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Agency
for Persons with Disabilities Budget Finalized Senate
Bill 2800, the General Appropriations Bill, and Senate
Bill 1124, the Conforming bill for the Agency for Persons with
Disabilities (APD) were completed yesterday. The new
appropriations language includes the following service reductions,
limitations and changes: ·
The agency will continue the third
party prior services authorization program to review all individual
support and cost plans for home and community based waiver services
for individuals with developmental disabilities. ·
The agency will implement
cost-containment measures for any new requests for supported living
services after July 1, 2007. These measures will include the total
annual cost of the provision of supported living services as
determined through the support plan process and will not exceed the
total annual cost of equivalent services in an appropriate licensed
residential facility. ·
Supported Living Coaching services will not exceed 20 hours per month for persons who also receive
in-home support services. ·
Limited Support Coordination
services will be the only type of Support Coordination service
provided to persons under the age of 18 who live in the family home. Effective October 1, 2007 all children under the age of 18 living with family will be require to have Limited Support Coordination. How will Limited Support Coordination affect each individual and their families? It is the viewpoint of the State of Florida that family members should take the primary role for children who reside with them. The requirements that agencies are to follow for Limited Support Coordination are drastically different than what you are used to your Waiver Support Coordinator (WSC) doing for you. It is written that WSC will conduct ontly two (2) visits a year. One visit will be done at the support plan meeting and one of those 2 contacts must be in your home. WSC should only make one contact per month. A contact could be a phone call to you or a provider. If you call the WSC or one of your providers call the WSC, this would count as the month's contact. This could be quite challenging if one individual has 5 or 6 providers and many services. In the past, when things were not going well, you had the benefit of making one call to your WSC and their agency took over dealing with the issues. Now, you the family will be the strongest advocate. Please keep in mind that within the limitations of one contact per month, that WSC must still fulfill prior service authorization activities to amend services or providers. Some of you may notice your agencies reassigning your file in an effort to limit the burden on WSC. ·
Personal Care Assistance
services will be limited to no more than 180 hours per calendar
month and will not include rate modifiers. Additional hours may be
authorized only if a substantial change in circumstances occurs for
the individual. ·
Residential Habilitation
services will be limited to 8 hours per day. Additional hours may be
authorized for persons who have intensive medical or adaptive needs
and if such hours are essential for avoiding institutionalization,
or for persons who possess behavioral problems that are exceptional
in intensity, duration, or frequency and present a substantial risk
of harm to themselves or others. (This
restriction shall be in effect until the four-tiered waiver system
(see below) is fully implemented.) ·
Chore, Non-Residential Supports
Services and Homemaker services
will be eliminated. The agency shall expand the definition of
In-Home Support services to enable the provider of the service to
include activities previously provided in these eliminated services. ·
Massage Therapy and
Psychological Assessments
services will be eliminated. ·
The agency will conduct
supplemental cost plan reviews to verify the medical necessity of
authorized services for plans that have increased by more than 8
percent during either of the two preceding fiscal years. ·
The agency will implement a
consolidated Residential Habilitation rate structure to increase
savings to the state through a more cost effective payment method
and establish uniform rates for Intensive Behavior Residential
Habilitation services. ·
Pending federal approval, the
agency is authorized to extend current support plans for clients
receiving services under Medicaid waivers for one year beginning
July 1, 2007, or from the date approved whichever is later. Clients
who have a substantial change in circumstances that threatens their
health and safety may be reassessed during this year to determine
the necessity for a change in their support plan. ·
The agency will only serve
additional clients on the Home and Community Based Services Waiver
if they are in crisis and sufficient funding is made available
through attrition. ·
The Agency for Persons with
Disabilities (APD) Area Offices will review, identify, and resolve
issues relating to support plans submitted by Waiver Support
Coordinators that are not in compliance with the agency’s rules,
policies and procedures, and with the appropriate waiver. Senate Bill 1124,
the Conforming Bill, outlines a four-tiered waiver system that
includes: TIER ONE
is limited to individuals who have service needs that cannot be met
in tiers two, three, or four for intensive medical or adaptive needs
and that are essential for avoiding institutionalization, or who
possess behavioral problems that are exceptional in intensity,
duration, or frequency and present a substantial risk of harm to
themselves or others. TIER TWO
is limited to individuals whose service needs include a licensed
residential facility and greater than 5 hours per day in residential
habilitation services or clients in supported living who receive
greater than 6 hours a day of in-home support services. Total annual
expenditures under Tier Two may not exceed $55,000 per individual
each year. TIER THREE
includes, but is not limited to, individuals requiring residential
placements, individuals in independent or supported living
situations, and individuals who live in their family home. Total annual
expenditures under Tier Three may not exceed $35,000 per individual
each year. TIER FOUR
is the family and supported living waiver. Tier Four shall include,
but is not limited to, individuals in independent or supported
living situations and individuals who live in their family home. An increase to the
number of services available to individuals in this tier shall not
take effect prior to July 1, 2008. Total annual expenditures under tier four may not exceed $14,792 per year.
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