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1. Introduction to SSD/Medicare, SSI/Medicaid, and ERISA, VA and Tricare Liens
2. The Disability Process from Application to Adjudication
3. Medicare and Medicaid Liens
4. ERISA, VA, and Tricare Liens
5. Medicare Set Asides
6. Special Needs Trusts
7. Conclusion

Continuing Education Credits:   

Continuing Legal Education

Credit Hrs    State    Credit Approval Expiration

* denotes specialty credits

1. Introduction to SSD/Medicare, SSI/Medicaid, and ERISA, VA and Tricare Liens
   10:00 - 10:45, David H. Abney II, Todd J. Belisle and Rafael Gonzalez.
   1. SSD/Medicare
   2. SSI/Medicaid
   3. ERISA/VA/Tricare
2. The Disability Process from Application to Adjudication
   10:45 - 11:30 and 11:45 - 12:30, David H. Abney II, Todd J. Belisle and Rafael Gonzalez.
   1. The Application Process
      1. The Initial Application
      2. Request for Reconsideration
      3. Request for Hearing
      4. Request for Review by Appeals Council
      5. Federal District Court
   2. The Sequential Evaluation
      1. Substantial Gainful Activity
      2. Severe Impairment
      3. Listing of Impairments
      4. Past Relevant Work
      5. Other Work in the National Economy
   3. Disability Insurance Benefits
      1. Who Can Get DIB?
      2. How Much Work is Necessary for Insured Status?
      3. Review by DDS and SSA
      4. How Disability is Determined
      5. When a Claim is Approved
   4. Medicare
      1. Department of Health and Human Services/Centers for Medicare and Medicaid Services
      2. Medicare Part A, B, C, and D
      3. Medical Benefits and Services Covered Under Part A
      4. Medical Benefits and Services Covered Under Part B
      5. Medical Benefits and Services Not Covered Under Part A or B
      6. Medical Benefits and Services Covered Under Part C
      7. Medical Benefits Available and Covered Under Part D
   5. Supplemental Security Income
      1. Who Can Get SSI?
      2. Income for SSI Purposes
      3. Items Not Considered Income
      4. Excluded Income
      5. Resources for SSI Purposes
      6. Items Not Considered Resources
   6. Medicaid
      1. Categorically Needy
      2. Medically Needy
      3. Special Groups
      4. Mandatory Medicaid Medical Services
      5. Medicaid for Categorically Needy
      6. Medicaid for Medically Needy
3. Medicare and Medicaid Liens
   12:30 - 1:00, David H. Abney II, Todd J. Belisle and Rafael Gonzalez.
   1. Medicare Conditional Payments
      1. Statutory Provisions and Federal Regulations Guiding Reimbursements
      2. Responsibilities of Beneficiary, Attorney, and Insurer Under MSP
      3. Recovery Process
      4. Conditional Payment Letter
      5. Recovery Demand Letter
      6. Assessment of Interest and Failure to Respond
      7. Attorney Can Become Liable for Medicare Conditional Payment
      8. US Sues for Failure to Comply with Medicare Secondary Payer Act
   2. Medicaid Liens
4. ERISA, VA, and Tricare Liens
   1:30 - 2:00, David H. Abney II, Todd J. Belisle and Rafael Gonzalez.
   1. ERISA Liens
   2. VA Liens
   3. Tricare Liens
5. Medicare Set Asides
   2:00 - 3:00, David H. Abney II, Todd J. Belisle and Rafael Gonzalez.
   1. The Medicare Secondary Payer Act
   2. CMS Policy Memorandums
      1. Medicare Payments Made While Claim is Open
      2. Current Medicare Beneficiaries
      3. Medicare Eligible Within 30 Months of Settlement
      4. No Expectation of Becoming Medicare Eligible
   3. Amount Placed in Medicare Set-Aside Arrangements
      1. Projection of Future Medical Expenses
      2. Age and Life Expectancy
      3. Recommended Medical Treatment and Prescriptions
      4. Treatment and Services Allowed by Medicare
      5. Payment Based Upon Applicable Reimbursement Schedule
   4. Getting CMS Approval of the Proposed Medicare Set-Aside Arrangement
      1. Identifying Information
      2. Introduction
      3. Injury and Initial Treatment
      4. Present Status of the Injured Individual's Health Condition
      5. Pre-Existing Conditions
      6. Future Injury Related Medical Requirements
      7. Life Expectancy Issues
      8. Settlement Funds
      9. Proposed Consideration of Medicare's Interest
   5. Administration of the Medicare Set-Aside Arrangement
      1. Self Administered Medicare Set Aside
      2. Medicare Set Aside Administered by Professional Custodian
      3. Funds Only to be Used for Future Injury Related Medicare Covered Medical Expenses
      4. Initial Set-Aside Account Funding
      5. Set-Aside Account Interest Income
      6. Distribution of the Set-Aside Account Funds
      7. Reimbursement to Medicare
      8. Accounting Records
      9. Annual & Final Accountings
      10. Delivery of Notices & Accountings
      11. Distributions Following Death of Beneficiary
      12. Misappropriated Set-Aside Account Funds
6. Special Needs Trusts
   3:15 - 4:30, David H. Abney II, Todd J. Belisle and Rafael Gonzalez.
   1. Recognized Special Needs Trusts
      1. Disabled Individual's Trust
      2. Miller's Trust
      3. Non-Profit Pooled Income Special Needs Trust
      4. Third Party Created Trust
   2. Administration of Special Needs Trusts
7. Conclusion
   4:30 - 5:00, David H. Abney II, Todd J. Belisle and Rafael Gonzalez.

DAVID H. ABNEY II built his Frankfort, Kentucky law practice on the philosophy that tort victims' settlement proceeds should not be eaten up by healthcare subrogation and reimbursement claims. By resolving thousands of subrogation claims over the past decade, Mr. Abney has cultivated extensive experience with ERISA, Medicare and Medicaid reimbursement claims. Before establishing his own practice, he served in the general counsel's office of the largest post-payment healthcare recovery vendor in the United States. Mr. Abney has written numerous articles and lectured extensively on the topics of ERISA, Medicare, Medicaid and other types of healthcare subrogation and reimbursement issues and contributed to the 2005, 2006, 2007 versions of The National Subrogation Law Manual. He is a member of the American Association for Justice, and the Kentucky Justice Association, where he serves on the board of governors. Mr. Abney also chaired the Kentucky Justice Association's subrogation seminars in 2008, 2009 and 2010.

TODD J. BELISLE is vice president, national sales coordinator for The Centers, (The Center for Special Needs Trust Administration, The Center for Lien Resolution, and The Center for Medicare Set-Aside Administration). Mr. Belisle has spent the last three plus years traveling across the country representing The Centers. He has had the opportunity to speak at multiple event educating attorneys, structure brokers and families about how The Centers can help relieve the burden of public benefit protection during and post settlement. Mr. Belisle graduated from the University of South Florida. Prior to coming on board with The Centers, he spent the previous 12 years as the executive vice president of product development and sales for a large manufacturing/distribution company in the medical industry. Along with assisting both physicians and medical engineers in the development and implementation of new products globally, Mr. Belisle also oversaw the constant changes in policy brought on by the FDA. He also guided the company through many of the domestic and international quality management processes.

RAFAEL GONZALEZ has been serving as chief executive officer of The Centers (The Center for Medicare Set-Aside Administration and The Center for Lien Resolution in Clearwater, Florida). As CEO, he oversees The Centers' national Medicare compliance efforts, which includes mandatory insurer reporting, conditional payments resolution, and Medicare compliance efforts, which includes mandatory insurer reporting, conditional payments resolution, and Medicare Set-Aside allocation, approval, and administration. In 2009, Mr. Gonzalez became a member of the Board of Directors of The Center for Special Needs Trust Administration, a 501(c) nonprofit organization and the largest pooled trust provider in the United States. He has served as chair of The Florida Bar Workers' Compensation Section and the Academy of Florida Trial Lawyers Workers' Association. Mr. Gonzalez was appointed by Governor Jeb Bush to the Florida Rehabilitation Council, appointed by Hillsborough County Commissioner, and now U.S. Representative, Kathy Castor to its Human Relations Council, and appointed by Mayor Pam Iorio to the city of Tampa Hispanic Advisory Council. He earned his B.S. degree from the University of Florida and his J.D. degree from Florida State University. During law school, Mr. Gonzalez interned for Rep. Lincoln Diaz Balart at the Florida House of Representatives. He also clerked for Judge Charles McClure at the Florida 2nd Circuit Court, Judge James Joanas at the Florida 1st District Court of Appeal and Justice Gerald Kogan at the Florida Supreme Court. After graduation from Florida State University, Mr. Gonzalez practiced social security disability, workers' compensation, longshore and harbor workers' compensation, and personal injury law in Tampa, Florida. He has published numerous articles, book chapters, and books, including his series on workers' compensation, permanent total disability, and Medicare Set-Asides. In addition, Mr. Gonzalez has lectured frequently on a national basis on the history, substance, and legislative composition of the U.S. workers' compensation system, the federal social security disability system, and the interplay between both of these systems' medical benefit structure, including the Medicare Secondary Payer Act's requirements affecting both.

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