“But Ya Didn’t Need It Last Year”
Cost Plan Rebasing

information from Aaron Nangle  

Although we are still in the midst of implementing the tiers, a new cost plan slashing exercise is just around the corner.  It is called “Cost Plan Rebasing”.

Those of you who said, “Use it or Lose it” were on target. Those of you who tried to be fiscally responsible, and only used bare bones services will be left short. 

Many people are still waiting for their “fair” hearings to see if their services will be cut by the tiers.   In fact, nearly 5,000 waiver recipients requested a due process hearing because they were asked to give up services that had already been determined to be medically necessary.  It is estimated that another 2,500 did not request a hearing, and their services have already been cut.     

People who are on the Medicaid waiver will get a letter in late November explaining possible future cuts to their cost plans.  This round of cuts is called Cost Plan Rebasing. 

The Agency for Persons With Disabilities will look at what you actually spent on services in the “previous state fiscal year”.  Then they will add 5 percent to that figure. 
This amount will then be your new cost plan cap.  This is called “Cost Plan Rebasing”

Cost plan Rebasing will occur UNLESS, your current cost plan is cheaper.  If your current cost plan is less, then you will have no changes at all. 

The Law – Cost Plan Rebasing

The 2007 Florida Legislature required APD to implement cost plan rebasing effective January 1, 2009.  The text of Section 292.0661(6), F.S.(2008) is as follows:

(6)  Effective January 1, 2009, and except as otherwise provided in this section, an individual served by the home and community-based services waiver or the family and supported living waiver funded through the Agency for Persons with Disabilities 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 individual’s existing cost plan. The Agency for Persons with Disabilities 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 an individual 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 individual enrolled or the cost plan was changed by more than 5 percent and ending with August 31, 2008, and multiplying the average by 12. In the event that 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. This subsection expires June 30, 2009, unless reenacted by the Legislature before that date.

 

TIP- The APD CARES Hotline Is There to Help You

You can contact The Agency For Persons With Disabilities (APD) at 1-866-APD-CARES or 1-866-273-2273. APD’s website states “It will be manned Monday through Friday from 8 a.m. until 5 p.m. (EDT). The phone operators will answer questions directly. For more complex questions, however, the caller will be transferred to the best person to respond in a timely manner”

If your much needed services are cut, remember that you have the right to a fair hearing.  The Florida Advocacy Center has very useful information about these hearings.  http://www.advocacycenter.org/news/APD_Tier.html