In a Dear Administrator Letter (“DAL”) dated May 28, 2021, the New York State Department of Health highlights the differing requirements long-term care (“LTC”) facilities must meet regarding COVID-19 vaccinations under recent federal and state regulations.

Under federal regulations adopted by CMS effective May 21, 2021 (42 C.F.R. §§483.80[d][3] and [g][viii]–[ix]), LTC facilities must:

  • educate residents (or resident representatives) and staff regarding the benefits and potential side effects associated with the COVID-19 vaccine and offer the vaccine unless medically contraindicated or the resident or staff member has already been immunized;
  • develop policies and procedures for providing such education;
  • maintain appropriate documentation demonstrating that the education was provided and whether the resident or staff member received the vaccine; and
  • report the COVID-19 vaccine status of residents and staff, each dose of vaccine received, adverse events related to the administration of the vaccine and therapeutics administered to residents for treatment of COVID-19.

DOH specifies in the DAL that to ensure compliance, surveyors will be requesting a facility point of contact to provide information on how residents and staff are educated about and are offered the vaccine, including samples of educational material.  Data regarding vaccinations and therapeutics must be included in NHSN submissions no later than 11:59 p.m. on Sunday, June 13th.

As we previously reported in a Client Alert dated April 21, 2021, NY State recently adopted emergency regulations (10 N.Y.C.R.R. §66-4.2) that require nursing facilities to:

  • Ensure that all new personnel, including contract staff, and every new resident and resident readmitted to the facility has an opportunity to receive the COVID-19 vaccine within fourteen days of having been hired or admitted or readmitted to the facility.

As the DAL points out, the new federal regulations do not impact the state emergency regulations and do not absolve nursing home administrators from meeting the state requirements.

Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at

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Due to impending estate and economic changes on the horizon, now is the time to review your estate plan to make sure it is in order. Several tax proposals have been introduced that if enacted will significantly increase income, gift, and estate taxes.  Introduction of these proposals means that the window for making changes to your estate plan may be closing.

In addition, with the passing of the SECURE Act, the favorable laws that governed distributions from IRAs and other retirement accounts have changed. The SECURE Act, theoretically designed to make saving for retirement easier, actually severely reduced the benefits of inherited IRAs for your children.

Also of interest, for New York residents, is a new Power of Attorney statute that takes effect in New York on June 13, 2021.  This law makes it necessary for all New York residents to review their Power of Attorney forms executed in the past to see if such forms comply with state law and practice, and to verify that they remain on file with their financial institutions as necessary. Residents of New Jersey and Connecticut should also review their Powers of Attorney every few years to ensure compliance and effectiveness.


Increases to Income, Capital Gains, Gift, and Estate Taxes.

  • Income tax rates may increase and there is discussion of treating long-term capital gains as ordinary income.
  • Currently, a beneficiary inherits assets at the fair market value as of the decedent’s date of death. This date of death valuation is a “step-up” in basis and it results in tremendous tax-savings for beneficiaries. If the step-up in basis were not available, as proposed, inherited assets would be subject to capital gains tax at death. In some cases, this would result in double taxation.
  • The Federal estate tax exemption may drop to $3.5 million, while the Federal gift tax exemption may drop to $1 million (from the current $11.7 million). The top estate tax rate could rise well above its current 40%.  New York’s top estate tax rate may also increase from 16% to 20%.  Connecticut’s estate tax exemption, currently $7.1 million, is scheduled to match the Federal estate tax exemption by 2023 and would be affected by a Federal reduction. While New Jersey repealed its estate tax in 2018, an inheritance tax of up to 16%  applies for certain classes of beneficiaries.
  • There are also proposals to severely reduce the effectiveness, or even eliminate, popular tax saving devices such as family partnerships/LLCs, grantor retained annuity trusts (GRATs), $15,000 annual exclusion gifts to trusts, and grantor trusts for income taxes.
  • The passage and timing of new legislation is not certain. Some proposals have an effective date in 2022, while claw backs to 2021 are possible.

Changes to Planning with Retirement Assets

  • The SECURE Act changed the rules to provide that only a surviving spouse, a minor child, or a disabled or chronically ill individual is eligible for a “stretch” IRA. Adult children and other individuals are limited to a ten-year payout period.  This eliminates the time assets can continue to grow within the IRA income tax-free and accelerates the income taxes that come due on required distributions.
  • Prior to SECURE, non-spouse beneficiaries that inherited IRAs took minimum required distributions over their own life expectancy. This gave younger beneficiaries more time to allow assets in the account to grow while deferring payment of income tax.
  • Prior to SECURE, an IRA could be held in a trust for the spouse. IRA distributions to Trusts were able to qualify for distributions over the spouse’s life expectancy.  This is no longer the case for the typical trusts used in estate planning (a “bypass” or “exemption” trust to escape estate tax at the spouse’s later death, or a “QTIP” Trust to control who inherits at the spouse’s death).
  • There are very complicated rules concerning what constitutes a “minor” child (it may be up to age 26) and a disabled or chronically ill beneficiary.
  • Sizeable retirement accounts have always presented challenges for estate planning. While it is always critical to periodically review all types of beneficiary designations (which can be just as important as the terms of a Will), SECURE makes it more critical. You should consult with your experienced trusts and estates advisor to salvage your estate plan from the effects of the SECURE Act.

New Power of Attorney Form for New Yorkers

  • New York Powers of Attorney signed after June 13, 2021 must use a new form (forms executed before June 13, 2021 are still valid). The new form is intended to be a more “user friendly” form, and is expected to be more readily accepted by financial institutions as it must be accepted or rejected within a period of 10 days of submission (or the institution faces liability for improperly rejecting a validly executed Power of Attorney).
  • A Power of Attorney is one of the most important and powerful documents in your estate planning toolbox. Without a legally enforceable Power of Attorney, situations may arise when court intervention is necessary to appoint a legal guardian for you.  This process is costly, time consuming, and emotionally draining.
  • Do not wait for a crisis to have your chosen agent try to implement your Power of Attorney. You should provide your Power of Attorney to the financial institutions you use now while you are able to present it yourself.  You should also ask your financial institutions if they prefer that you use their in-house form of Power of Attorney.
  • A Power of Attorney created by your trusts and estates lawyer should address your individual financial needs and will include the powers necessary for the agent of your choice to carry out your financial and estate plan as intended. The standard form without additional provisions and modifications crafted by your attorney will fall short in many cases, including in particular gift, estate and Medicaid planning.
  • Keep in mind, Powers of Attorney expire when you die and are not valid after death. This underscores the importance of a complete and thorough estate plan.

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We are available and ready to discuss these matters with you at your convenience, but do not delay or opportunities can be lost and circumstances may compromise your ability to act. Should you have any questions, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at

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Click Here to download the Legal Alert.


The Centers for Medicare & Medicaid Services (CMS) released a notice on June 3, 2021 advising that Medicare Administrative Contractors (MACs) may now begin conducting post-payment medical reviews of items and services for dates of service March 2020 and after.  Previously, MACs had resumed post-payment reviews only for dates of service before March 2020.   CMS also advised that the “Targeted Probe and Educate” program, involving intensive education to assess provider compliance through up to three rounds of review, will restart later.  Finally, CMS advised that the MACs will continue to offer detailed review decisions and education as appropriate.

As the country continues to “re-open,” clients should expect to see increased audit activity from not only CMS, but also from other federal and state agencies, as well as from commercial payers/health plans.  Garfunkel Wild routinely advises clients on all aspects of payer audits and regularly works with reviewers from Garfunkel Health Advisors (GHA), a heatlhcare consulting subsidiary.  GHA’s reviewers add significant clinical, practical and real-world expertise on the complex documentation, coding and billing issues that routinely arise during a payer audit.

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Should you have any questions regarding the above or if you are currently being audited and need assistance, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at

Click Here to download the Legal Alert.


Garfunkel Wild, P.C., a premier law firm with a specialty in health law, is pleased to announce the arrival of Elisabeth A. Pimentel as a partner in the firm’s Health Care and Corporate Practice Groups. Ms. Pimentel who will be based in the firm’s Connecticut office joins from Wiggin and Dana, LLP.

“Growing our Health Care and Corporate practice in Connecticut – and nationwide – has been an ongoing strategic focus for us,” said Garfunkel Wild Chairman, Andrew Blustein.  “Lis’ experience working on a variety of corporate and regulatory issues for health care providers will be a great addition to our multi-disciplinary health care team.”

Ms. Pimentel brings experience advising clients with respect to mergers, acquisitions, and affiliations, medical foundations, and professional services and employment agreements. Her regulatory practice encompasses certificate of need matters, licensure issues, and counseling nonprofit organizations with governance and tax-exemption questions.

Ms. Pimentel will re-unite with former colleague Merton G. Gollaher who joined Garfunkel Wild in 2019. “Lis’ arrival bolsters our strong health care team and will help us continue to meet clients’ needs for sophisticated counsel with a commitment to quality and value,” said Mr. Gollaher. “I am excited to share Garfunkel Wild’s culture with Lis which enables individuals to learn and grow while fostering collaboration and team work. I am confident the opportunity to collaborate with an impressive set of attorneys across many diverse practice specialties in Connecticut and elsewhere will take her practice to the next level and provide the best possible service to her clients.”

The appointment of Ms. Pimentel further illustrates the firm’s continued focus on strategic planning, including attorney development and growth into new markets and practice areas. “Chambers USA 2021 nearly doubled our firm’s Health Care Practice rankings, recognizing for the first time our practice in Connecticut, in addition to New York and New Jersey,” said Mr. Blustein. “This recognition speaks to the experience, knowledge and reputation of our Health Care attorneys in every office and reflects our commitment to serving the needs of the health care industry at the highest level and to attracting top talent like Lis to our firm.”

Prior to private practice, Ms. Pimentel was a judicial intern for the Honorable Alfred V. Covello, Senior United States District Judge for the District of Connecticut, and for six years was an officer in the United States Navy where she conducted research in the field of medical education and simulation-based training technology.

Ms. Pimentel received her J.D. with high honors and an intellectual property certificate from The University of Connecticut School of Law where she was the Business Manager for the Connecticut Law Review.  She received her B.A. in chemistry with a concentration in cell molecular biology from Colby College.

Click Here to read her biography.


Salvatore Puccio and Jean Krebs, co-authored the article “Avoiding Pandemic Predicaments: Be ready to navigate the changing landscape brought on by COVID-19,” published in the May 2021 edition of Outpatient Surgery Magazine.

The article discusses how centers should prepare for continued COVID-related legal challenges as lingering restrictions brought on by the pandemic are lifted. The workplace is now different, both in appearance and in the rules that govern it. The article identifies three ongoing issues you will likely need to manage in the coming months.

Click Here to read the article.