We are grateful for the work that George Andrew did in summerizing the Medicaid Reform Bill as it relates to APD.  Andrew has more than a decade working with people with disabilities.  He worked first for APD and later because a support coordinator, where he is currently serving.

George Andrew Summary of the Medicaid Reform bill 234 pages long as of 2-17-11,

This is as it relates to APD not including the medical part DD folks would still be subject to.

Executive Summary:

Adds Downs Diagnosis to our program.

Requires monthly payments by Medicaid recipients.

Prevents using a Medicaid service if employer has health care sponsored plan

Requires parental income based fee for DD kids in HCBS waivers.

Require AHCA to apply to modify Federal Waiver & run limited managed care if denied

Requires all Medicaid recipients to be enrolled in Medicaid managed care

Prevents Medicaid recipient from enrolling in managed care if has employer sponsored HC.

Plans require Primary care providers to get same Medicare rate

APD required to develop / implement a comprehensive redesign the program

AHCA can impose and collect fees from recipients if approved by Medicare s. 409.906(13)(d)

AHCA/APD given power to chg rates, # of services, limit enrollment based on funds available.

Exempts DD persons as defined under F.S.393.63 from receiving medical services under managed care program.

Summary Lines 6-9: 

Bill Lines:

redefining the term

7 ―developmental disability‖ to include Down syndrome;

8 defining the term ―Down syndrome‖ as it relates to

9 developmental disabilities; amending s. 393.0661

 Summary Lines 65-67

Bill Line 1077-1087 providing

65 for the payment of monthly premiums by Medicaid

66 recipients; providing exemptions to the premium

67 requirement;

Comment: Would exempt SSI elig receipients receiving instutitional care payments

Summary Lines 69-71

Bill Lines:

prohibiting a recipient who has access to employer-sponsored health care from obtaining services reimbursed through the Medicaid fee-for-service system;

Summary Lines 91-94 

Bill Lines 1904-1911 

providing for a parental fee based on family income to

92 be assessed against the parents of children with

93 developmental disabilities served by home and

94 community-based waivers

Lines 136-139

Bill Lines:

  directing the agency to apply for and

137 implement waivers; providing for public notice and

138 comment; providing for a limited managed care program

139 if waivers are not approved; creating s. 409.964

Lines 140-141 requiring all Medicaid recipients to be enrolled

141 in Medicaid managed care; providing exemptions;

Lines 142-146  prohibiting a recipient who has access to employer

143sponsored health care from enrolling in Medicaid

144 managed care; requiring the agency to develop a

145 process to allow the Medicaid premium that would have

146been received to be used to pay employer premiums;

Summary Lines 189-191 

Bill Line 2423-2426

requiring plans

190 to pay primary care providers the same rate as

191 Medicare by a certain date

Summary Lines 424-457 

Bill Lines:

393.063 Definitions.—For the purposes of this chapter, the

424 term:

425 (9) ―Developmental disability‖ means a disorder or syndrome

426 that is attributable to retardation, cerebral palsy, autism,

427 spina bifida, Down syndrome, or Prader-Willi syndrome; that

428 manifests before the age of 18; and that constitutes a

429 substantial handicap that can reasonably be expected to continue

430 indefinitely.

431 (13) ―Down syndrome‖ means a disorder that is caused by the

432 presence of an extra chromosome 21.

433 Section 3. Present subsections (7) and (8) of section

434 393.0661, Florida Statutes, are redesignated as subsections (8)

435 and (9), respectively, a new subsection (7) is added to that

section, and present subsection (7) of that section is amended,

437 to read:

438 393.0661 Home and community-based services delivery system;

439 comprehensive redesign.—The Legislature finds that the home and

440 community-based services delivery system for persons with

441 developmental disabilities and the availability of appropriated

442 funds are two of the critical elements in making services

443 available. Therefore, it is the intent of the Legislature that

444 the Agency for Persons with Disabilities shall develop and

445 implement a comprehensive redesign of the system.

446 (7) The agency shall impose and collect the fee authorized

447 by s. 409.906(13)(d) upon approval by the Centers for Medicare

448 and Medicaid Services.

449 (8)(7) Nothing in This section or related in any

450 administrative rule does not shall be construed to prevent or

451 limit the Agency for Health Care Administration, in consultation

452 with the Agency for Persons with Disabilities, from adjusting

453 fees, reimbursement rates, lengths of stay, number of visits, or

454 number of services, or from limiting enrollment, or making any

455 other adjustment necessary to comply with the availability of

456 moneys and any limitations or directions provided for in the

457 General Appropriations Act or pursuant to s. 409.9022.

Summary Lines  

Bill Lines 3218 & 3223-3224  

(1) The following recipients are excluded from

3218 participation in the Medicaid managed care program:

(c) Persons who have a developmental disability as defined

3224 in s. 393.063.

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