For most people, being admitted to a hospital will probably raise some level of anxiety, especially if it involves a serious health crisis and likely extended stay. However, the experience may be even more complicated if the patient is on Medicare. The regulations that govern Medicare payments are many and detailed; hospitals and skilled nursing facilities (SNFs) must familiarize themselves with the rules or risk being denied payment. Clearly, this would be a problem for the facility, but can also have serious ramifications for patients.

An important element of Medicare hospital coverage (Medicare Part A) is the ‘hospital benefit period.’ When a patient is admitted to the hospital as an inpatient, the benefit period ‘clock’ will begin ticking. Once the patient’s deductible has been met ($1,216 in 2013), Medicare will cover most of the costs of the hospital stay for up to 60 days. Beyond that, the patient begins to incur more of the costs: $304 a day for days 61 to 90 and, from day 91, the patient is responsible for the full costs of their care. Clearly, this is not sustainable for most seniors living on fixed incomes, especially those without Medicare Supplemental Insurance (Medigap).

The ‘deadlines’ that arise within the system undoubtedly factor into the care-planning decisions made at many facilities. Some patients are eligible for Medicaid, the primary source of funding in these cases, which relieves much of the financial burden. For those who are not eligible, but have only modest resources, a balance must be found between the patient’s medical condition and needs, the feasibility of a home discharge, possibly supplemented by home care, and transfer to a skilled nursing facility. In any event, in order to trigger a new benefit period, the patient must stay out of the hospital or SNF for at least 60 days. Clearly, non-Medicaid/Medigap patients requiring long-term hospital or SNF care could find themselves with substantial medical bills.

Another concern for patients is the risk that the hospital will classify them as being under ‘observation status.’ Although, by all appearances, the patient receives the usual medical care as would be expected, hospitals are aware that Medicare could suspect that the patient’s admission is an attempt by a skilled nursing facility to restart the clock for Medicare payments. The regulations require that the patient must first have been admitted to the hospital for at least three days for Medicare to pay for post-acute care or rehabilitation services. While under observation status, Medicare does not cover the medical expenses incurred during the patient’s stay. Therefore, it may come as a shock to patients to discover that their ‘hospital stay’ was not covered as expected, and they are responsible for the full costs that have accrued.

Thus, patients and their families must ask pointed questions about their care before signing any discharge papers, as well as understand how Medicare limits on benefits may play a role in a patient’s care while in the hospital.

First, any patient on Medicare must understand the Medicare limits and how they may affect their options as ‘deadlines’ approach. Once the patient is aware of these limits, he or she can inquire whether the same treatment available at the time of admission will continue to be available once a benefit limit is reached. Finally, the patient should also question whether he or she will be required to privately pay for any part of the care provided because Medicare coverage has either not begun or has run out. These inquires will go a long way in helping patients and their families understand the process and identify any hidden costs they may need to consider when deciding the course of treatment and the options available for an extended hospital stay.

Vivienne Duncan is Director of the Elderlaw and Cancer Advocacy Projects at the City Bar Justice Center

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Russia recently passed legislation that bans “propaganda of nontraditional sexual relations among minors.” What speech and activities constitute propaganda are unclear, and the law has been implemented to ban not only gay pride parades but also any demonstration raising awareness of the plight of LGBT people in Russia. The law has had the secondary effect of inciting violence against the LGBT community by placing an official stamp of disapproval on it. This state-sanctioned stigma has resulted in job loss, gay baiting, and police indifference to violent hate crimes against LGBT community. The US has seen an increase in LGBT Russians seeking asylum as a result of this worsening situation.

Russia is currently hosting the Winter Olympics in Sochi. The unambiguous, express language of the Olympic Charter states “[a]ny form of discrimination … on grounds of race, religion, politics, gender or otherwise, is incompatible with belonging to the Olympic movement.” The International Olympic Committee had an opportunity to stay true to its charter and call to task its 2014 host nation. Instead the IOC has supported Russia’s stance by claiming that it is not in violation of the Olympic Charter and that the Olympics are not a political forum. The IOC has warned both the athletes and spectators not to engage in any form of political protest or demonstration during the Winter Olympics. This seems to include wearing rainbow flags or holding hands.

While other nations, notably in Africa, the Caribbean and the Middle East, may have a more chilling human rights record with respect to their LGBT citizens, Russia is now the focus of international attention due to the Olympics, which presents a unique opportunity to raise global awareness of a persecuted minority. The controversy will not end, as the World Cup will be held in Russia in 2018 and in Qatar in 2022, where men can be jailed for up to three years for homosexual acts, and the FINA world swimming championships will be in Kazan Russia in 2015.

The City Bar Justice Center is cosponsoring a forum titled Human Rights and International Sporting Events: Russian Anti-Gay Legislation, the Sochi Winter Olympics, and Next Steps at the New York City Bar Association on February 24 from 6:30 to 8:30 pm. You can register for the event here: http://bit.ly/1bvALyE

K. Scott Kohanowski is a Staff Attorney at the City Bar Justice Center and Co-President of the International Gay and Lesbian Aquatics Association

 

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A mother with a crying child in the background wants to know how she can obtain a divorce from her abusive husband. A caller teeters on the brink of homelessness after being legally evicted from his home. A long-term unemployed father of two wants to know how to file for bankruptcy.  These and some 100 other New Yorkers called the City Bar Justice Center’s Legal Hotline in the first week of the New Year.

Among the first 100 cases, 32% were about Divorce and Family law, 30% Landlord-Tenant and 27% Consumer. The calls to the Hotline reflect what is happening in New York City civil courts, which are jammed with divorce/family law filings, housing court disputes and consumer debt cases.  The Legal Hotline seeks to fill the gap in New York City’s legal services system, as many of the legal services providers are over-burdened and under-resourced, while court clerks can provide some legal information but can’t give legal advice.

The Legal Hotline is the largest free general civil legal hotline for low-income New Yorkers.  In 2013, the Hotline assisted over 11,000 callers, providing advice, legal information and referrals on a variety of civil issues. The Hotline also provided over 1,500 callers with brief services,  including mailing written information to callers on their rights and responsibilities, assisting callers in drafting legal documents, and curing defects in legal documents.

The Legal Hotline can be reached at 212 626 7383, Monday through Friday, from 9:00 a.m. to 1:00 p.m. and 2:00 p.m. to 5:00 p.m.

Libby Vazquez is Director of the City Bar Justice Center’s Legal Hotline.

 

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While recent studies note that people are living longer, healthier lives, it should be recognized that some seniors remain at risk of being targeted due to physical or cognitive decline, isolation and loneliness and lack of information about their rights.

In New York City, the prospect of losing the home in which one has lived for decades or becoming the victim of a scam is not mere theory; many have experienced these or similar difficulties, or have a direct relationship with someone who has. For many years, the Elderlaw Project (ELP) has conducted free legal clinics at senior centers in New York City. Attorneys from the law firm of Reed Smith LLP staff the clinics and meet individually with low- and moderate-income seniors to discuss their legal problems. The seniors bring to the clinics a wide range of issues, including housing, government benefits, life planning and consumer debt, and each one receives advice, counseling and/or referrals to address their specific concern.

In addition to legal clinics, ELP also conducts community workshops throughout the city on topics of particular interest and relevance to seniors. At a recent event held at a New York City Housing Authority complex in the Bronx, the focus was on senior safety and awareness of rights. The session began with a lively presentation by community police officers who provided the audience with excellent advice, complete with demonstrations, on how to protect themselves from becoming crime victims. From learning how to safely carry a purse to avoid being strangled by a bag-snatcher, to responding to unsolicited telephone calls, the officers provided the seniors with examples of how to plan ahead and reduce the chance of being taken off guard.

ELP followed with a presentation on consumer debt. Living on a fixed income in the city is challenging, and many seniors find themselves grappling with debt. For some, trying to keep up with the increasing credit card interest payments becomes impossible, and they find themselves fending off aggressive calls from debt collectors. A substantial number of the audience admitted that they never answer the telephone but, instead, let it go to voicemail as they can no longer deal with the constant ‘dunning’ calls. The presentation focused on the importance of establishing certain key points, such as verifying whether the debt is really theirs, since some claims are based on mistake or fraud; if the debt is old, checking whether the statute of limitations applies; and being aware that the debt collector’s actions may be in contravention of the Fair Debt Collection Practices Act. The seniors were also advised about what constitutes harassment. Of particular interest was the information about protected sources of income that cannot be ‘taken’ by debt collectors. It was something of a revelation to the audience to learn that their social security and pensions cannot be swallowed up by creditors, contrary to what some debt collectors tell them. At the end of the session, the seniors felt more confident, empowered and prepared.

Another successful community event recently took place at the Peter Dellamonica Jr. Senior Center in Astoria, Queens. Approximately 40 seniors attended a presentation on life planning preparation conducted by one of ELP’s volunteer attorneys, Oscar Straus, III.  The audience was advised about the importance of advance planning, using wills, health care directives and powers of attorney.  A similar presentation is scheduled at the Stein Senior Center this month.

 

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In late 2013, the City Bar Justice Center and the Connecticut Veterans Legal Center co-sponsored a conference in Hartford on legal problems faced by veterans. Legal services providers from 10 different organizations from New York, New Jersey, Connecticut, Pennsylvania and Maine attended the Veterans Legal Services Provider Conference. The group of veterans advocates included representatives from bar associations, local and national legal service providers, law firms and law schools all committed to serving veterans.

The participants’ diverse perspectives and a range of expertise in different legal practice areas provided for a unique platform for collaboration to assist veterans.  Lawyers working on veterans issues took this opportunity to discuss the challenges of their work and strategize about solutions. A significant issue that many veterans face is difficulty in accessing VA disability benefits for injuries related to their service. The attendees discussed the obstacle of long wait times at the VA and regional differences in the processing of these claims. The Veterans Assistance Project at the City Bar Justice Center recruits, trains, and mentors pro bono volunteers from firms and corporations around New York City to help veterans with these claims for benefits.  Participants also discussed ways they support the pro bono volunteers who work with their organizations to most effectively leverage legal services for veterans.

The attendees agreed that there is a great need for more legal assistance for veterans, mainly in the areas of family law and housing.  A bill is currently pending in the U.S. Senate that would authorize the VA to fund legal services for veterans. The legal services providers that assist veterans are watching this bill with great interest and working to make the need for legal services known.

Veterans who are given less than honorable discharges from the military often face additional significant barriers adjusting to civilian life.  These discharges can impact veterans’ ability to find work and can make them ineligible for important VA benefits, such as the GI Bill, healthcare or disability compensation. Many of the legal services providers that attended the conference are interested in helping veterans file for discharge upgrades given the lack of services available in this area.  Overcoming these discharges can be an important first step in allowing veterans to become self-sufficient. Caitlin Kilroy, Staff Attorney on the City Bar Justice Center’s Veterans Assistance Project noted, “In our clinics, we have seen many deserving veterans who have been discharged for behavior that likely resulted from an underlying mental health issue, such as PTSD.”

Professor Michael Wishnie of the Yale Veterans Legal Services clinic delivered the keynote address. He spoke about the wide-ranging legal issues that the clinic tackles on behalf of veterans. Each clinic student works on both individual matters with a veteran, such as an application for VA benefits, and on systemic legal issues. For example, the clinic has sought public records regarding the incidence of sexual assault in the military, fought to expand pretrial diversion programs for veterans, and sued the military for failing to properly review discharge upgrade applications from veterans with PTSD. The depth and breadth of the work of the Yale Veterans Legal Services clinic inspired attendees to discuss ways they might be able to expand the scope of the services they offer to veterans.

The networking opportunity and chance to pool expertise and resources provided by the conference was invaluable. Carol Bockner, Director of the Veterans Assistance Project and Director of Pro Bono Initiatives at the City Bar Justice Center said, “We look forward to continuing to work together in our shared mission to help veterans in need.”

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When Tania Lopez, a single mother of two from the Bronx, was laid off from her job in 2006, she decided to turn misfortune into opportunity and use her entrepreneurial spirit to follow her passion for food. Tania spent most of her life in the South Bronx but moved to Puerto Rico for ten years to raise her children. It was there that she delighted in the gastronomic culture of her native country and grew accustomed to cooking all of her dishes from scratch. Upon returning to the United States, however, her fast-paced New York lifestyle left her little time to carry on with her healthy eating habits. Tania found herself resorting to more efficient – yet less healthy – fast food to accommodate her busy schedule, and she felt her health decline as a result.

Tania LopezLooking around her local, predominantly Latino community, Tania saw that she was not alone. She constantly heard complaints from her friends and family about their weight, diabetes, heart problems, high cholesterol, and high blood pressure. Realizing that these widespread health problems were inextricably linked to an American habit of depending on overly-processed food, Tania was inspired to start Coquí the Chef, a company that promotes a holistic approach to eating through healthy recipes and fresh ingredients. The company’s philosophy centers on the idea that cooking at home is not only essential, but fun as well. The entrepreneur said, “I grew tired of hearing about obesity, diabetes and other life threatening health issues taking lives. I got to the point where I realized I no longer wanted health issues to control me or my loved ones, so I decided to look into food instead of relying on western medicine to ‘fix’ us. My exploration led me on a journey… a journey into a different world: one that acknowledges the wonders of food.” Tania chose the coquí frog to be her company’s mascot due to the endangered amphibian’s symbolic importance to her native island, and she partnered with talented graphic artists to draw up the cartoon frog.

Coqui frogIn January 2013, Tania approached the Neighborhood Entrepreneur Law Project for assistance with a trademark application. Through NELP, Tania was paired with Jordana Garellek, an associate at Duane Morris LLP who helped her trademark her business name and logo. They discussed other intellectual property issues and plans for expanding her business as well, such as licensing her mark and creating her own cooking show. Ms. Garellek remarked on Tania’s entrepreneurship: “She has been a pleasure to work with and her entrepreneurial spirit seems to have no bounds. She is always looking for ways to improve her business in order to truly make a difference in her community.”

Tania and Coqui the frogTania has a recipe blog to help parents make healthy eating choices for their children, and she sells cookbooks and shares recipes through her website, www.coquithechef.com. She has also started a YouTube channel through which she shares cooking tutorials. And for special occasions such as the 54th Annual National Puerto Rican Day Parade, she even dons the Coqui the Chef costume herself to help spread nutritional awareness! What began as a true passion became an enduring business for Tania, who said, “Coqui the Chef not only speaks about healthy eating and nutritional awareness; he is here to remind us that food is more than something we eat. It creates and defines us… most of all it connects us.”

Tania & Kids

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The Philippines recently requested that Washington designate the country for Temporary Protected Status (TPS). The request was made in the devastating wake of Typhoon Haiyan, which has killed more than 6,000 people, displaced more than four million, and affected an estimated 12 million since it struck the Philippines on November 8th, 2013.

What is TPS?
TPS is a temporary, humanitarian form of relief extended to foreign nationals who hail from a country suffering from an ongoing armed conflict or, like the Philippines, a natural calamity that makes it unsafe for them to return. Individuals who receive TPS are not removable from the United States, can obtain work authorization, and may be granted travel authorization. “It’s meant to help people who are in the U.S. and whose conditions in their home country prevent them from returning safely, or in certain circumstances, where the country is unable to handle the return of its nationals adequately,” said Claire Nicholson, a spokeswoman for U.S. Citizenship and Immigration Services. “It allows them to stay in the U.S. and work until they can safely return home.”  However, as TPS does not lead to permanent resident status, when the designation terminates beneficiaries revert to the same immigration status they maintained before TPS or to any other status they may have acquired while registered for TPS.

Current TPS designated countries include El Salvador, Haiti, Honduras, Nicaragua, Somalia, Sudan, South Sudan and Syria.

How Would TPS Benefit the Philippines and Filipino Nationals Now in the U.S.?
A number of public policy objectives would be addressed by a TPS designation for the Philippines. First, given the devastation wrought by Typhoon Haiyan and the ensuing massive relief and restoration efforts, TPS would alleviate the Philippines’ burden of having to reabsorb thousands of its nationals from abroad during this national emergency. Second, TPS would protect Filipinos in the United States from being forced to return to their home countries in the midst of an unprecedented humanitarian calamity. Third, TPS would grant eligible Filipinos here in the United States employment authorization, thereby enabling them to work and send money to support their families in the Philippines and otherwise aid in the recovery process. Indeed, prior to Typhoon Haiyan, remittances from overseas Filipinos equaled nearly 10 percent of the Philippines’ Gross Domestic Product. Now more than ever, Filipino nationals temporarily living in the U.S. should be empowered to aid in the recovery of their own homeland and to alleviate the tragic consequences befalling the Philippines.

What Role Could the City Bar Justice Center Play In the Event TPS is Designated for the Philippines?
Uniquely able to leverage the resources of the New York City legal community, the City Bar Justice Center is fully prepared to respond in the event the Department of Homeland Security designates the Philippines for TPS. Within two weeks of the Typhoon, the Justice Center worked closely with the New York City Bar Association and its Immigration and Nationality Committee to issue a letter calling upon the Obama Administration to designate the Philippines for TPS.  The Justice Center also has a long track record and tremendous experience organizing large scale legal clinics in response to emerging needs and crises, such as Special Registration following 9/11, Deferred Action for Children Arrivals (DACA), and Hurricane Sandy. Indeed, following the tragic earthquake and subsequent U.S. government designation of TPS for Haiti in January 2010, the Justice Center immediately organized free legal clinics to assist Haitian New Yorkers in navigating the TPS application process. Mobilizing pro bono attorneys from law firms throughout the city, the Justice Center assisted hundreds of Haitian nationals in receiving TPS.

The City Bar Justice Center urges the U.S. Department of Homeland Security to designate the Philippines for Temporary Protected Status without further delay, and stands ready to mobilize its vast legal network and resources to aid this disaster-stricken community.

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When faced with a cancer diagnosis, priorities shift and patients find themselves in unfamiliar territory on many levels. A workplace that has been a second home for many years can suddenly feel less secure when asking for time off for surgery and ongoing treatment. The quality of one’s health insurance is put to the test and medical costs can balloon. A health crisis can also trigger a desire to ensure that one’s wishes are documented in life-planning documents. Acquiring the vital information necessary to deal with these matters can take considerable effort under any circumstances, so for those dealing with a serious illness, the toll is greater. For minority populations, there are often additional impediments that result from more limited access to resources and, for some, a language barrier.

With support from the Greater New York City Affiliate of Susan G. Komen® and Judges and Lawyers Breast Cancer Alert (JALBCA), the City Bar Justice Center’s Cancer Advocacy Project (CAP) is meeting this challenge in the Latino community on a number of fronts. The project has fostered close partnerships with Latino community groups and, with them, has organized a number of community presentations for support groups. The events are conducted in Spanish and offer the groups a chance to learn about important issues that affect them as cancer patients, survivors, or caregivers. Audiences have been very appreciative of the information they receive through these forums, including medical-debt and life-planning issues. On a wider scale, CAP has conducted presentations and workshops on these and other topics for communities and health care providers throughout New York City.

In addition, CAP has created a series of user-friendly guides on a number of topics of relevance to cancer patients and survivors. Of these, three have been translated into Spanish: A Simple Guide to Advance Directives and Estate Planning, A Guide to Medical Debt: Your Rights and Options, and A Guide to Funeral and Burial Options in NY.  It is anticipated that this will be expanded over time so that all materials are available in Spanish.

CAP seeks to offer information to the Latino community in a safe and supportive setting where participants are able to receive information and share information specific to their own situation.  Most recently, in November, CAP conducted a medical-debt presentation at Beth Israel Comprehensive Cancer Center during LatinaSHARE’s monthly support group meeting. As is often the case during these presentations, the participants were surprised to learn of their rights with regard to dealing with medical bills and debt collectors. They left the session feeling more empowered and confident in their abilities to navigate these processes.

CAP is eager to continue its community partnerships in 2014 to focus further on assisting the Latino population in this manner.

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The City Bar Justice Center’s Pro Bono Consumer Bankruptcy Project provides direct advice or assistance on personal bankruptcy to hundreds of low-income debtors each year.  However, hundreds of other debtors are unable to obtain this help and must file a pro se bankruptcy without any professional assistance or guidance. The Project tries to reach out and provide education to these debtors by conducting bankruptcy workshops and providing educational materials such as the guidebook “Personal Bankruptcy: Is It Right for You?”

Unfortunately, many of these pro se filers run into issues and complications they are unable to deal with on their own. Some of these problems can lead to a case being dismissed or an otherwise unsatisfactory outcome for the debtor. A typical problem would be the need for a debtor to enter into a Reaffirmation Agreement with a creditor in order to preserve a necessary piece of property; this might involve the preservation of an automobile being financed by the debtor and needed to get to work.  Pro Se debtors often do not understand the conditions or consequences involved in such agreements, and the judges must spend time and effort explaining these to the debtor.

When several judges in the Southern and Eastern District reached out to the Project to see if we could produce an educational pamphlet for pro se debtors explaining Reaffirmation Agreements, we collaborated with the Pro Bono Subcommittee of the New York City Bar Committee on Bankruptcy and Corporate Reorganization to write a pamphlet called “Bankruptcy: Understanding Reaffirmation Agreements.”  The subcommittee sought input from a variety of sources, including bankruptcy judges and experienced bankruptcy attorneys in order to produce a comprehensive and informative pamphlet. With the help of a grant from the Eastern District Civil Litigation Fund, Inc., the Project was able to publish and distribute 2,000 copies of the pamphlet. Most of the copies have gone to the Clerk’s Offices of the U.S. Bankruptcy Courts in the Southern and Eastern Districts of New York. They are being made available free of charge to pro se debtors who need the information. An electronic version is also available to the general public on the City Bar Justice Center’s website.

The information in this pamphlet will make it easier for pro se debtors to make informed decisions about how to proceed when they are confronted with demands by creditors to enter into a Reaffirmation Agreement. This will lead to a better outcome and a true “fresh start” for the debtors.

Download “Bankruptcy: Understanding Reaffirmation Agreements” here: http://bit.ly/1eauqcD

 

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Chief Judge Jonathan Lippman announced on Monday a new rule that will allow thousands of additional corporate in-house attorneys to provide pro bono services in the State of New York. Attorneys who work in corporate law departments in New York but are not admitted in New York State will now be allowed to provide pro bono representation as long as they are admitted and in good standing in another state. This new rule will afford in-house counsel the same opportunities to provide pro bono services to indigent and underserved New Yorkers that are already available to attorneys admitted to practice law in New York State. The rule is in effect as of today.

The City Bar Justice Center has a rich history of leveraging the resources of New York’s in-house legal community to provide access to justice to the city’s neediest populations. The City Bar Justice Center has been active since 2003 in assisting in-house counsel in starting pro bono programs and in finding appropriate projects for corporate counsel.  To date, we have assisted about 50 corporations with organizing programs, drafting documents, choosing appropriate projects and overcoming as many obstacles as possible to the successful launch of corporate pro bono programs. Most of our projects at the Justice Center have active in-house counsel volunteers.  The Justice Center joins the in-house community in celebrating this step forward in providing access to justice to New York’s underserved.

We are hopeful that Chief Judge Lippman’s new rule will mean many additional pro bono hours devoted to underserved New Yorkers. The new rule offers an exciting opportunity for in-house legal departments to expand and strengthen existing pro bono programs, and for even more corporations to launch pro bono programs for the first time.

For additional important information about the rule on pro bono by registered in-house counsel, visit the court’s website here.

 

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