, including coordinating with the cemetery. A typical cemetery offers various types of grave spaces for earth burial and mausoleum crypts for entombment. Similar options are available for burial or entombment of cremated remains. The cemetery also provides services to open and close the grave or crypt and to install grave markers. Some cemeteries charge recurring fees for the perpetual maintenance of the grounds. Since you are likely to visit the cemetery periodically to remember your loved one, location is an important consideration in selecting a cemetery. Many people purchase cemetery property in advance to relieve their survivors of this responsibility. There are several cemeteries available in Lincoln and you should decide where you may want the "final resting place" for your loved one. A few local cemeteries are listed below:

www.wyuka.com - (402) 474-3600

(402) 474-4500

(402) 476-8787

(402) 441-0585

www.lincolnfh.com - (402) 423-3826

Some choices will influence others. If the deceased is to be directly cremated before a funeral, then you may opt for a simple casket to transport the body to the crematorium, but choose an attractive urn if the cremated remains are to be present at the subsequent service. If there is to be an open casket for viewings, then embalming becomes a consideration, as does the type of casket. A cemetery interment means choosing between ground burial and entombment in a mausoleum, whereas a scattering of ashes raises the question of location and accompanying ceremony. If you want a funeral or memorial service held at a church or other place of worship, you'll need to make such arrangements with the appropriate officials, and you'll need to discuss the nature of the service. Some of the choices that must be made when arranging a funeral are set forth below:

Method of interment

· Will the deceased be buried or entombed?

· Will the deceased be cremated? If so, will the cremated remains be buried, entombed, scattered or kept by the family?

· Will the body be donated to science? Will organs be donated?

Ceremonies

· Will there be a traditional funeral with the casket present or a memorial service without the presence of the casket? Will both types of services be held or no ceremonies at all?

· Where will the ceremonies be held? At a funeral home? At a place of worship? At the graveside?

· Will there be one or more visitations? If so, will the casket be open or closed?

· Will the deceased be embalmed?

· Should a DNA sample be taken?

· Who will participate in the funeral ceremonies? Clergy? Pallbearers? Speakers? Musicians or vocalists?

· Will the ceremonies feature certain music, readings, or tributes?

· Will there be a procession to the cemetery? Will the deceased be transported in a hearse? Will family travel in a limousine?

Following the funeral a variety of financial, legal and administrative matters must be addressed. The tasks you may need to do include:

  1. Sending acknowledgement notes expressing gratitude for flowers, donations and special assistance.
  2. Commencing estate proceedings. Whether an extensive Probate proceeding is necessary is determined by the size of the estate and the existence of a will and living trusts. An Executor, named in the will or appointed by the Probate Court will shepherd the estate through this process. Also, it may be necessary to hire an estate planning attorney to provide legal guidance.
  3. Accounting for all assets and debts of the deceased. Make arrangements to pay outstanding bills. It may be necessary to have the Probate Court release short-term funds to cover these bills.
  4. Filing death benefit claims with insurance companies, Social Security, the Veterans Administration, pension/retirement funds, unions, etc. Certified copies of the death certificate are usually required in making these claims. See http://www.socialsecurity.gov/pubs/10084.html.
  5. Changing all jointly held accounts including, bank accounts, credit cards, mortgages, loans, brokerage accounts, stocks, bonds and other investments.
  6. Sending notifications of death to:
    • Employers.
    • Fraternal, social, and religious organizations.
    • State and local agencies, such as the Department of Motor Vehicles, to transfer all licenses and titles.
    • Telephone, utility, newspaper and any other services that are registered in the deceased's name.

Try not to take on the entire responsibility for organizing a loved one's funeral and post-funeral yourself. Others will want to help, to share the experience as a way to feel connected to the one who has died and to make a contribution to the memorial, and you need to allow yourself time to grieve.

NEBRASKA FUNERAL & BURIAL REQUIREMENTS

DO YOU KNOW WHAT YOUR STATE REQUIRES?

  1. Does the law of your state require a licensed professional (such as a funeral director) to prepare a body for burial?

In Connecticut, Indiana, Louisiana, Michigan, Nebraska and New York, laws require that a funeral director handle human remains at some point in the process. In the 44 other states and the District of Columbia, loved ones can be responsible for the body themselves. The state of Nebraska requires a licensed Funeral Director to care for human remains. See below, Neb Rev. St. § 71-605.

  1. Does the law of your state require embalming for an open casket funeral service?

In Nebraska, funeral homes have their own rules and factors (such as time) regarding whether or not to embalm. Required embalming depends on such factors as whether the family selected a service with a public or private viewing of the body with an open casket; if the body is going to be transported by air or rail; or because of the length of time prior to the burial or cremation. If a funeral home charges for embalming, they must explain why in writing. EXAMPLES: (i) Selected a service with a viewing or (ii) Arranged for shipment by common carrier or (iii) Selected arrangements that require the funeral home to hold the remains for more than 24 hours provided that no refrigeration is available or a hermetically sealed container is not used and provided that embalming does not conflict with religious beliefs or medical examination.

According to the Federal Trade Commission Funeral Rule, all funeral homes are required to get permission to embalm. If you select a funeral service which requires embalming, such as a funeral with a viewing, you may have to pay for embalming. You are not required to have embalming if you selected arrangements such as direct cremation or immediate burial. If a funeral home charges for embalming, they must explain why in writing. EXAMPLES: (i) Selected a service with a viewing or (ii) Arranged for shipment by common carrier or (iii) Selected arrangements that require the funeral home to hold the remains for more than 24 hours provided that no refrigeration is available or a hermetically sealed container is not used and provided that embalming does not conflict with religious beliefs or medical examination.

Truth about Embalming

Preparing the body for public viewing nearly always involved embalming and cosmetic restoration, processes that can add $600 or more to a funeral bill. Is embalming otherwise necessary or required? Not really.

  • Embalming generally is not necessary if the body is buried or cremated within a reasonable time after death.
  • Embalming is not required by law except in certain cases when a body is transported across state lines.
  • Embalming does not preserve the deceased’s body indefinitely; it merely masks the appearance of death and temporarily postpones decomposition.
  • Embalming chemicals are highly toxic. Embalmers must wear a respirator and full-body covering while performing the procedure.
  • Refrigeration is an alternative to embalming for maintaining a body intact while awaiting a funeral service. Although not all funeral homes have refrigeration facilities, most hospitals do.
  • Embalming is common only in the United States and Canada. Orthodox Jews and Muslims consider the procedure a desecration of the body. — From the Funeral Consumers Alliance.

  1. Does the law of your state require the use of a vault or grave liner?

No state law requires a grave-liner or vault, but many cemeteries require them, to keep the grave from caving in. It's a maintenance convenience for the cemetery.

  1. Does the law of your state license or restrict the disposition of cremated human remains?

There are no “cremains police” in any state to ensure proper etiquette, permits, or permission are obtained and used. There are no health, safety or environmental issues to be concerned about. However, if your scattering ceremony is to be held within a city or town limits, city/town ordinances and bylaws should be consulted. See Neb Rev. St. § 71-1381, § 71-1382.

  1. Does the law of your state prohibit the kind of "home funeral" commonly experienced 100 years ago (i.e. a calling in the home of the deceased and burial by the family)?

Home funerals are legal in all states except five. Connecticut, Delaware, Indiana, Nebraska, and New York have restrictions. See Neb Rev. St. § 71-605.

SOURCES:

Nebraska Department of Health and Human Services- Statutes relating to Funeral Directing and Embalming Practice Act Cremation of Human Remains Act..

http://www.dhhs.ne.gov/crl/statutes/Funeral%20Directing%20and%20Embalming.pdf

NEBRASKA REVISED STATUTES

Neb Rev. St. § 71-605 Death certificate; cause of death; sudden infant death syndrome; how treated; cremation, disinterment, or transit permits; how executed; filing; requirements.

Neb Rev. St. § 71-1381 Cremated remains; how treated.

Neb Rev. St. § 71-1382 Cremated remains; final disposition.


Michael W. Khalili
Associate Attorney
*Licensed in Washington State & the U.S. District Court of Nebraska

http://www.knudsenlaw.com/Att_Bio_MWK.htm

Tuesday, March 2, 2010

New Nurses Don't Feel Comfortable Implementing Quality Improvement Measures

An analysis of survey responses by researchers at New York University's
College of Nursing has found that a large number of new nurses feel
ill-prepared to implement quality improvement measures and more than 12%
have never heard of "quality improvement".

The survey was sent to 436 newly graduated nurses with bachelor and
associate's degrees from around the country. The study found that 38.6%
of those surveyed felt that their degree courses either "poorly" or
"very poorly" prepared them to implement quality improvement measures
and 41.7% didn't feel prepared at all to use national patient safety
resources including the National Quality Forum.

The researchers defined quality improvement as the "use of data to
monitor the outcomes of care processes and use of improvement methods to
design and test changes to continuously improve the quality and safety
of health care systems." There is debate over just exactly who should
be responsible for teaching quality improvement with some believing it
should be the school and others believe it should fall to the employer.
However, the study's authors note that only 23.3% of those surveyed said
that their employer provided quality improvement training was "very
helpful."

<http://www.knudsenlaw.com/Att_Bio_JRL.htm>
<http://www.knudsenlaw.com/>

Jeanelle R. Lust

Knudsen, Berkheimer, Richardson & Endacott, LLP

3800 VerMaas Pl

Suite 200

Lincoln NE 68502

402 475 7011

402 423 4768 (H)

402 440 3731 (M)

402 475 8912 (F)

www.knudsenlaw.com

jlust@knudsenlaw.com

Wednesday, February 24, 2010

Wrongful Termination

We are often contacted by people who have been fired from their job and who want to know if they have a potential lawsuit against their employer for wrongful termination. It is important to remember that Nebraska is an at-will employment state. That means that if your private employer fires you, and you are not part of a union and do not otherwise have a written contract, your employer may generally fire you for any reason, as long as that reason is not illegal or in violation of certain public policies. In other words, your employer can be the world’s biggest jerk, have had no reason for firing you, and your firing can be completely “unfair,” but in most cases there is no legal remedy for your firing. The most common exception for this general rule is when your employer has violated your civil rights. Therefore, when you’ve been let go by your employer, you may want to ask yourself these questions before contacting the lawyer:

1) Is a union involved, or did you have an employment contract with your employer?

2) Was your firing on account of your race, color, religion, national origin, sex, age, physical or mental disability (or perceived disability), marital status, genetics, service in the uniformed services, or any other classification protected by law?

3) Was your firing in relation to having recently been injured at work or making a workers compensation claim?

4) Have you complained about not being paid overtime, minimum wage, or similar concerns?

5) Have you reported your employer to any authorities because of illegal conduct or unsafe working conditions?

Jeanelle R. Lust

Knudsen, Berkheimer, Richardson & Endacott, LLP

3800 VerMaas Pl

Suite 200

Lincoln NE 68502

402 475 7011

402 423 4768 (H)

402 440 3731 (M)

402 475 8912 (F)

www.knudsenlaw.com

jlust@knudsenlaw.com

Managing Partner

Tuesday, February 16, 2010

Federal court compels arbitration in nursing home dispute despite unavailability of the NAF

Earlier this month in Jones v. GGNSC Pierre, LLC, the U.S. District Court for the District of South Dakota agreed with arguments made by the Knudsen Law Firm, compelling the parties to arbitrate pursuant to their arbitration agreement despite the unavailability of the named National Arbitration Forum (NAF).  Arbitration agreements naming the NAF are rapidly being challenged nationwide as a result of that entity’s unavailability under the terms of a recent consent judgment with the State of Minnesota.  In Jones, the Court noted the parties’ arbitration agreement incorporated the NAF Code of Procedure, but found no reason to believe that specification was integral to the agreement, relying instead on the parties’ primary promise to resolve any future disputes “exclusively by binding arbitration” and “not by a lawsuit or resort to court process.”  The Court also noted the agreement’s severance clause as further evidence of their intention to arbitrate if a portion of the agreement was unenforceable.  

Kevin R. McManaman

krm@knudsenlaw.com

402/475-7011

Monday, February 15, 2010

Arbitration in favor of Nursing Home

The AHCA reported the following this week.

February 12, 2010 Vol. VIII Issue 6
Long Term Care
Arbitrator Rules In Favor Of Nursing Home In Negligence Action, Awards
Attorney's Fees

An arbitrator rejected February 4 a complaint against a nursing home for
medical malpractice and other allegations, finding "the great weight of
the evidence" suggested the resident in question "died of natural causes
while on her nocturnal ventilator."
Pursuant to the arbitration agreement executed as part of the admissions
process, the arbitrator also awarded the nursing home, as the prevailing
party, attorney's fees totaling over $259,000. The cost of the
arbitration was split between the two parties.

Jason Bring and Robert Strang of Arnall Golden Gregory LLP defended the
nursing home defendants in the three-day arbitration. "The attorney's
fees represented a major victory for the defendants, and their award
demonstrates that these cases are not without risk for the plaintiffs,"
Bring said.
The surviving spouse and estate of Mae Frances Holmes Reed initially
sued Heritage Healthcare of Savannah, LLC, which operates the nursing
home where Reed resided, in a Georgia trial court.
The nursing home sought to enforce the parties' arbitration agreement
and filed suit in a South Carolina federal district court. The claimants
then conceded that the case should be arbitrated and the district court
entered an order compelling arbitration.

The complaint alleged that Reed died because her nocturnal ventilator
was not connected per her physician's orders. The complaint relied on an
affidavit of a certified nurse assistant (CNA) who worked for Heritage
Park but who was terminated roughly two weeks after Reed's death.
According to the CNA, the ventilator was not connected and the nursing
home engaged in a conspiracy to cover up the incident.
The arbitrator found, however, that the evidence demonstrated Reed's
ventilator was connected and operating appropriately. The arbitrator
also noted that no other witnesses came forward to corroborate the CNA's
allegations.
"In addition, [the CNA's] credibility was seriously undermined by
inconsistent statements that she made and by the lack of plausibility of
her accounts," the arbitrator said.

Friday, February 12, 2010

Nebraska New Hire Reporting Act Now Includes Independent Contractors

Effective January 1, 2010, the definition of "employee" under the Nebraska New Hire Reporting Act, for the first time, expressly included "independent contractors." Nebraska law requires all employers to report any newly hired or rehired employees, including, their name, address, social security number, and the date of hire or rehire, within 20 days of the date of hire or rehire.  Nebraska employers must now perform new hire reporting when hiring independent contractors.  This is required regardless of how little money is involved because there is no de minimis standard like the $600 threshold for 1099-MISC.  Also, independent contractors who are paid after January 1, 2010 need to be reported, regardless of how long the employer has done business with the contractor in the past. 

For reasons unknown the Nebraska amendment adding "independent contractor" to the definition of "employee" did not include a definition of the term "independent contractor."  Other states have expressly adopted such a definition, and the Nebraska's website (www.nenewhire.com/) has described an independent contractor using the definition used by other states as "an individual who provides goods or services to an employer under terms specified in a contract or within a verbal agreement for compensation that is reported as income other than wages and who is an individual, the sole shareholder of a corporation, or the sole member of a limited liability company.”  However, Nebraska did not adopt that language in its statute, and as of this writing (February 2010) there are no regulations or proposed regulations addressing this oversight.  The precise language of the law requires a hiring or rehiring report for any contractor providing goods or services for compensation, with nothing in law expressly limiting that to individuals, sole proprietors, or single member corporations or LLCs. 

Submitting a copy of an employee’s W-4 form, with a notation of the date of hire or rehire, is typically be sufficient for the requirements of this Act.  However, employers may now want to consider using the new federal Form W-9 which has been revised to now require such independent contractors providers to list their first and last names, and FEIN or SSN.  Importantly, employers need to submit their reports using the social security number of self-employed individuals, even if they operate with a company having a FEIN.  Therefore, while employers may ask independent contractors to complete the new Form W-9, if the individual’s social security number is still not known after reviewing the W-9, the employer should ask the independent contractor for it.  If refused, the employer is probably best to decline to hire the contractor.  Employers are advised to seek advice from their attorney on how to proceed given the unanswered questions arising from this amendment.

Kevin R. McManaman

krm@knudsenlaw.com

402/475-7011

The CLASS Act

The Community Living Assistance Services and Supports (CLASS) Act is
currently in both the House and Senate healthcare reform bills. Its
purpose is to increase access to long-term care.

The CLASS Act would create a voluntary long-term care and disability
benefit for workers. Panelists at a briefing on January 5, 2010 state
that more actions need to be taken to overcome problems facing the
field. Those panelists agree the bill benefits the long-term care field
but they suggest other ways to improve the industry as a whole.

One of the panelist identified the need for expanding the long-term care
workforce and providing increased education and training. Another
panelist stated there should be additional funding available for
existing programs to strengthen the relationship between family
caregivers and formal caregivers.

Supporters of the Act state that it will help seniors and the disabled
pay for things such as in-home caretakers all while supposedly lowering
the federal budget deficit. The Congressional Budget Office (CBO) says
that over the first decade the CLASS Act would lower the federal deficit
by $72.5 billion. Others state that the CBO used some creative math to
come up with that "savings" and that after the first decade of the
program, costs would actually increase.

The CLASS program is voluntary and open to all Americans and various
government analysts estimate that 2-6% of those eligible will sign up
for the program. CMS' analysis of the CLASS provision in the House bill
finds that there is a significant risk that the CLASS program will
become unsustainable and is at risk for failure. CMS calculated that
the CLASS program's premiums could initially be as high as $180 a month.


James Firman, President and CEO of the National Council on Aging, has
countered the critics in a letter to the Wall Street Journal stating
that there are several safeguards within the CLASS Act to guarantee that
the program is solvent over a 75 year period after the addition of an
amendment of Sen. Judd Gregg (R-NH) that the critics fail to mention.
He states that few understand that the program would be self-funded,
would promote personal responsibility, would create a new private
supplemental market and would prohibit taxpayer dollars being used to
pay for benefits. Firman says that the CLASS Act also has the potential
in health reform to bend the Medicaid cost curve downward.

www.knudsenlaw.com

Thursday, February 11, 2010

Your Therapy Allowance is Shrinking, Healthcare Reform Already!

Long term care residents started fresh this year with their
annual allowance for therapy on January 1, 2010. This is due to the
expiration of Medicare Part B therapy exceptions. The spending limits
are $1,860 for combined speech and physical therapy, and $1,860 for
occupational therapy. But how long will the allowance really last? If,
however, healthcare reform should pass, it would extend the therapy caps
exceptions process.

When a resident exhausts the therapy benefit, it causes a
problem for the resident who needs the therapy and the nursing home
which provides it. The options the residents have are not very appealing
but they include: the resident privately funding the therapy; the
facility could continue to provide the therapy with the expectation it
will be reimbursed when the bill passes; or it could altogether suspend
the therapy. Another option is to send a resident to a hospital
outpatient facility where there is no limit on the therapy because
Hospitals are not subject to the therapy caps rule. However, there can
be many problems transporting residents who may be frail or unwilling.
The resident who most likely would feel the impact of the allowance cap
would be someone who suffered a high-acuity event, such as a stroke or
hip or knee replacement, and needs intensive, short-term therapy.

Although there is no cause for alarm just yet, with each day
that passes residents and nursing homes are stuck with the dilemma of
what happens next. At this point it seems that the best option for
residents in need of regular therapy is for Congress to pull together
and pass the healthcare bill. As each day passes, the health needs of
residents are depending on it. Some are optimistic in swift action by
Congress, such as Peter Clendenin, executive vice president for the
National Association for the Support of Long Term Care, stating "I think
they'll [Congress] get to it early this month, but we're sort of hanging
out there until that gets done." The Senate bill would extend the
exceptions process for one year, while the House bill would extend it
for two.

Thus, whether or not you are a fan of healthcare reform,
this is at least one reason you may consider supporting it.

Michael Khalili

mwk@knudsenlaw.com

www.knudsenlaw.com

Tuesday, February 9, 2010

Royal College of Physicians Releases New Report Regarding Use of Feeding Tubes for Terminally Ill Patients

According to a recent report from the Royal College of Physicians,
tube-feeding may not be the most beneficial option for feeding
terminally ill patients.

The report, which is entitled 'Oral feeding difficulties and
dilemmas: A guide to practical care, particularly towards the end of
life,' was issued by the Royal College of Physicians and the British
Society of Gastroenterology in early January in order to address the
appropriateness of feeding tubes for patients approaching the end of
life. According to the report, hand feeding, modified if necessary,
should be the primary aim of a nutrition strategy for terminally ill
patients. In addition, the report states that even in situations where
tube feeding is necessary, oral intake should be additional whenever
possible. The report also makes several other recommendations,
including the recommendation that a risk management approach be used to
evaluate all patients deemed to have "unsafe swallow." Additionally,
the authors of the report recommend that there be a clear agreement
between the parties involved regarding the aims of any nutritional
regimen.

According to the Royal Academy of Physicians, the report was
prepared to respond to the lack of consensus among physicians and others
regarding the appropriateness of artificial nutrition and hydration in
certain situations.

Laura Troshynski

www.knudsenlaw.com

Wednesday, February 3, 2010

Red Flags Rule update

The Red Flags Rule could be held to not apply to the health care setting
based on a federal court ruling exempting attorneys.

http://www.mcknights.com/advocates-urge-ftc-to-exempt-healthcare-from-re
d-flags-rule-following-federal-court-decision/article/163019/?utm_source
=feedburner&utm_medium=feed&utm_campaign=Feed%3A+McKnights+%28McKnights+
Home%29&utm_content=Google+Feedfetcher

<http://www.knudsenlaw.com/Att_Bio_JRL.htm>
<http://www.knudsenlaw.com/>

Jeanelle R. Lust

Knudsen, Berkheimer, Richardson & Endacott, LLP

3800 VerMaas Pl

Suite 200

Lincoln NE 68502

402 475 7011

402 423 4768 (H)

402 440 3731 (M)

402 475 8912 (F)

www.knudsenlaw.com

jlust@knudsenlaw.com

Managing Partner

Ms. Lust is a charter fellow in the Litigation Counsel of America
http://www.trialcounsel.org <http://www.trialcounsel.org/> and is
admitted in Colorado, Nebraska and South Dakota. Circular 230
Disclosure: Pursuant to recently-enacted U.S. Treasury Dept Regulations,
we are now required to advise you that, unless otherwise expressly
indicated, any federal tax advice contained in this communication,
including attachments and enclosures, is not intended or written to be
used, and may not be used, for the purpose of (i) avoiding tax-related
penalties under the Internal Revenue Code or (ii) promoting, marketing
or recommending to another party any tax-related matters addressed
herein. CONFIDENTIALITY NOTICE: This electronic message contains
information from the law firm of Knudsen, Berkheimer, Richardson &
Endacott, LLP which may be confidential or privileged. DO NOT FORWARD
THIS E-MAIL WITHOUT ASSURING PROTECTION OF PRIVILEGED MATERIAL. If you
have questions about forwarding this message, contact us first. All
clients are advised that communication by e-mail may not be secure and
may be subject to interception. This electronic message is intended
solely for the use of the individual or entity named above. If you are
not the intended recipient, be aware that any disclosure, copying,
distribution or use of the contents of this message is prohibited. If
you have received this electronic transmission in error, please delete
it from all computers and notify us by telephone (402-475-7011) or by
electronic mail immediately.

Monday, February 1, 2010

FW: NSHHRA Update re Nebraska New Hire Reporting Act - please send to the membership.

Nebraska New Reporting Requirements Now Include Independent Contractors

Effective January 1, 2010, the definition of "employee" under the
Nebraska New Hire Reporting Act, for the first time, expressly included
"independent contractors." Nebraska law requires all employers to report
any newly hired or rehired employees, including, their name, address,
social security number, and the date of hire or rehire, within 20 days
of the date of hire or rehire. Nebraska employers should now perform
new hire reporting when hiring independent contractors. This is
required regardless of how little money is involved because there is no
de minimis standard like the $600 threshold for 1099-MISC. Also,
independent contractors who are paid after January 1, 2010 need to be
reported, regardless of how long the employer has done business with the
contractor in the past.

For reasons unknown the Nebraska amendment adding "independent
contractor" to the definition of "employee" did not include a definition
of the term "independent contractor." Other states have expressly
adopted such a definition, and the Nebraska's website
(www.nenewhire.com/) describes an independent contractor using the
definition used by other states as "an individual who provides goods or
services to an employer under terms specified in a contract or within a
verbal agreement for compensation that is reported as income other than
wages and who is an individual, the sole shareholder of a corporation,
or the sole member of a limited liability company." However, Nebraska
did not adopt that language in its statute, and there are no current
regulations addressing this oversight. Therefore, the language of the
law requires broad reporting, and employers must report hiring or
rehiring any contractor providing goods or services for compensation,
with nothing in law expressly limiting that to individuals, sole
proprietors, or single member corporations or LLCs.

Submitting a copy of an employee's W-4 form, with a notation of the date
of hire or rehire, is typically be sufficient for the requirements of
this Act. However, employers may now want to use the new federal Form
W-9 which has been revised to now require such independent contractor
service providers to list their first and last names, and FEIN or SSN.
Importantly, employers need to submit their reports using the social
security number of self-employed individuals, even if they operate with
a company having a FEIN. Therefore, while employers should ask
independent contractors to complete the new Form W-9, if the
individual's social security number is still not known after reviewing
the W-9, the employer should ask the independent contractor for it. If
refused, the employer is probably best to decline to hire the
contractor.

Employers are advised to seek advice from their attorney on how to
proceed given the myriad unanswered questions arising from this
amendment.

<http://www.knudsenlaw.com/Att_Bio_KRM.htm>
<http://www.knudsenlaw.com/>

Kevin R. McManaman

krm@knudsenlaw.com <mailto:krm@knudsenlaw.com>

Knudsen, Berkheimer, Richardson & Endacott, LLP

3800 VerMaas Place, Suite 200

www.knudsenlaw.com

Lincoln, NE 68502

402/475-7011 (office)

402/475-8912 (fax)

402/440-2982 (cell)

Tuesday, January 5, 2010

Happy New Year

In this time of resolution making, consider resolving to make sure your
legal house is in order:

1) Do you have a will? Do you need one?

2) Do you have powers of attorney that will allow another person to
manage your financial affairs if you should become incapacitated?

3) Do you have medical health care powers of attorney that spell out
what your wishes are should you be unable to express your own wishes?

4) Is your business structured appropriately?

5) Have you made provisions for caring for your children should
something happen to you?

6) Do you have more debt than you can handle?

<http://www.knudsenlaw.com/Att_Bio_JRL.htm>
<http://www.knudsenlaw.com/>

Jeanelle R. Lust

Knudsen, Berkheimer, Richardson & Endacott, LLP

3800 VerMaas Pl

Suite 200

Lincoln NE 68502

402 475 7011

402 423 4768 (H)

402 440 3731 (M)

402 475 8912 (F)

www.knudsenlaw.com

jlust@knudsenlaw.com

Managing Partner

Ms. Lust is a charter fellow in the Litigation Counsel of America
http://www.trialcounsel.org <http://www.trialcounsel.org/> and is
admitted in Colorado, Nebraska and South Dakota. Circular 230
Disclosure: Pursuant to recently-enacted U.S. Treasury Dept Regulations,
we are now required to advise you that, unless otherwise expressly
indicated, any federal tax advice contained in this communication,
including attachments and enclosures, is not intended or written to be
used, and may not be used, for the purpose of (i) avoiding tax-related
penalties under the Internal Revenue Code or (ii) promoting, marketing
or recommending to another party any tax-related matters addressed
herein. CONFIDENTIALITY NOTICE: This electronic message contains
information from the law firm of Knudsen, Berkheimer, Richardson &
Endacott, LLP which may be confidential or privileged. DO NOT FORWARD
THIS E-MAIL WITHOUT ASSURING PROTECTION OF PRIVILEGED MATERIAL. If you
have questions about forwarding this message, contact us first. All
clients are advised that communication by e-mail may not be secure and
may be subject to interception. This electronic message is intended
solely for the use of the individual or entity named above. If you are
not the intended recipient, be aware that any disclosure, copying,
distribution or use of the contents of this message is prohibited. If
you have received this electronic transmission in error, please delete
it from all computers and notify us by telephone (402-475-7011) or by
electronic mail immediately.