1. 1 Chuck Crews Crews Law Offices 215 Batesville Road, Suite C Simpsonville, SC 29681 864-675-9581 Chuck@CrewsLaw.us www.CrewsLawOffices.com Legal Issues Related to Care of Transition Age Patients

2. 2 TRANSITION POLICY Transition Policy is the first element of the Six Core Elements of Health Care Transition Medical providers should have a well-defined, written policy that clearly states the expectatons for health care transition of adolescent patients to adult model of care

3. 3 TRANSITION POLICY A practice’s Transition Policy should include the following: - Education of staff about the practice’s approach to transition

4. 4 TRANSITION POLICY A practice’s Transition Policy should include the following: - Education of staff about the practice’s approach to transition - Explanation of legal changes regarding patient privacy and consent

5. 5 TRANSITION POLICY A practice’s Transition Policy should include the following: - Education of staff about the practice’s approach to transition - Explanation of legal changes regarding patient privacy and consent - Discussions with patients and parents concerning transition

6. 6 TRANSITION POLICY A practice’s Transition Policy should include the following: - Education of staff about the practice’s approach to transition - Explanation of legal changes regarding patient privacy and consent - Discussions with patients and parents concerning transition - Written policy posted for all to see

7. 7 TRANSITION POLICY Set expectations of the patient and the patient’s parents or guardian

8. 8 TRANSITION POLICY Set expectations of the patient and the patient’s parents or guardian Document the patient file!!!

9. 9 AGE OF MAJORITY The age at which a person is considered an adult capable of making their own decisions, including medical care Age is 18 in most states, including SC Exceptions are Alabama (19), Nebraska (19), Washington, D.C. (21) and Mississippi (21)

10. 10 COMMON ISSUES IN TRANSITION Privacy

11. 11 COMMON ISSUES IN TRANSITION Privacy Informed consent

12. 12 COMMON ISSUES IN TRANSITION Privacy Informed consent Guardianship/Conservatorship

13. 13 COMMON ISSUES IN TRANSITION Privacy Informed consent Guardianship/Conservatorship SSI Benefits

14. 14 COMMON ISSUES IN TRANSITION Privacy Informed consent Guardianship/Conservatorship SSI Benefits Special Needs Trusts

15. 15 PRIVACY HIPAA rules apply just as with any other patient

16. 16 PRIVACY HIPAA rules apply just as with any other patient -Patient is entitled to a copy of their records

17. 17 PRIVACY HIPAA rules apply just as with any other patient -Patient is entitled to a copy of their records -Patient has right to have errors in records corrected

18. 18 PRIVACY HIPAA rules apply just as with any other patient -Patient is entitled to a copy of their records -Patient has right to have errors in records corrected - Patient has right to know who has seen records

19. 19 PRIVACY SHARE MEDICAL INFORMATION OF PATIENT ONLY UNDER LIMITED CIRCUMSTANCES

20. 20 PRIVACY SHARE MEDICAL INFORMATION OF PATIENT ONLY UNDER LIMITED CIRCUMSTANCES -Patient consents

21. 21 PRIVACY SHARE MEDICAL INFORMATION OF PATIENT ONLY UNDER LIMITED CIRCUMSTANCES -Patient consents -Patient present and fails to object

22. 22 PRIVACY SHARE MEDICAL INFORMATION OF PATIENT ONLY UNDER LIMITED CIRCUMSTANCES -Patient consents -Patient present and fails to object -Professional judgment

23. 23 INFORMED CONSENT -Patient fully able to understand the nature of the proposed treatment, including the benefits and risks

24. 24 INFORMED CONSENT -Patient fully able to understand the nature of the proposed treatment, including the benefits and risks -Provider must have accurate information about patient’s independent decision-making status

25. 25 GUARDIANSHIP/CONSERVATORSHIP PROCESS

26. 26 GUARDIANSHIP/CONSERVATORSHIP PROCESS - File petition with Court

27. 27 GUARDIANSHIP/CONSERVATORSHIP PROCESS -File petition with Court -Court appoints physicians, GAL, Visitor

28. 28 GUARDIANSHIP/CONSERVATORSHIP PROCESS -File petition with Court -Court appoints physicians, GAL, Visitor -Hearing

29. 29 GUARDIANSHIP/CONSERVATORSHIP PROCESS -File petition with Court -Court appoints physicians, GAL, Visitor -Hearing -Appointment

30. 30 GUARDIANSHIP/CONSERVATORSHIP OTHER REQUIREMENTS - Bonding - Bonding

31. 31 GUARDIANSHIP/CONSERVATORSHIP OTHER REQUIREMENTS - Bonding - Bonding - Annual report

32. 32 SSI BENEFITS Cessation of benefits beyond age 18 is common

33. 33 SSI BENEFITS Cessation of benefits beyond age 18 is common - Ensure medical record fully documents any disability

34. 34 SSI BENEFITS Cessation of benefits beyond age 18 is common -Ensure medical record fully documents any disability -Advise patient and guardian to seek legal assistance

35. 35 SPECIAL NEEDS TRUSTS WHAT IS IT? A legal arrangement and fiduciary relationship that allows a physically or mentally disabled or chronically ill person to receive income without reducing their eligibility for the public assistance disability benefits provided by Social Security, Supplemental Security Income, Medicare or Medicaid.

36. 36 SPECIAL NEEDS TRUSTS HOW DOES IT WORK? Trustee manages funds for benefit of disabled person and uses funds for the beneficiary’s benefit AT DISCRETION OF THE TRUSTEE

37. 37 SPECIAL NEEDS TRUSTS CAN BE USED FOR - Personal care attendants

38. 38 SPECIAL NEEDS TRUSTS CAN BE USED FOR - Personal care attendants - Education - Education

39. 39 SPECIAL NEEDS TRUSTS CAN BE USED FOR - Personal care attendants - Education - Education - Recreation

40. 40 SPECIAL NEEDS TRUSTS GET LEGAL ASSISTANCE

41. 41 QUESTIONS?

42. 42 Chuck Crews Crews Law Offices 215 Batesville Road, Suite C Simpsonville SC 29651 (864) 675-9581 Website: CrewsLawOffices.com E-Mail: Chuck@CrewsLaw.us