This information was obtained from Aaron Nangle’ newsletter.  To receive Nangle’s newsletter, visit his website at waiverinfo@aol.com

Emergency Rule Lifted By Rick Scott

Details About How/When Rates Are Restored

Provider Update

The APD emergency rate reduction to provider rates will end at midnight, April 15. Provider rates will return to their March 2011 levels effective Saturday, April 16.

Rates for services provided between April 1 and April 15 will remain at the reduced rate.

To keep from issuing over 150,000 new service authorizations, APD is changing current service authorizations (April 1 – June 30). These service authorizations will have an approved amount based on the reduced rate for services provided between April 1 through April 15 and the old (higher) rate from April 16 through the service authorization end date.

Changed service plans will be available in ABC by close of business Monday, April 18.

Service authorization requests will be submitted to FMMIS the evening of April 18. Service authorizations are anticipated to be available Tuesday, April 19.

Billing is suspended until system changes are complete. APD anticipates that service authorizations will be available to Waiver Support Coordinators on Tuesday, April 19.  WSC must review and distribute these service authorizations. Once a provider has received a service authorization, they may begin billing for April services.

If you have any questions or problems with your service authorization, Area Office staff can answer questions and make corrections to service plans.

Rates

The rate shown on the service authorization will be the old (higher) rate. The approved amount on the service authorization may not be equal to the old rate shown on the service authorization multiplied by the number of units. The service authorization for April may show an amount slightly less than the original rate multiplied by the number of units because of the reduced rate used from April 1 through April 15.

When billing for April, please remember to reduce the amount billed for services provided before April 16.   

Because of the rate change, services (other than monthly) should be billed daily by date in April. Please do not “roll-up” service rates used after April 15 with services provided during the April 1 through April 15 period.

Service Scenarios

The sections below describe how reduced rate service authorizations will be handled to increase the rates.

Service Plans with Approved Amount <= $1.00 or Rate = $0.00 : 

 Service Plans with Approved Amount <= $1.00 or Rate = $0.00 will not be updated by this process.

 Monthly Services (One unit per month billed)

The services below will be handled as follows:

For April,    

The reduced rate will be multiplied by 50% (.5).              

The old rate will be multiplied by 50% (.5).

These two amounts will be added together to get the blended amount for April

Each remaining month (May and June) will be billed at the old rate ($100.00)

New Service Authorization Amount (April-June) 92.50 + 100 + 100 = $292.50

 Example:

Reduced rate = $85, Old rate = $100, 4/1/2011-6/30/2011

For April,

$85 x .5 = $42.50

$100 x .5 = $50

$42.50 + $50 = $92.50 (blended amount for April)

92.50 + 100 + 100 = $292.50 New Service Authorization Amount (April-June)

Monthly Services

Res Hab Basic – Standard

Res Hab Ext 1 – Behavior Focus

Res Hab Ext 1 – Standard

Res Hab Ext 2 – Behavior Focus

Res Hab Ext 2 – Standard

Res Hab Min – Behavior Focus

Res Hab Min – Standard

Res Hab Mod – Behavior Focus

Res Hab Mod – Standard

Support Coordination – Limited

Support Coordination – Full

Support Coordination – Transitional

Support Coordination CDC+ – Limited

Support Coordination CDC+ – Full

 Unit Based Services

The services below will be handled as follows

Calculate number of days between begin date and 4/15/2011 = Reduced rate days (DaysReduced)

Calculate the number of days between 4/16/2011 and service authorization end date = remaining days (DaysRemain)

DaysReduced + DaysRemain = DaysSA

Approved amount / reduced rate = number of units (Units)

Units / DaysSA = units per day (UnitsDay)

UnitsDay * DaysReduced * reduced rate = 4/1/2011-4/15/2011 amount (ReducedAmt)

UnitsDay * DaysRemain * old rate = 4/16/2011-end of service authorization amount (RemainingAmount)

ReducedAmt + RemainingAmount = New Service Authorization Amount

 Example:

Reduced rate = $85, Old rate = $100, Period 4/1/2011-6/30/2011, Amount $8500

4/1/2011 – 4/15/2011 = 15 (DaysReduced)

4/16/2011 – 6/30/2011 = 76 (DaysRemain)

15 + 76 = 91 (DaysSA)

$8500 / $85 = 100 (Units)

100/91 = 1.0989 (UnitsDay)

1.0989 * 15 * $85 = $1401.0975 (ReducedAmt)

1.0989 * 76 * $100 = $8351.64 (RemainingAmount)

$1401.0975 + $8351.64 = $9752.7375 (New Service Authorization Amount)

Unit Based Services

In – Home Supports (Live-In Staff)

Res Hab Basic – Standard – Daily

Res Hab Ext 1 – Standard – Daily

Res Hab Ext 2 – Standard – Daily

Res Hab Min – Standard – Daily

Res Hab Mod – Standard – Daily

Residential Habilitation – (Live In Staff) – Daily

Respite Care – Day

Adult Day Training – Facility Based

Adult Day Training – Off Site

Behavior Analysis Level 1

Behavior Analysis Level 2

Behavior Analysis Level 3

Behavior Assistant Services

Companion

Dietitian Services

In – Home Supports (Awake Staff)

Occupational Therapy

Personal Care Assistance

Physical Therapy

Private Duty Nursing – LPN

Private Duty Nursing – RN

Residential Habilitation – (Quarter Hour)

Residential Nursing Services – LPN

Residential Nursing Services – RN

Respiratory Therapy

Respite Care – Quarter Hour

Skilled Nursing – LPN

Skilled Nursing – RN

Specialized Mental Health – Therapy

Speech Therapy

Supported Employment   Group

Supported Employment – Individual Model

Supported Living Coaching

Services Reduced by a flat 15 percent

The services below will be handled as follows

Calculate number of days between begin date and 4/15/2011 = Reduced rate days (DaysReduced)

Calculate the number of days between 4/16/2011 and service authorization end date = remaining days (DaysRemain)

DaysReduced + DaysRemain = DaysSA

Approved amount / reduced rate = number of units (Units)

Units / DaysSA = units per day (UnitsDay)

Reduced rate / .85 = old rate

UnitsDay * DaysReduced * reduced rate = amount prior to 4/16/2011 (amount 1)

UnitsDay * DaysRemain * old rate = amount after 4/15/2011 (amount 2)

Amount 1 + amount 2 = New Service Authorization Amount

 Example:

Reduced rate = $85, Period 4/1/2011-6/30/2011, Amount $8500

4/1/2011 – 4/15/2011 = 15 (DaysReduced)

4/16/2011 – 6/30/2011 = 76 (DaysRemain)

15 + 76 = 91 (DaysSA)

$8500 / $85 = 100 (Units)

100/91 = 1.0989 (UnitsDay)

$85 / .85 = 100 (old rate)

1.0989 * 15 * $85 = $1401.0975 (ReducedAmt)

1.0989 * 76 * $100 = $8351.64 (RemainingAmount)

$1401.0975 + $8351.64 = $9752.7375 (New Service Authorization Amount)

 Services Reduced by a flat 15 percent

CONSUMABLE MEDICAL SUPPLIES

IN HOME SUPPORTS MONTHLY – S.L.WAIVER

Personal Emergency Response – Service

Res Hab Basic – Behavior Focus

Residential Habilitation – (Day) Intensive Behavior in a Licensed Facility

Special Medical Home Care

Transportation – Mile

Transportation – Month

Transportation – Trip

One time or infrequent services

The services below will be handled as follows:

A list of these service authorizations is being provided to the Area Offices. Changes for these services will be handled manually by the Area Offices

Services

Adult Dental Services

Behavioral Analysis Services Assessment

Durable Medical Equipment

Environmental Accessibility Adaptations

Home Accessibility Assessment

Occupational Therapy Assessment

Personal Emergency Response – Installation

Physical Therapy – Assessment

Respiratory Therapy Assessment

Specialized Mental Health – Assessment

Speech Therapy – Assessment

Special Case for Res Hab Behavior Focus

The services listed below have the same procedure code of either “T2020U6” or “T2023U6” in the Rate table. However Res Hab Basic does not have any given rates as this service comes under services with negotiated rates. The business rule being applied is:

a) Take the pre-April 1 ABC service plan rate (old) and compare it with all the rates available in the old rate table.

 b) If a perfect rate match is found for the procedure code and rate, the matched rate will be used in the current service plan. Otherwise the ABC old service plan rate will be used in the current service plan.

Services

Res Hab Basic – Behavior Focus

Res Hab Min – Behavior Focus

Res Hab Mod – Behavior Focus

Res Hab Ext 2 – Behavior Focus

Res Hab Ext 1 – Behavior Focus – Daily

Res Hab Ext 2 – Behavior Focus – Daily

Res Hab Min – Behavior Focus – Daily

Res Hab Mod – Behavior Focus – Daily

 Problems That Might Occur

One time or infrequent services are being handled manually

Units may not be used on a daily basis so the calculated amount is not correct

Source:  http://apdcares.org/news/news/2011/new-rule.htm

  ______________________________________________________

Message From Aaron Nangle

The aim of win-win negotiation is to find a solution that is acceptable to both parties, and leaves both parties feeling that they’ve won, in some way, after the event.  I don’t believe that has happened  for either party, and that worries me.  Providers and families are very, very thankful to The Governor and to the Legislators for restoring rates, yet they are also  fully aware that there is not enough funding to serve everyone and future cuts are likely. The Governor has made it very clear that APD must stay within its budget, and he has an obligation to tax payers to balance the Florida budget.  

There are about 50,000 people who need services from The Agency For Persons With Disabilities- just over 30,000 are on the waiver and 19,000 on the waiting list.   Historically, the budget has not been enough to provide services for the 30,000 on the waiver.  Furthermore, many people have been waiting for services for five years or more. 

In this crisis, we have come together and worked towards solutions.  We need to continue to do so.  The absolute worst thing we can do is to panic and start blaming each other.  Let’s face it, the money wasn’t wasted on private jets for our workers or exotic retreats, it was spent on medically necessary services. 

In order to balance the APD budget and also serve everyone on the waiting list, people would need to cut their service utilization nearly in half.  In most cases that is an impossible request.  We can not tell people they can only live in their group homes for 182 days per year.  From this experience we have also learned that provider rates can not be cut by 30-40 percent.  The law requires that agencies pay their employees at least minimum wage, and minimum wage is usually not enough to keep dependable, quality, caring providers. 

The second rule of successful negotiation is to understand the wants and needs of the other party.  

http://www.youtube.com/watch?v=yA7nCI1Q8Kg

(video of meeting in the Governor’s office)

We have a lot of work to do.

__________________________________________

Ever Care Adult Care Services LLC,

Is Ready To Help

  We have beds available immediately and are prepared to help anyone in need during these difficult times. Behavior focused adult male, Standard female and male beds are available. Live near the beach, enjoy great daily activities. Contact – Mary Jo, 727-449-7045 or Email: mhscan@aol.com 

 See our website at http://evercareadultservices.com/

______________________________________
 

Call to Advertise your company & be listed on our websites.
We want people to have a true choice.

SupportCoordinators.Com  –  WaiverProvider.Com

FloridaGroupHome.Com  –  FloridaUnites.com

FloridaAutism.org  –  FloridaGuardianship.com

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