Commonly Asked Questions of an Elder Law Attorney – Part III

What is Medicaid and how does it differ from Medicare? Medicare is a federal health insurance program for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease, meaning permanent kidney failure requiring dialysis or a kidney transplant. Most people get their Medicare health care coverage in one of two ways, the original Medicare Plan or the Managed Health Plan. Your costs vary depending on your plan, coverage, and the services you use.Medicare is divided into four parts. Part A covers hospital care, Part B covers physician and outpatient services. Part C is an HMO alternative that covers the same as Parts A and B. Part D is the prescription drug benefit. You can also purchase privately a Medigap or Medicare Supplement policy that fills in the gaps in Part A and B coverage.Medicare is a federal entitlement program, meaning both rich and poor alike are eligible for Medicare if they are over age 65 and are entitled to receive social security benefits or come under one of the previously mentioned exceptions. Even if you are not covered by social security, you may buy your way into the Medicare program. With reference to long-term care, Medicare covers only acute care in a hospital, medically necessary care in a nursing facility or at home. It should be noted that these benefits involve large co-pays and limited coverage.Medicaid is a federal and state program based on need with stringent financial eligibility requirements. Unlike Medicare, when dealing with long-term care, Medicaid covers custodial care in a nursing home. Custodial care includes assistance with eating, bathing, toileting, transferring from the bed to a chair, and dressing, which are what we refer to as activities of daily living.To qualify for Medicaid you must be a resident of the United States, who is either a citizen, a lawfully admitted alien, or otherwise permanently residing in the United States under color of law. You must be over age 65, blind or disabled to be eligible for Medicaid. In that Medicaid is administered by the individual states, each state handles Medicaid differently.The following discussion of Medicaid applies to residents of the State of New Jersey only. You must contact an Elder Law Attorney in your state in order to learn how Medicaid works in your state. The resource limits are $2,000 for an individual and $3,000 for a married couple when both apply for benefits. Under New Jersey’s medically needy program, the resource limit is increased to $4,000 for an individual and $6,000 for a married couple.Resources are cash and any other asset, including real or personal property that an individual can convert to cash. The key to eligibility is whether or not a resource is available. A resource is available when a person has a right to liquidate it. Unavailable resources are resources that the applicant cannot convert to cash. Only countable resources are considered in determining Medicaid eligibility. Noncountable assets include one automobile, the family home if it is occupied by the Medicaid applicant or the community spouse, property used in a trade or business, property used for self-support or employment, personal effects and household goods up to $2,000, wedding and engagement rings, medical devices, life insurance with a total face value of $1,500 or less, or term insurance, regardless of the value. Medicaid law provides for the pooling of the couple’s total resources and allows the community spouse to retain a community spouse resource allowance, which is a portion of the total assets, as a protection against impoverishment. Please keep in mind that even from the assets that are excluded, the Medicaid estate recovery unit may come back against the estate to recover payments made to a Medicaid recipient after the death of the recipient and their spouse, if they are married. Because of this pitfall is important to discuss these issues with a qualified elder law attorney who can properly advise you on the current Medicaid laws.For Medicaid eligibility, an individual must meet the income test as well. New Jersey has an income cap of 300 percent of the SSI benefit rate. The income of the Medicaid applicant is the only income that counts toward the cap. The income of the community spouse is not deemed to be available to the institutionalized spouse for the cost of care. The community spouse is also entitled to a monthly minimum maintenance needs allowance, which comes from the income of the institutionalized spouse’s income. As they say, please do not try this at home. You need to consult a qualified elder law attorney to advise you on Medicaid qualification as well as other long-term care issues.

The Evolution of Project Management

Importance of Project Management is an important topic because all organisations, be they small or large, at one time or other, are involved in implementing new undertakings. These undertakings may be diverse, such as, the development of a new product or service; the establishment of a new production line in a manufacturing enterprise; a public relations promotion campaign; or a major building programme. Whilst the 1980′s were about quality and the 1990′s were all about globalisation, the 2000′s are about velocity. That is, to keep ahead of their competitors, organisations are continually faced with the development of complex products, services and processes with very short time-to-market windows combined with the need for cross-functional expertise. In this scenario, project management becomes a very important and powerful tool in the hands of organisations that understand its use and have the competencies to apply it.The development of project management capabilities in organisations, simultaneously with the application of information management systems, allow enterprise teams to work in partnership in defining plans and managing take-to-market projects by synchronising team-oriented tasks, schedules, and resource allocations. This allows cross-functional teams to create and share project information. However, this is not sufficient, information management systems have the potential to allow project management practices to take place in a real-time environment. As a consequence of this potential project management proficiency, locally, nationally or globally dispersed users are able to concurrently view and interact with the same updated project information immediately, including project schedules, threaded discussions, and other relevant documentation. In this scenario the term dispersed user takes on a wider meaning. It not only includes the cross-functional management teams but also experts drawn from the organisation’s supply chain, and business partners.On a macro level organisations are motivated to implement project management techniques to ensure that their undertakings (small or major) are delivered on time, within the cost budget and to the stipulated quality. On a micro level, project management combined
with an appropriate information management system has the objectives of: (a) reducing project overhead costs; (b) customising the project workplace to fit the operational style of the project teams and respective team members; (c) proactively informing the executive management strata of the strategic projects on a real-time basis; (d) ensuring that project team members share accurate, meaningful and timely project documents; and (e) ensuring that critical task deadlines are met. Whilst the motivation and objectives to apply project management in organisations is commendable, they do not assure project success.However, before discussing the meaning and achievement of project success it is appropriate at this stage to provide a brief history of project management.Brief History of Project Management
Project management has been practiced for thousands of years dating back to the Egyptian epoch, but it was in the mid-1950′s that organisations commenced applying formal project management tools and techniques to complex projects. Modern project management methods had their origins in two parallel but different problems of planning and control in projects in the United States. The first case involved the U.S Navy which at that time was concerned with the control of contracts for its Polaris Missile project. These contracts consisted of research, development work and manufacturing of parts that were unique and had never been previously undertaken.This particular project was characterised by high uncertainty, since neither cost nor time could be accurately estimated. Hence, completion times were based on probabilities. Time estimates were based on optimistic, pessimistic and most likely. These three time scenarios were mathematically assessed to determine the probable completion date. This procedure was called program evaluation review technique (PERT). Initially, the PERT technique did not take into consideration cost. However, the cost feature was later included using the same estimating approach as with time. Due to the three estimation scenarios, PERT was found (and still is) to be best suited for projects with a high degree of uncertainty reflecting their level of uniqueness. The second case, involved the private sector, namely, E.I du Pont de Nemours Company, which had undertaken to construct major chemical plants in U.S. Unlike the Navy Polaris project, these construction undertakings required accurate time and cost estimates. The methodology developed by this company was originally referred to as project planning and scheduling (PPS). PPS required realistic estimates of cost and time, and is thus a more definitive approach than PERT. The PPS technique was later developed into the critical path method (CPM) that became very popular with the construction industry. During the 1960s and 1970s, both PERT and CPM increased their popularity within the private and public sectors. Defence Departments of various countries, NASA, and large engineering and construction companies world wide applied project management principles and tools to manage large budget, schedule-driven projects. The popularity in the use of these project management tools during this period coincided with the development of computers and the associated packages that specialised in project management. However, initially these computer packages were very costly and were executed only on mainframe or mini computers. The use of project management techniques in the 1980s was facilitated with the advent of the personal computer and associated low cost project management software. Hence, during this period, the manufacturing and software development sectors commenced to adopt and implement sophisticated project management practices as well. By the 1990s, project management theories, tools, and techniques were widely received by different industries and organisations.Four periods in the development of modern project management.[1] Prior to 1958: Craft system to human relations. During this time, the evolution of technology, such as, automobiles and telecommunications shortened the project schedule. For instance, automobiles allowed effective resource allocation and mobility, whilst the telecommunication system increased the speed of communication. Furthermore, the job specification which later became the basis of developing the Work Breakdown Structure (WBS) was widely used and Henry Gantt invented the Gantt chart. Examples of projects undertaken during this period as supported by documented evidence include: (a) Building the Pacific Railroad in 1850′s; (b) Construction of the Hoover Dam in 1931-1936, that employed approximately 5,200 workers and is still one of the highest gravity dams in the U.S. generating about four billion kilowatt hours a year; and (c) The Manhattan Project in 1942-1945 that was the pioneer research and development project for producing the atomic bomb, involving 125,000 workers and costing nearly $2 billion.[2] 1958-1979: Application of Management Science. Significant technology advancement took place between 1958 and 1979, such as, the first automatic plain-paper copier by Xerox in 1959. Between 1956 and 1958 several core project management tools including CPM and PERT were introduced. However, this period was characterised by the rapid development of computer technology. The progression from the mainframe to the mini-computer in the 1970′s made computers affordable to medium size companies. In 1975, Bill Gates and Paul Allen founded Microsoft. Furthermore, the evolution of computer technology facilitated the emergence of several project management software companies, including, Artemis (1977), Oracle (1977), and Scitor Corporation (1979). In the 1970′s other project management tools such as Material Requirements Planning (MRP) were also introduced.Examples of projects undertaken during this period and which influenced the development of modem project management as we know it today include: (a)Polaris missile project initiated in 1956 that had the objective of delivering nuclear missiles carried by submarines, known as Fleet Ballistic Missile for the U.S Navy. The project successfully launched its first Polaris missile in 1961; (b) Apollo project initiated in 1960 with the objective of sending man to the moon; and (c) E.I du Pont de Nemours chemical plant project commencing in 1958, that had the objective of building major chemical production plants across the U.S.[3] 1980-1994: Production Centre Human Resources. The 1980s and 1990′s are characterised by the revolutionary development in the information management sector with the introduction of the personal computer (PC) and associated computer communications networking facilities. This development resulted in having low cost multitasking PCs that had high efficiency in managing and controlling complex project schedules. During this period low cost project management software for PCs became widely available that made project management techniques more easily accessible.Examples of major projects undertaken during this period that illustrate the application of high technology, and project management tools and practices include: (a) England France Channel project, 1989 to1991. This project was an international project that involved two governments, several financial institutions, engineering construction companies, and other various organisations from the two countries. The language, use of standard metrics, and other communication differences needed to be closely coordinated; (b) Space Shuttle Challenger project, 1983 to 1986. The disaster of the Challenger space shuttle focused attention on risk management, group dynamics, and quality management; and (c) xv Calgary Winter Olympic of 1988 which successfully applied project management practices to event management.[4] 1995-Present: Creating a New Environment. This period is dominated by the developments related to the internet that changed dramatically business practices in the mid 1990′s. The internet has provided fast, interactive, and customised new medium that allows people to browse, purchase, and track products and services online instantly. This has resulted in making firms more productive, more efficient, and more client oriented. Furthermore, many of today’s project management software have an internet connectivity feature. This allows automatic uploading of data so that anyone around the globe with a standard browser can: (a) input the most recent status of their assigned tasks; (b) find out how the overall project is doing; (c) be informed of any delays or advances in the schedule; and (d) stay “in the loop” for their project role, while working independently at a remote site.An example of a major project undertaken during this period is the Year 2000 (Y2K) project. The Y2K Project, known as the millennium bug referred to the problem that computers may not function correctly on January lst, 2000 at 12 AM. This was a global phenomenon and was highly problematic because resolving the problem at one’s organisation did not guarantee immunity, since a breakdown in the organisation’s supply chain could affect the organisation’s operating capability. Many organisations set up a project office to control and comply with their stakeholders regarding the Y2K issue. Furthermore, use of the Internet was common practice that led to the establishment of the virtual project office. The goal of this virtual project office was: (a) to deliver uninterrupted turn-of-the-century; (b) monitor Y2K project efforts; (c) provide coordination; (d) develop a risk management plan; and (e) communicate Y2K compliance efforts with various stakeholders. Thus, the virtual project office was a focal point for all the project works, and it increased the awareness and importance of risk management practices to numerous organisations.Why Project Management?There is no doubt that organisations today face more aggressive competition than in the past and the business environment they operate in is a highly turbulent one. This scenario has increased the need for organisational accountability for the private and public sectors, leading to a greater focus and demand for operational effectiveness and efficiency.Effectiveness and efficiency may be facilitated through the introduction of best practices that are able to optimise the management of organisational resources. It has been shown that operations and projects are dissimilar with each requiring different management techniques. Hence, in a project environment, project management can: (a) support the achievement of project and organisational goals; and (b) provide a greater assurance to stakeholders that resources are being managed effectively.Research by Roberts and Furlonger [2] in a study of information systems projects show that using a reasonably detailed project management methodology, as compared to a loose methodology, improves productivity by 20 to 30 percent. Furthermore, the use of a formalised project management structure to projects can facilitate: (a) the clarification of project scope; (b) agreement of objectives and goals; (c) identifying resources needed; (d) ensuring accountability for results and performance; (e) and encouraging the project team to focus on the final benefits to be achieved. Moreover, the research indicates that 85-90% of projects fail to deliver on time, on budget and to the quality of performance expected. The major causes identified for this situation include:(a) Lack of a valid business case justifying the project;(b) Objectives not properly defined and agreed;(c) Lack of communication and stakeholder management;(d) Outcomes and/or benefits not properly defined in measurable terms;(e) Lack of quality control;(f) Poor estimation of duration and cost;(g) Inadequate definition and acceptance of roles (governance);(h) Insufficient planning and coordination of resources.It should be emphasised that the causes for the failure to deliver on time, on budget and to the quality of performance expected could be addressed by the application of project management practices. Furthermore, the failure to deliver on time, on budget and to the quality of performance expected does not necessarily mean that the project was itself a failure. At this stage what is being discussed is the effectiveness and efficiency of project execution and not whether a project is a success or failure.ConclusionProject management should be viewed as a tool that helps organisations to execute designated projects effectively and efficiently. The use of this tool does not automatically guarantee project success. (project success will be discussed in a subsequent issue). However, in preparation for the next issue, I would like you to think about the distinction between project success and project management success. This distinction will provide further insight to the questions: Why are some projects perceived as failures when they have met all the traditional standards of success, namely, completed on time, completed within budget, and meeting all the technical specifications? Why are some projects perceived to be successful when they have failed to meet two important criteria that are traditionally associated with success, namely, not completed on time and not completed within budget?

What is a Medical Spa and How Do I Choose the Best One?

What is a medical spa and how is it different than a day center? A medical spa is essentially the same as a day spa with the primary difference being that it operates under the supervision of a licensed health care professional. These centers may offer procedures that can only be administered by a licensed medical practitioner or treat facial and body conditions that cannot be treated by estheticians alone.Here’s a quick overview of medical spa services. In general these services include:* Laser and IPL (intense pulsed light) procedures
* Medical mircrodermabrasions
* Photofacials
* Botox and restylane injections and other fillers
* Medical peels and skin tighteningMost of these centers are designed to enhance outer beauty and inner wellness. They attempt to do this by providing a safe, relaxing, and aesthetically pleasing environment just like the day spas. However patients have reported that medical spas often do not feel as relaxing as day spas but more like a medical clinic.The supervising doctors may be practitioners of internal medicine, family practice, dermatology, plastic surgery, chiropractics, doctors of naturopathic medicine, or doctors of another specialty. Often medical spas are made up of a combination of doctors with many of these specialties.Larger medical spas with a wide range of specialties allow them to offer additional services including acupuncture, nutrition counseling, massage therapy, dermatology, exercise training, stress management, and weight loss assistance.Some medical spas are much smaller in scale and may, for example, be a spa attached to the practice of an individual plastic surgeon looking to sell more to his patients working on their appearance. Whatever size or style of wellness center you choose, make sure to use common sense and use good judgment when considering doctors’ advice. People tend to give more credence to doctors’ suggestions when in reality they may just be making a sale rather than prescribing a completely necessary procedure.Another piece of advice when selecting your center: check to see if the medical practitioner will really be overseeing the procedure. Regulations vary from state to state; some require the doctor to be onsite and overseeing each of the actual procedures, but other states do not even require the doctors to be on the premises. In some situations, doctors just lend their name to the institution and collect a percentage of the profits.You should also research the techniques and the equipment that each wellness resort uses. The equipment in the medical spa industry is always improving and changing and you will want to make sure that you choose the spa that utilizes the latest and greatest technology. Choosing such a center will make it more likely that you will receive the least painful treatments possible.But remember that the latest technology comes with a high price. Medical spa treatments and packages can be very expensive but that is because the machinery and the equipment itself, is very expensive. Keep this in mind when considering how much you will pay for medical spa services.