Here are sample letters you will receive notifying you of your tier assignment.  Remember should you disagree with your placement, you have the right to appeal but it must be done within 10 days so that you can maintain the level of services you are now receiving.  The explanation of the appeal process is given after your letter.

Unfortunately, cut and pasting is somewhat unstable with WordPress blogs.  If you believe you will be in Tier 1 or 2, please see the next entry up.

NOTICE OF IMPLEMENTATION OF CHANGES IN LAW FOR

TIER WAIVER ASSIGNMENT

EFFECTIVE OCTOBER 1, 2008

 

August 20, 2008

 

RE:  Tier Assignment – Tier 3 Waiver

 

 

We previously notified you that the Florida Legislature passed a law that requires the Agency for Persons with Disabilities (APD) to assign individuals receiving Medicaid waiver services to a four-tier waiver system.  The law requiring tier assignment is Section 393.0661, Florida Statutes (2007).  Rule 65G-4.0021 through 65G-4.0025, Florida Administrative Code, contains the criteria for tier assignment.

 

Effective October 1, 2008, you are assigned to the Tier 3 waiver.  The annual spending limit for this tier is $35,000 a year.  According to our agency’s records, you currently receive services within this spending limit and there is no need to make any changes to your services.  You may wish to contact your Waiver Support Coordinator to verify this information.

 

The Agency for Persons with Disabilities is committed to protecting your health and safety.  Additional information about the tier waivers can be found on the Agency’s website at http://apd.myflorida.com.  You may also contact your Waiver Support Coordinator or your local Agency for Persons with Disabilities office if you have questions.

 

Your due process hearing rights are described in the enclosed “Notice of Hearing Rights.”

 

 

Enclosure:  Notice of Hearing Rights

 

 

Notice of Hearing Rights

 

The agency tier assignment is an automatic action caused by a change in state law required by Section 393.0661, Florida Statutes (2007) and Agency Rules 65G-4.0021 through 65G-4.0025, Florida Administrative Code.  Therefore, if the only issue you raise is the change to the State law requiring the tier waiver system, your request for a hearing will be denied as authorized by 42 CFR 431.220.   

 

However, if you believe that the agency’s decision on your tier assignment is wrong, you may be entitled to an administrative hearing as provided in Sections 120.569 and 120.57, Florida Statutes (2007) and 42 CFR 431.220.  A hearing will only be granted if your hearing request states facts that demonstrate there was an error in your tier assignment.  Mediation is not available in this proceeding

 

If the agency determines you have a right to hearing, you may represent yourself or use legal counsel, a relative, a friend, or other spokesperson in a hearing on this matter.  If you are not representing yourself, proof of guardianship or other documentation of your representative’s authority to act on your behalf is required with the request for hearing.

 

Section 393.125(1)(c), Florida Statutes (2007), states that you must make your hearing request to the agency, in writing, within thirty (30) days of receiving this notice.

 

Additionally, your hearing request must include the following information: 

1.      The name, address, and telephone number of the party making the request and the name, address and telephone number of the party’s counsel or representative upon whom service of pleadings and papers must be made;

2.      A statement that you are requesting an administrative hearing;

3.      A list of any facts and circumstances on which you rely to assert an error in your tier assignment,

4.      A reference to, or copy of, the agency tier assignment notice.

5.      A statement indicating the date you received your tier assignment notice, and  

6.      If someone is making the request for hearing on your behalf, a document, such as an Order Appointing Guardian or a written statement of authorization, establishing the representative’s authority to act on your behalf.

 

If you file your request within ten (10) days of receiving notice of your tier assignment, your services will continue at the existing level until the final decision on your request for hearing. 

 

To request a hearing mail or fax your completed request to:

Agency Clerk, Agency for Persons with Disabilities

4030 Esplanade Way, Suite 380

Tallahassee, Florida 32399-0950

Facsimile – 850-410-0665

 

You may contact your local APD office if you have questions or need assistance in completing a hearing request.  You may also view the Administrative Hearings Rights brochure located at http://apd.myflorida.com/customers/legal/docs/administrative-hearings-guide.pdf

 

 

Tier 4 Letter 

 

NOTICE OF IMPLEMENTATION OF CHANGES IN LAW FOR

TIER WAIVER ASSIGNMENT

EFFECTIVE OCTOBER 1, 2008

 

August 20, 2008

 

Re: Tier Assignment – Tier 4 Waiver

 

We previously notified you that the Florida Legislature passed a law that requires the Agency for Persons with Disabilities (APD) to assign individuals receiving Medicaid waiver services to a four-tier waiver system.  The law requiring tier assignment is Section 393.0661, Florida Statutes (2007).  Rule 65G-4.0021 through 65G-4.0025, Florida Administrative Code, contains the criteria for tier assignment.

 

Effective October 1, 2008, you are assigned to the Tier 4 waiver.  The annual spending limit for this tier is $14,792 a year.  The following services are available on the Tier 4 waiver:

 

Adult Day Training

In Home Support Services

Behavior Analysis

Behavior Assistant

Personal Emergency Response System

Consumable Medical Supplies

Respite Care

Durable Medical Equipment

Supported Employment

Environmental Accessibility Adaptations

Supported Living Coaching

Waiver Support Coordination

Transportation

 

The following Developmental Disabilities waiver services are not available on Tier 4.  If you have been receiving any of these services, they will be terminated effective September 30, 2008.  For individuals enrolled in the Tier 4 waiver from the DD waiver, however, substitution of some of the above listed services can be made to meet your needs. 

 

Adult Dental

Companion

Dietitian

Medication Review

Occupational Therapy

Personal Care Assistance

Physical Therapy

Private Duty Nursing

Residential Habilitation

Residential Nursing

Respiratory Therapy

Skilled Nursing

Special Medical Home Care

Specialized Mental Health

Speech Therapy

 

 

In creating the new four-tier waiver system, the Legislature required client choice in selecting waiver services.  You current cost plan may exceed the spending limit for Tier 4, or you may receive one or more services that are no longer available to you.  APD encourages you to immediately contact your Waiver Support Coordinator to discuss information about your tier assignment and cost plan.  APD is supplying your Waiver Support Coordinator with information on how to assist you in choosing services to adjust your current approved plan to comply with the statutory limits of Tier 4. Your Waiver Support Coordinator can assist you in choosing the services that are most important to you and adjusting your plan to stay within the $14,792 annual limit.

 

If your cost plan exceeds $14,792 or you receive services that are being terminated, your cost plan must be revised and submitted to the Area Office by your Waiver Support Coordinator no later than September 10, 2008.  Your waiver support coordinator must submit the adjusted cost plan to the APD area office for review and final approval. 

 

If you are under 21 years old and approved for personal care assistance services, these services will remain available to you, but they will not be paid through an APD waiver.  Thus, when adjusting your cost plan to bring it within your annual limit, the cost of personal care assistance services will not be included in the calculation.

 

Your due process hearing rights are described in the enclosed “Notice of Hearing Rights.”

 

           The Agency for Persons with Disabilities is committed to protecting your health and safety.  Additional information about the Tier Waivers can be found on the Agency’s website at http://apd.myflorida.com.  You may also contact your Waiver Support Coordinator or the local Area Agency for Persons with Disabilities office if you have questions or need assistance in completing a hearing request.

 

Enclosure:  Notice of Hearing Rights

Notice of Hearing Rights

 

The agency tier assignment is an automatic action caused by a change in state law required by Section 393.0661, Florida Statutes (2007) and Agency Rules 65G-4.0021 through 65G-4.0025, Florida Administrative Code.  Therefore, if the only issue you raise is the change to the State law requiring the tier waiver system, your request for a hearing will be denied as authorized by 42 CFR 431.220.   

 

However, if you believe that the agency’s decision on your tier assignment is wrong, you may be entitled to an administrative hearing as provided in Sections 120.569 and 120.57, Florida Statutes (2007) and 42 CFR 431.220.  A hearing will only be granted if your hearing request states facts that demonstrate there was an error in your tier assignment.  Mediation is not available in this proceeding

 

If the agency determines you have a right to hearing, you may represent yourself or use legal counsel, a relative, a friend, or other spokesperson in a hearing on this matter.  If you are not representing yourself, proof of guardianship or other documentation of your representative’s authority to act on your behalf is required with the request for hearing.

 

Section 393.125(1)(c), Florida Statutes (2007), states that you must make your hearing request to the agency, in writing, within thirty (30) days of receiving this notice.

 

Additionally, your hearing request must include the following information: 

1.      The name, address, and telephone number of the party making the request and the name, address and telephone number of the party’s counsel or representative upon whom service of pleadings and papers must be made;

2.      A statement that you are requesting an administrative hearing;

3.      A list of any facts and circumstances on which you rely to assert an error in your tier assignment,

4.      A reference to, or copy of, the agency tier assignment notice.

5.      A statement indicating the date you received your tier assignment notice, and  

6.      If someone is making the request for hearing on your behalf, a document, such as an Order Appointing Guardian or a written statement of authorization, establishing the representative’s authority to act on your behalf.

 

If you file your request within ten (10) days of receiving notice of your tier assignment, your services will continue at the existing level until the final decision on your request for hearing. 

 

To request a hearing mail or fax your completed request to:

Agency Clerk, Agency for Persons with Disabilities

4030 Esplanade Way, Suite 380

Tallahassee, Florida 32399-0950

Facsimile – 850-410-0665

 

You may contact your local APD office if you have questions or need assistance in completing a hearing request.  You may also view the Administrative Hearings Rights brochure located at http://apd.myflorida.com/customers/legal/docs/administrative-hearings-guide.pdf