Long-term care page 4-6 in TTB

[veritas]

In the paragraph defining chronically ill the definition includes the senetence "within the previous 12 months" a licensed health care provider has certified (really?) that the individual meets either of the following descriptions..

My question is previous to what?

The tax year?

The due date of the return?

Entering the long term care facility?

What if it was "certified" in June of 2012 and they were in the facility all year?

I could go on but you get the idea.

[taxea]

within the previous months of the deduction, the TP was declared in need of long term care. Use the diagnosis document as proof. Get a doctor's statement if TP also qualified as disabled as a result of the need for LTC. If the "injury" occured prior to the LTC, all expenses can be taken because the doctor's statement should show the date the disability began.

[JohnH]

I think you start the clock running from the date on the most recent certification (it usually starts when the patient is discharged from a hospital into the LTC facility with discharge instructions). If they happen to go 10-11 months from that date without needing hospitalization, it's a good idea to have the medical director of the LTC facility sign a new statement. Then I'd start tracking again from that date. Any time there is a hospitalization, the patient receives discharge instructions prior to returning to the LTC facility, so that would reset the entire clock.

[veritas]

Thank you

So I gather the certification needs to happen before the person enters the care facility in order to deduct the expenses 100%.

[JohnH]

I don't know if that would be a "rule", but it generally works out that way. Maybe I'm being over-simplistic in my thinking, but I'd say that while many people enter assisted living facilities of their own volition, most admissions to long-term care facilities come after a hospitalization or medical incident of some sort.

The doctor will often present it in terms of a recommendation that they go for "rehab" in order to soften the blow, but in fact they are going into the facility because they are no longer able to perform key activities of daily living and need assistance for medically necessary reasons. Every experience I've had in this arena included detailed discharge instructions from the doctor (required by Medicare). In NC, the form is called an "FL-2" - I think it may be different in other states but still essentially the same. So as I understand it, that becomes the base you build on when trying to determine if the care is medically necessary.

The only problem with this whole scenario is that some day when I have to be hospitalized, I'm wondering if I'll bite when the doctor tells me I need to go for "rehab". (Unless of course I've had surgery which requires some kind of intensive physical therapy) We will see when the time comes.

[joanmcq]

lol, this is exactly what we did with my dad. Kicker was, he liked the assisted living home we picked out so much, he didn't WANT to go home. Blessing.

We had to recertify each year that he couldn't perform two of the 5 basic functions. I believe the care facility did this, or they had a doctor on staff that did. He had LTC insurance, and it paid for everything as long as the 2 out of 5 were certified.

[veritas]

Found this article

Ads by GoogleHow is qualified long-term-care services defined?
Qualified long-term-care services are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative services, and maintenance and personal-care services that are (1) required by a chronically-ill individual, and; (2) provided under a plan of care prescribed by a licensed health-care practitioner.




Who is a chronically-ill Individual?
Patients may qualify as “chronically-ill individuals” if they meet one of these two tests:




•Activities of Daily Living (ADLs): patient must be certified as unable to perform, without substantial assistance from another person, at least two ADLs (eating, toileting, bathing, dressing and continence). This disability must exist for at least 90 days and be due to a loss of functional capacity,

•Substantial Supervision/Cognitive Impairment Test: patients must be certified as requiring substantial supervision to protect themselves from threats to health and safety due to “severe cognitive impairment”.

The federal tax authorities have given guidance that “severe cognitive impairment” means a loss or deterioration in intellectual capacity that includes Alzheimer’s disease and similar forms of irreversible dementia, and is reported in good faith by clinical evidence and standardized tests that measure impairment in (1) short- or long-term memory, (2) orientation to people, places or time, and (3) deductive or abstract reasoning.




Guidance also exists stating that “substantial supervision” means continual supervision by another person that is necessary to protect severely cognitively-impaired individuals against threats to their health or safety.




[b]What are the required certifications, care plans, etc.?
For purposes of the tax deduction, a person must be certified as meeting the requirements of a chronically-ill individual. This certification must be done by a licensed health-care practitioner (MD, RN, or licensed social worker “within the preceding 12-month period,” which implies an annual review for a person with a chronic illness or disability.[/b}


This agrees with Joan's post.

I wonder what recent law graduate wrote the atrocious definition in the code?