England & Associates
Rehabilitation Services, Vocational Evaluations, Medical & Vocational Case Management, Reemployment Services, Expert Testimony, Life Care Plans

 

England and Associates

Medical Case Management

Medical Services at England & Associates are provided by Phyllis Rothman. Phyllis has over thirty years of experience in nursing and experience in preparing life care plans for Medicare Set Aside Arrangements. She can provide you with a life care plan that meets Medicare requirements as well as obtain the information and prepare the paperwork needed for Medicare approval.

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The Life Care Plan

 A Life Care Plan Is a dynamic document that provides an organized outline of the disabled individual’s need for future care and treatment along with associated costs of these needs. The Life Care Plan is based upon published standards of practice, comprehensive review of medical records, analysis or pre- and post-injury status, data analysis, and in-depth patient evaluation.

The Life Care Plan Includes the patient’s medical history, current health, vocational potential, functional status, potential complications, long-term medical care needs, and associated costs. It also gives recommendations for medications, medical supplies, surgical medical intervention, therapeutic intervention, facility care services, necessary adaptive transportation, home care services, educational and vocational services, mobility equipment, and necessary home modifications.

The Life Care Plan Benefits any claim that is ready for settlement or in need of setting reserves. This may include injured persons with disabilities such as chronic pain syndrome, traumatic brain injury, amputations, toxic exposure, HIV, multiple trauma, orthopedics/neurological problems, cardiac and psychiatric problems, burn or electric shock, and spinal cord injury. Case management files involving multiple physicians or that have been open longer than six months may also benefit from the development of a Life Care Plan

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The Medicare Set Aside Arrangement

A Medicare Set Aside Arrangement Is Required If the client is contemplating settlement of a worker’s compensation claim or personal injury case and he or she is receiving Medicare. If the client is not receiving Medicare, but there is a chance he or she may enroll in the future, he or she may also need a Medicare Set Aside Arrangement.

A Medicare Set Aside Arrangement Consists Of the patient’s medical history, life care plan, the settlement agreement, including its present day value, and a Trust arrangement which specifies all costs and fees. Medicare then evaluates the arrangement to ensure it is appropriate and the amount of the lump sum or structured settlement will demonstrate Medicare’s interests.

The Medicare Set Aside Arrangement Is Required Because Medicare requires that after the funds in a set-aside arrangement exhaust and the appropriate funds have been provided, Medicare will begin making payments for the injury-related medical expenses. So, they must approve any settlement to ensure the settlement allocates a reasonable portion of the settlement to future medical expenses. Medicare requires that all worker compensation settlements adequately consider Medicare’s interests, and Medicare does not pay for medical services until the funds set aside have been used.

A Medicare Set Aside Arrangement Must Include a Life Care Plan because the Life Care Plan covers the required background on the injury, recommendations from health providers, future medical requirements, all forecasted medical costs and life expectancy. This information must be presented before a Medicare Set Aside Arrangement is written.

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Phyllis Rothman, RN, MS, CLCP, CCM, CDMS, QRP

Certified Life Care Planner
Certified Case Manager
Certified Senior Nurse Case Manager
Certified Disability Management Specialist
Completed 120 hour Intelicus/University of Florida Life Care Planning For Advanced Catastrophic Case Management
Former adjunct professor at Upsala College
37 years experience in nursing
President of West Coast Regional Case Managers Association

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