N E W S     U P D A T E       March 5, 2014           Home
                       FL Legislative Session:  March 4 to May 2, 2014          
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 News Update Archival (Past News items posted)

March 4, 2014
Summary of Moreland Lawsuit, letter I sent out to my consumers.  APD letters out by 3-15-14.

APD PowerPoint presentation about this iBudget findings from Moreland case.
To view the entire presentation, go to  http://apd.myflorida.com/ibudget/rules-regs.htm

May 7, 2013

Be aware that Florida Legislature attempted but failed to insert managed care language that may have allowed
 the HMO model to replace the current iBudget system.  The Florida Developmental Disabilities Council and
 others helped to prevent this from happening.  The iBudget system has so far been effective to control APD
 program and operational costs and so the HMO model is not needed nor desired.    
Click here to read more detail on Aaron Nagle's site
What would it be like if FL legislature ever votes APD into managed care > click on   HMO skit.                

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New APD Director Barbara Palmer took over August 22, 2012 from Mike Hansen whom took a new job
with the FL Senate. 

iBudget $ Reductions Issued
iBudget annual funding numbers were released to district 7 MW support coordinators on 6-7-12. 
Between 40-60% of the nearly 3,000 consumers in district seven had reductions. I have already provided
my review analysis of the budget numbers to my consumers and families. APD has still not reviewed and
adjusted one of my consumers reduction allocation thus far.  APD insisted that we enter the APD reduction
amounts and their "decision tree" would then determine if they could lower or change the reduction amount
 based upon the analysis and recommendations we sent to them. The effective date for these reductions
are 10-1-12.  I submitted all my AIM spreadsheets to APD on 7-2-12 but have only had 1 of 16 of my
requested reductions changed by APD.  So it appears several weeks later that APD will not likely lower
these reduction amounts and hearings in some cases will be requested.  APD was trying to avoid hearings
as they had many during the budget tier implementation. 

APD issued a new document, "Welcome to iBudget Florida" Guide for APD consumers. Explains iBudget, lists new
larger area APD area offices, and lists the smaller number of service categories ie ADT now Life Skills Develolpment level 3.

RESIDENTIAL FEE COLLECTION  is now on HOLD INDEFINITELY.  So until further official notice from APD,
no funds need to be sent in to APD previously due on 6-15-12.  This is likely a result of the law suit that was
filed. See below.  I recommend to save as much money up to the Medicaid limit as possible meanwhile. You
will be able to then have some funds available for camp, prescriptions, dental etc.

Lawsuit filed by Disability Rights FL Inc. on April 26, 2012 concerning new Residential Fee Collection on RULE 65G-2.016.
http://medicaidwaivernews.blogspot.com/2012/05/rule-challenge-filed-by-disability.html
This legal action may delay implementation of this rule.  But since I have not heard officially from APD, the first
payment is still due on 6-15-12 for month of May and future months on 15th thereafter. 
 

Effective Date Postponed. See new date below.
APD Group Home Residents to contribute funds effective April May 1, 2012.    Some APD residents residing in group homes will be paying a portion of any excessive funds they receive beginning on 5-1-12.   This is called Residential Fee
Collection.  "Residential fee collection will require APD customers with federal benefits to help pay for their services
that they receive in a group home, foster care facility, residential habilitation center, or comprehensive transitional
education program".   Fees Due on 15th each month. First one due 6-15-12.

If you feel this new law is unjust, unfair or takes away choice since the additional money will no longer be available for non-waiver
services such as camp, there is a petition you may wish to sign.  One of my families sent me this link to this petition.  You can also
contact your state representative or senator.   I have heard that there is a class action law suit in the works. If this is true, it would
likely interrupt the collection process and may even determine the legality of the statute.  Lawyers may ultimately sort this out
in the justice system.  Stay tuned.  Meanwhile, the fee is still due and spreadsheet completed with payment made to APD. 
 
04-28-2012 Update:                  Fees Due on 15th each month. First one due 6-15-12.

Important Fee Collection Downloads below: 
1) the official notice regarding the residential fee collection initiative with timeframes/requirements   (residential fee collection notice.docx)
(2) a list of frequently asked questions (along with responses to those questions  (Residential Fee Collection FAQs.docx)
(3) a fee calculation worksheet that may be completed by the representative payees  (fee collection worksheet.docx)
(4) a copy of the rule notice.  65G-2.016 Notice of Change (3-28-12).docx)

(5) My explanation as I understand fee collection  (RH_Pay_to_APD_ExplainedGA312.doc)

Basically the Representative payee (typically the group home provider) will be required to forward any
monthly excessive residential payments from residents to APD as required by law, rule and operating procedure.
They must also send a written accounting of all received benefits and calculations showing all the deductions
such as room and board and personal allowance to show how they arrived at the owed amount.  If there is a
surplus amount after Room & Board and Personal Allowance are deducted, that amount can be requested to
be deducted and later applied towards a Medicaid Waiver service not being funded but needed such as a
submitted / approved dental plan of care or consumable medical supplies etc.  Once the entire amount is
collected by APD towards the requested and approved service, a transfer of funds into that support can be
made and a service authorization created so the dental or other service can be conducted.

It appears from discussions with APD, that if a family member or guardian or other party is the repr payee
instead of the group home provider, that they may have to have this transferred to the group home provider
to become repr payee but this has not been officially made certain as far as I know. Any excessive money owed
must be paid by the repr payee by the 15th of each month including a full written accounting. Remember, funds
collected will be figured effective 5-1-12.   An example I created to explain this fee collection can be
reviewed. APD also created an official example for review. Remember, this is my best interpretation of the rule,
which may not be totally accurate at this point. As of 4-5-12, APD just provided official documents which I listed
above in MS Word that can be downloaded for your careful review.

New IBudget eff 10-1-12 in District 7 (Orlando area) APD.  Training for WSCs and providers will take place 5-10 or 5-11-12.  Other districts such as panhandle began Ibudget 4-1-12 and lake county district 13 eff 7-1-12. 
Cost plans will need to be adjusted. They will be prorated from 7-1-12 to 9-30-12 and the new Ibudget cost plan
will run from 10-1-12 to 7-1-13 with new amounts and new service categories mostly into "Life Skills Development".

APD Director Mike Hansen video summarizing the recent 2012 Leglislative session and other budgetary comments
http://www.youtube.com/watch?v=ZI4NntT-JUk&feature=youtu.be  Good news, APD budget increase for FY12/13.
Bad news for local APD districts. Some will be consolidated into a smaller number overall statewide. My guess
is that district seven will remain but may become responsible for and incorporate additional counties such as
Lake.  This change eff 7-1-12, will save money but will likely reduce the speed and quality that the district can deliver.


Gov. Rick Scott recommends a larger APD budget eff 7-1-12 to help prevent past deficits.  If legislature adopts it, This would signify a step in the right direction.

IBudget.   Factors that determine your new budget and how formula is implemented.  Word doc here
Fall 2011 presentations by APD to legislature:   http://apd.myflorida.com/publications/legislative/

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New I Budget Website:  APD has a new website that provides details about the new IBudget eff 1-1-13 in District 7 (Orlando area)
APD is conducting comprehensive cost plan budget reviews currently to facilitate implementation.  As a result, some consumers may
experience a reduction or have room for an increase to their budget.  There will likely be another cut to all services in next few
months due to the APD budget shortfall.

APD sends cost cutting measures to Legislature / governor 9-1-11. APD presented to legislature on 9-1-11 several proposals on how it plans to cut the budget by 76+ million dollars.  The 22 page report is worth reading if you want to know the details of what services may get rate cuts and what APD recommends. 

The Agency for Persons with Disabilities (APD), in consultation with the Agency for Health Care Administration and other stakeholders, has met its legislative requirement by submitting a cost-containment report to the president of the Florida Senate, speaker of the House, and governor on September 1. The report analyzes more than two dozen options for controlling expenditures within the Home and Community-Based Services (HCBS) Developmental Disabilities waiver.  The Legislature approved $810 million for the HCBS waiver for the 2011-12 state fiscal year that began on July 1. APD customers received $930 million worth of services during the 2010-11 fiscal year.

To view the Cost-Containment Plan on APD’s website, visit http://apdcares.org/publications/legislative/docs/apd-cost-containment-plan-2011-2012.pdf.

 
Respite Care Pool Created, Cost plans cut by 50% eff 9-1-11 to help reduce APD budget since not enough budgeted for program.
 Basically if you currently receive respite care, your cost plan budget will be reduced by 50% eff 9-1-11.  APD discovered that 50% of the respite funds that are approved are not utilized by consumers.
 Since many times these funds are approved for emergencies or "just in case" we need them.  So a respite pool was created instead to allow for these unused hours to be utilizied if needed.
 APD notice about is published below:

 APD to Create Respite Pool

TALLAHASSEE - After reviewing the use of respite services with stakeholders, the Agency for Persons with Disabilities (APD) is adjusting how families will access the service. Beginning on September 1, APD will reserve 50 percent of respite service from all cost plans and put the hours into a respite pool. Families will be able to access all respite service hours that were previously approved in the individual’s cost plan, if needed.

The review of respite services showed that families traditionally use about half of their respite hours each year, and keep the other half on their cost plan as a safety net for unexpected emergencies. About $19 million dollars of respite services were not used last fiscal year. After discussions with stakeholders, the idea of creating a respite pool to assist families during emergencies won approval.

Respite services are used when the primary caregiver is unavailable to help the person with a disability due to illness, vacation, or other situations.

Families should contact their waiver support coordinator to learn more about this service adjustment. During the year, the waiver support coordinator will handle requests to access the respite pool. Also, APD has been working to develop free respite resources for families in some areas.

The Florida Legislature has mandated that APD bring its Medicaid waiver expenditures within its appropriation. The Legislature approved $810 million for the Home and Community-based Services (HCBS) waiver for the 2011-12 state fiscal year that began on July 1. APD customers received $930 million worth of services during the 2010-11 fiscal year.

For more information on the agency, call 1-866-APD-CARES or visit APDcares.org.

I Budget UPDATE:
The Agency for Persons with Disabilities (APD) announced its statewide implementation schedule for iBudget Florida. iBudget Florida is a new way to deliver Medicaid waiver services that has been approved by both the Florida Legislature and the federal government.

Simultaneously with iBudget Florida, APD is rolling out its customer central record online system throughout the state. This new system reduces paperwork for APD providers so they may focus more on serving the customer. APD annually serves more than 50,000 Floridians with developmental disabilities of autism, cerebral palsy, Down syndrome, intellectual disabilities, spina bifida, and Prader-Willi syndrome.

 The agency’s Medicaid waiver supports about 30,000 Floridians with developmental disabilities so they may live and participate in their local community. Those 30,000 people will all transition to iBudget Florida over the next 10 months.

The final phase is scheduled to be implemented on April 1, 2012, covering 9,490 customers in Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, Putnam, Suwannee, Union, Baker,
Duval, St. Johns, Nassau, Brevard, Orange, Osceola, Seminole, Flagler, Volusia, Citrus, Hernando, Lake, Marion, and Sumter counties.

As more information becomes available about iBudget, it will be posted on the agency’s website at APDcares.org. iBudget Florida is designed to make the funding process fair and equitable for all Medicaid waiver customers. It will provide for more opportunities for customers to direct their own care. The new system
will also allow the agency to have more financial predictability.

      Some of the customer benefits of iBudget are:

     · Greater ability to choose services that matter to them, given their unique situations.
     · Greater flexibility for customers to respond to changing needs.
     · Reduced bureaucracy and “red tape.”
     · Support coordinators freed from paperwork to focus on providing help that makes an even greater difference.
     · Confidence that funding is fair compared to other customers who are similarly situated.
     · Reduced likelihood of policy changes that cause significant disruption due to budget deficits.
     · Security of a financially stable system that will be there to serve customers down the road.
     · Greater control over their lives.
      

APD ACTING DIRECTOR INTERViEW JUNE 27, 2011 - 40 minutes on You Tube        

    BUDGET UPDATE:

    -4% RATE cut for all APD MW funded providers.
    -15% reduction taken 4-1 to 4-15-11 on services
    -APD is still millions in deficit for fiscal year 2011-12
    -Support Coordinators job description modified by APD to require them to ask families to voluntarily cut or eliminate MW funded supports.
    -Support Coordinators job expanded to give more emphasis/refer to natural, community and generic supports and resources (free instead of using MW $)
    -APD implemented a budget freeze effective 3-1-11. This means no increases in funded services unless you reduce 1 service to transfer $ to new one.
    Until the revenues increase in the state budget, APD budget will continue to remain extremely tight which means no increases will be the norm and even
     reductions may become typical throughout the year to balance the budget.
   
     Managed Care for APD: 
     No HMO Managed Care for APD program.   But managed care HMOs will be required for healthcare 1-2012 to 7-2012 approximately.
     APD has 3 years to prove to the Legislature that it can balance its budget to prevent an HMO managed care model from happening.
     Senate held strong despite the House pushing HMOs for our 50,000 DD citizens. 
    They heard their voices. Democracy still works.
     Thanks for all of you that took the time to write, call, visit your senator or representative.  It made a difference.

               May 6th 2011 decided the HMO fate of APD.  There will be none, at least from this session.   
          
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 www.FloridaUnitedForChoice.com   It is a grassroots effort to prevent HMOs from taking over APD and your services.  T

I Budgets are coming in late 2011 or 2012. Being tested in Tallahassee area office currently. See powepoint presentation about IBudget here.

 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.
 

Tier 1 = $120,000 (not yet implemented by APD but legislatively passed into law 2010)
Tier 2 =$53,625,
Tier 3 = $34,125
Tier 4 =14,422.

Effective 7-1-11. Since ALL provider rates are going down by 4%, the overall budget will decrease and some cuts were necessary.  But if ADT / transportation was
reduced some, either by illness, camp or vacation / holiday time with family may help accommodate this service reduction.

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 in future 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:
     - Currently if you are in tier 4, dental is not an allowed service under MW funding.

Questions to Ponder and needed changes to our program
    - When will the 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 it is 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. Basic fairness.
    - 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.
     - Since natural and community supports are being emphasized to ease budgetary pressures, two community contacts should substitute for a FF and secondary
       contact for up to two months in a row. So third month back to required face to face for those that currently require FF each month, unless health/safety.
       This change would promote natural and community contacts and promote budgetary cuts when free supports could take over.
     - Eliminate Delmarva monitoring and replace it by state APD employees to conduct monitoring using a digital approach saving millions each year.
     - Providers with years of experience and excellent reputations with good monitoring scores or excellent satisfaction surveys, monitor every 3 yrs instead of yearly
     - Reduce annual 24 hrs to 12 required training for WSCs since doctors only require this amount.  Rates continue to be cut and workloads increased.
     - Encourage and solicit ideas and efficient cutting edge business practices for providers and APD instead of out dated costly approaches.
       Ask the top providers in each district and APD veterans what other improvements / suggestions they would make to our program.  
    

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. these will be eliminated once the Ibudget
takes over.

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



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