N E W S     U P D A T E       July 5, 2010           Home
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 NCI is National Core Indicators:  Florida recently joined over 27 other member states to join resources to improve measures to improve quality of delivered
services to Floridians with developmental disabilities.  See learning center, terms here.  What are the actually indicators? click here for word doc.

*APD provider rates and consumer budget tier cuts by 2.5%  Read good article posted by Aaron Nangle's website article here.

A veto by Gov. Crist which excludes from the provider rate cut of 2.5%  are: Personal Care Assistance, transportation, durable medical equipment,
consumable medical supplies, support coordination, and environmental and Home Accessibility services. 

Tier 1 will go from $ unlimited to $150,000, Tier 2 will go from $55,000 to $53,625, Tier 3 from $35,000 to $34,125 and Tier 4 from $14,792 to $14,422.
Effective 7-1-10. Since provider rates are going down, the tier budget will decrease as well so cuts might not be necessary. Details not yet provided by APD. The
tier category budget maximum reductions are still tentative as far as I have heard.  APD in central office has been silent regarding how or when any reductions
will be taken so it is an educated guess at this point.  They may take 2.5% reduction from the non-excluded other APD services using a computer program that
automatically makes these changes. Then revised authorizations would be sent out to the effected providers.

Last day of FL Legislature ended without passing Managed Care bill.  So we have 1 more year before efforts by HMOs to pass managed care for APD resume next year.

Great Miami Herald article on managed care issue published April 23, 2010.
Managed Care bill HB 7223 conferenced version is going to Gov Crist.  Write him to veto.  To see details of bill & Sample Governor letter - click here MSWord Doc.  
To view without MS Word on internet, right now click here.   "By January 1, 2014, the agency shall begin implementation of statewide long-term care managed care for persons with developmental disabilities, with full implementation in all regions by October 1, 2015."  Support Coordination will be terminated.
Case management will be taken over by your new HMO or PPN.  

  It is time (March 2010 through April 2010)  to write an email to your senator or representative urging not to cut any services you value.
  
All medicaid consumers which include DD medicaid waiver consumers, will be required to become enrolled in an HMO administered program to access services if
vote passes in house/senate on 4-15-10.  Full house and senate would then vote on including any amendments offered. Passed House now in conference then to governor.

Results of below DD budget compromised bill are as follows:
  1.  DD Providers lose 43 million dollars with a 5.5 % cut.
   2. Cost Plans will be frozen at the expenditure level plus 5% with certain exceptions
   3. Tier One remains uncapped
   4. Fair Hearings remain in the Department of Administrative Hearings.
   5. There was over 3 million dollars assigned for more people to do consumer assessments.
   Source: DD council Volume 7, issue 6

Here is actual copy of Senate proposed CS 1468 as of 3-29-10 that will be voted on with cuts.  Details I Budget.
Dental should be exception added in line 290 to 296.    Dental should also be added as a tier 4 option.
Here is actual copy of House bill proposed which is more detailed than Senate. 

 Tier Level      Current      Proposed in bill               Both House and Senate reduction bills will be voted on this Week Wed 3-30-10  !!!
Tier 1 =          unlimited      $120,000
Tier 2 =           $55,000        $ 49,500
Tier 3 =           $35,000        $31,500 
Tier 4 =           $14,792        $13,313        

     2010 A.P.D. BUDGET reduction proposals  - click on each of 3 below links or this link that summarizes in more detail.

   The State of FL must cut 3 billion dollars or so FY 2010/11 due to fallen property values which means less revenue to spend. No one likes cuts.
   Do you have some realistic ideas on how APD or other agencies could save money while actually improving services?  You heard me right.
   It is not an easy task for anyone, so speak up if you have some innovative / creative ideas.  I have been working on some ideas of my own.
   We didn't really see any cuts last year, that is basically due to the federal stimulus dollars the state received.

  Here is a TV news story that aired on Orlando WESH Channel 2 news on 3-8-10 about possible APD budget cuts.
   Discussed how a local SWOP ADT workshop may be impacted by these cuts.
   After further research, I located legislative budget proposal doc which goes into more detail.
   February 9, 2010 APD budget presentation to State of FL Legislative House of Representatives Health Care Appropriations Committee

1. IBudgets: (Individual Budgeting) -   More details click on > Questions and Answers 
      - APD presented IBudget to Florida Legislature in February 2010.  
    - Determines MW budget funding levels via QSI, living situation, age etc
      - Consumers with similar needs will receive similar funding levels as well as consumers with greater needs receive greater funding.
      - Gives more flexibility with services and consumer involvement in spending
    -APD not yet sharing IBudget algorithm which is really the essence of what criteria will determine consumers new budget (as of 3-9-10)
   
  2. Flexible Benefit Service:
    - Is optional for enrolled MW consumers
     - Uses Medicaid providers
     - ADT, companion, respite, I.H.S., SEmployment, SLiving
     - Budgets must take a 8% cut to be a part of
     - Option might begin as earlier as spring or summer 2010 per APD

3. New Quality Assurance / Person Centered Planning system:
   -Uses national core indicators
    - Fewer forms
    - Complete forms online
    - Issue service authorizations electronically
  - Emphasizes the consumer abilities

4.  Funding for Dental service
    - For Tier 4:  Now in Gov Crist's proposed budget
     - Currently if you are in tier 4, dental is not an allowed service under MW funding. Legislature would have to still approve it.

Questions to Ponder and needed changes to our program
    - Will this new IBudget take the place of current tier system and will it be fair?
     - When will the annual rebasing of cost plan budgets be ended since rebasing process costs more money to conduct by APD / WSCs than they save
        as well as not being very fair to many of our consumers?  If they not ended, when will date for rebasing be changed from around thanksgiving /
        xmas to earlier say in September?   This is the only time many WSCs and APD employees take time off with their families and friends.
    - When will APD and all of it's certified MW providers utilize a more efficient business model and become fully digital? Currently many providers
       still snail mail volumes of papers to support coordinators (I get 110 pages/month from 1 provider) or APD each month to document their activities/
       services when they could send a digital file such as a pdf file instead. All the major email services are encrypted already or at least a CD disk could
       be mailed out instead.  This change would save everyone time / money and would make data retrieval very fast.  Very few items need to be originals
       such as birth certificates, legal docs. SS card etc. but even these can be scanned from an original for safe  storage and quick retrieval.  
     - When will providers not be required to send monthly bill invoices to WSC since they no longer do the provider billings and providers are responsible
        for and should maintain their OWN documentation for billing purposes?  Why does the WSC need a copy still? ABC lists out providers bills if needed.

Tier 4 changes per APD memo 12-18-09: 
     1. Family and Supported Living Waiver Services Directory no longer in effect.
     2. Individual service level budget caps from FSL were eliminated for Tier 4.
     3. Respite services no longer limited to 30 days or 720 hours as described in DD handbook.

Providers will still need to be enrolled in tier 4 (formerly FSL) separately to render services.
Tier 4 services are still limited to same FSL services but without the caps.
There have been unofficial discussions about the tier system being eliminated but this is not
confirmed.  If the legislature were to do this, the new iBudget "Individual Budget" along with the QSI
assessment would likely determine appropriate service levels.  

Rebasing APD notification letter copy here.   >    More info on.
Rebasing Procedures 2009:  Basically by 11-23-09 notices to consumers that are to be rebased will be notified by APD.  Depending on the amount to be rebased (reduced), your support coordinator (me) will work with you on what supports you decide to adjust to comply with the rebasing law. Revised budgets need to be completed by support coordinator due 12-8-09.  The law states:
(6)  Effective January 1, 2010, and except as otherwise provided in this section, a client served by the home and community-based services waiver or the family and supported living waiver funded through the agency shall have his or her cost plan adjusted to reflect the amount of expenditures for the previous state fiscal year plus 5 percent if such amount is less than the client's existing cost plan. The agency shall use actual paid claims for services provided during the previous fiscal year that are submitted by October 31 to calculate the revised cost plan amount. If the client was not served for the entire previous state fiscal year or there was any single change in the cost plan amount of more than 5 percent during the previous state fiscal year, the agency shall set the cost plan amount at an estimated annualized expenditure amount plus 5 percent. The agency shall estimate the annualized expenditure amount by calculating the average of monthly expenditures, beginning in the fourth month after the client enrolled, interrupted services are resumed, or the cost plan was changed by more than 5 percent and ending on August 31, 2009, and multiplying the average by 12. In order to determine whether a client was not served for the entire year, the agency shall include any interruption of a waiver-funded service or services lasting at least 18 days. If at least 3 months of actual expenditure data are not available to estimate annualized expenditures, the agency may not rebase a cost plan pursuant to this subsection. The agency may not rebase the cost plan of any client who experiences a significant change in recipient condition or circumstance which results in a change of more than 5 percent to his or her cost plan between July 1 and the date that a rebased cost plan would take effect pursuant to this subsection.

Please work with your support coordinator on this rebasing project.  There will be appeal procedures like last year available.  See rebase procedures.  Basically if you didn't use a given service, then your budget is likely to be reduced by that amount.  So my recommendation if to fully utilize the allocated services
amounts approved by APD for the coming year.  Exceptions such as hospitalization or changing providers or if lost Medicaid may not count a given month in APD calculations.

Appeals decsion as of 8-21-09:

Rebasing
CS/ SB 1660 Governor Crist signed into law 5-27-09. Basically it makes changes as follows:
(amending s. 393.065, F.S.)

1. Rebasing will take place annually. Basically spend funds in your cost plan or lose them next year.
   I sent insertion language that basically says that they won't count time frames when services
   were interrupted such as going into hosptial, losing your Medicaid, or switching to another provider.
   It appears they adopted this necessary more fair approach.  Bill now states "

...the agency shall estimate the
  242  annualized expenditure amount by calculating the average of
  243  monthly expenditures, beginning in the fourth month after the
  244  client individual enrolled, interrupted services are resumed, or
  245  the cost plan was changed by more than 5 percent and ending on
  246  with August 31, 2009 2008, and multiplying the average by 12. In
  247  order to determine whether a client was not served for the
  248  entire year, the agency shall include any interruption of a
  249  waiver-funded service or services lasting at least 18 days.
 

So your budget will at least have a fair chance in not being arbitrarily reduced based upon factors
beyond your control.  So fall 2009, we will be rebasing some budgets again.
2. Medication review service eliminated eff 4-1-10. "

" ...directing the agency to eliminate medication-review services"
3.  Attempt to add some services such as dental back into tier 4 failed.
4. APD must develop / eliminate redundancies between S.Lvg, in home supports, companion, PCA.
5. APD must develop a plan to reduce intensity of supported employment if job is stable for 3 years.
6. Wait list for APD MW criteria was established by priority.
 

      REBASING COST PLANS basically is back on track and so reductions or outright cuts will take place to comply with the law. Support Coordinators have been asked to get all this done in a short time frame during the holidays.  Many of us have taken vacation as you have. So try to complete and mail your request for a hearing as soon as you can if you do not agree with the amount of the reduction.  But remember APD will want to know why you think they miscalculated the reduction, not that you merely think it is unfair, which is not grounds for a hearing. 

- Will 2009 be the last year consumers have to go through the sometimes unfair rebasing budget reductions?

Some cost plan budgets will be reduced via "rebasing" if consumer's budget prorated amount is more than  105% of last years expenditures cost plan budget.  Amendment reduction deadlines are set by APD.   Consumers / families must decide prior to the deadline what services will be adjusted. 
Food for thought?
Why for second year in a row, is rebasing conducted at thanksgiving and Christmas time?
Highly inappropriate time for families, WSCs and APD staff trying to relax with their families over holidays.  What timing !  If rebasing is to continue, should be conducted in Sept/October not Nov/Dec. 

TIME TO WRITE AND CALL YOUR SENATOR if you are affected.   You will be notified by APD and myself or your WSC if you are affected. A third of my consumers are affected by rebasing.   click>  REBASING EXPLAINED AND THE LAW.

WSCs were notified which consumers will be "rebased" basically meaning cost plan reduced.  Consumers and families should also be notified.  Fair Hearings will apply apparently.  If you are currently awaiting a hearing from tier, the state APD can still rebase / cut your budget meanwhile if you qualify under their criteria!   If you file for a rebase hearing or legitimate explanations are identified why current budget
is more than last year's budget, APD still wants WSCs to file an amendment to adjust reductions.  They
have told WSCs they will not implement amendment reductions unless hearing is not granted or lost or
exceptions submitted are not validated.

TIERS.  Tier 1 which is unlimited currently may be changed to a maximum of $120,000.  If this happens, many consumers will end up in an ICF DD facility (nearly $50,000 cheaper to the state), which violates the "least restrictive" philosphy of APD, since ICFs are very restrictive and have little "community inclusion or natural supports."  The trend to deinstutionalize consumers moving them from ICFs into the community seems to regressing backwards to instutionalization when costs get too high. The State may be realizing they can no longer afford the original philosophical basis of the Medicaid Waiver program - to have the least restrictive environment utilizing natural supports, integrating into the community discovering social roles, making their own choices to become as independent as possible to maximize their potential.  Tiers 1-4 Criteria-Click HERE

 QSI consumer interviews will eventually effect budget tier assignments based upon this assessment of need determining fund / tier category.  There will also be follow up interviews to validate these QSI interviews called SIS. Call support coordinator if unsure about. 
 
If you are assigned tier 4, certain services such as companion, dental and mental health counseling
are NOT covered on this "Family and Supported Living Waiver" you are transferring to within APD. 
I might be able to transfer companion to "in home supports" if your current provider offers this under
this new waiver.

Tier 4 only pays for: ADT, Beh Analysis / Assistant, CMS, EAA, DME, in home supports, pers emerg
response, respite, SE, S.Lvg coaching, transp, and Waiver support coord.  So if your service is not listed
here and you have been assigned to tier 4, then the service ended on 10-14-08.  These new tiers were effective on 10-15-08.

 If I am your support coordinator, please email, snail mail or fax me.  GeoAndrew@aol.com or 407 246-1874 fax. 

The annualized tier budget caps for spending on supports are as follows:
    Tier 1 = no limit
    Tier 2 = $55,000
    Tier 3 = $35,000
    Tier 4 = $14,792

What this means is that if your total spending in your cost plan is above the tier cap limit you
have been placed into, then you must work with the support coordinator to identify how your
budget can be reduced to comply with the cap.  So if you are in tier 3 and current spend $40,000,
then you must cut $5,000.  If you spend say $30,000, then no cuts are necessary since you are
under the $35,000 cap.  APD has already sent out letters notifying you what tier number you have been
assigned to.   

Remember, except for a higher tier level, this is a legislatively mandated change.  The good news is
that services continue during an appeal for hearing, if filed within 10 days
of receiving your official APD notice letter.  Bad news is that you may be liable to pay back to the
state APD any supports from effective date forward that are denied as a result of your hearing appeal
decision that you request.  You only have 10 days (if you want services to continue) 30 days (if services
don't continue) from when you, the consumer or group home receives the tier notification letter,
in which to appeal and keep services.  . 

You may elect to call or write your state senator or representative in Tallahassee and indicate how this
 change has effected you.  Here is a form letter you can use for writing.   You can call APD district seven
407 245-0440 for further clarification or to  verify any statements above since this is my best
 understanding of materials that were presented to me.  
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