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 are in Tier 3 or 4, please see the last entry down.

Agency for Persons with Disabilities 

                           NOTICE OF IMPLEMENTATION OF CHANGES IN LAW FOR

TIER WAIVER ASSIGNMENT

EFFECTIVE OCTOBER 1, 2008

 

August 21, 2008

 RE:  Tier Assignment – Tier 1 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 Tier 1.  According to the agency’s records, this tier assignment does not require a change to your current waiver services.  You may wish to contact your Waiver Support Coordinator to verify this information.

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 contact your Waiver Support Coordinator or the local Area APD 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

 

Second Tier Letter–Under Cap

 

NOTICE OF IMPLEMENTATION OF CHANGES IN LAW FOR

TIER WAIVER ASSIGNMENT

EFFECTIVE OCTOBER 1, 2008

 

August 20, 2008

 

RE:  Tier Assignment – Tier 2 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 2 waiver.  The annual spending limit for this tier is $55,000 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.”

 

Tier 3 Letter-Under Cap

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