Managed care

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

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.


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


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


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


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


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



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


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.


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



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.

(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: 

 See our website at


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

SupportCoordinators.Com  –  WaiverProvider.Com

FloridaGroupHome.Com  –  –

In every negotiation, there are winners and losers.  Perhaps there are other winners yet to be revealed. 

Who wins in Medicaid overhaul? | Top Story | Health News Florida.

Medicaid bill eyes HMO profits

By Jim Saunders
03/14/11 © Health News Florida

As Florida lawmakers get ready to transform Medicaid into a managed-care system, they are split on a complex question: How do you make sure HMOs don’t receive a windfall at the expense of patient care?  For more, see original at Health News Florida


The Networks Self-Advocates traveled to Tallahassee to see the Florida legislators.  Here is several links to some of the articles their visit engendered.  The two people holding the sign are self-advocates from Titusville.




*We are fundamentally opposed to the aspect of Medicaid Reform that entrusts the coordination and care of the developmentally disabled of Florida to Health Maintenance Organizations (HMO’s). The current system of identifying, providing, overseeing, and funding of needed supports and services to the disabled of the state involves thousands of private contract HCBS Medicaid Waiver support and service providers who advocate for the needs of their caseloads and strive to get the needs of the developmentally disabled citizens of the State met. These providers work in concert with the state’s Agency for Persons with

Disabilities (APD) playing a significant role in quality assurance and oversight of the system. Surrendering the entire service system over to contracted HMO’s would eliminate choice, eliminate adequate oversight, and it would create a system nearly impossible for a developmentally disabled citizen and/or their family to navigate. Our reasons for opposing an HMO take over of the support and services system for the developmentally disabled of Florida are:

HMO is Not the Model That Best Serves the Developmentally Disabled Population

*There is something fundamentally different about being developmentally disabled versus any other kind of public assistance recipient — HMO is not geared for them.*

  • · Developmentally disabled (“DD”) recipients had absolutely no choice being born with their conditions and situations. They made no mistakes, errors in judgment and the nature of their assistance is hardly ever temporary.
  • · They will need life long care and support from an established cadre of specialized providers knowledgeable in DD issues. This care involves much more than merely medical concerns.
  • · There are social, self-care and self-advocacy issues that are unique to them. Many are non-verbal and nearly all could not successfully understand and navigate an HMO’s 1-800 number access system nor be able to advocate for their own needs effectively against an HMO’s opposition to funding services. Disabled people are easily intimidated and confused. Frequently they are cared for by highly stressed single caregivers. Yet they are lumped together with non-disabled welfare recipients.
  • · 30,000 people with disabilities and their families including over 2.7 million other voting Floridians will be negatively impacted. HMOs and PPNs are based on a medical model not on the special needs of DD consumers.



The thousands of service providers in the current system are hired and fired by the recipients of services THEMSELVES.

  • · In other words, the disabled of Florida now have the greatest choice in the freest fair-market system anywhere in the country. They have an independent case manager–a Support Coordinator whom they can hire and fire–whose overriding responsibility is to advocate for their preferences, help them identify their needs, and then assist them in navigating many complex service systems.
  • · When a disabled recipient is unhappy with the service provider (Support Coordinator, Respite provider, Companion, etc.), they can immediately terminate them and then be assisted in interviewing and locating a replacement provider that will best meet their needs.
  • · Going to an HMO model would eliminate this choice-based fair-market model. It would require them to rely on an HMO-funded case manager—a case manager WITHIN the HMO itself to push for support and service approvals and navigate the HMO’s complex requirements for these service approvals. In other words the HMO-funded case manager would be tasked with advocating against his own employer on behalf of the disabled person. This represents a debilitating conflict of interest as the HMO’s essential concern is profit and that case manager works for them. HMO’s have no established history of dealing effectively with this inherent conflict.
  • · A developmentally disabled recipient would essentially go from a model offering thousands of providers to a small handful. Opting for an HMO take-over of services for the developmentally disabled of Florida removes choice for these citizens and needlessly eliminates the highly specialized providers that these disabled individuals have known for years, come to trust, and who have developed an accurate and effective understanding of them and their needs. *This is a process that takes years with this population and equates in many cases to their avoiding institutionalization. Eliminating the independent provider system in favor of approximately 4 HMO’s carving up the state eliminates the current independent advocate provider system. This represents removing independent third party advocacy for the most vulnerable, poor and disabled population of the state.

Fiscal Responsibility:

It is understood that the state is in difficult financial times and that spending must be reduced.

  • · The developmentally disabled of Florida and their caregivers as well as the provider system that works for them understand the need for a sustainable system. The current Agency for Persons with Disabilities

(APD) and HCBS Medicaid Waiver systems afford the state an effective infrastructure to enforce accountability and compress funding when times are tough.

  • · Rather than paying HMO’s a fully-funded contract UP FRONT for five years, the current system allows the state to enact reductions at any time until the economic situation improves. Simply put, the current system allows the Florida state government real, dynamic flexibility. (*You can tear pages out of the

Waiver Services Handbook but keep the book so that when you can you add those pages BACK IN.)

  • · The current ‘Tier system’ places recipients into capped budgets. This is a ready infrastructure that allows you to decrease budgets for individuals receiving services when you have no other choice because of the economic situation. And again, when the budget improves, you can increase the Tier budgets for recipients.
  • · Once in a contract with an HMO you are stuck with that system for 5 years, regardless of how well or poorly the HMO performs. Historical data throughout the history of HMO’s in this country shows it is extremely difficult and costly to recoup funding from them when improprieties are discovered.


This entry comes from the Department of Justice website

Department of Justice

Office of Public Affairs
Thursday, June 24, 2010
Judge Orders State of Florida to Provide Community Services to Jacksonville Woman at Risk of Institutionalization

WASHINGTON – The state of Florida must provide Michele Haddad with services that will enable her to remain in her home, a U.S. District Court in Jacksonville, Fla., ruled Wednesday. Haddad, who has quadriplegia as a result of a motorcycle accident with a drunk driver in 2007, has successfully resided in the community since the accident, but is at risk of entry into a nursing home due to changes in her caregiver situation. Haddad, who has been on the waiting list for Medicaid community-based waiver services for two years, notified the state of her increased need for services, but was told that community services would only be available if she was willing to enter a nursing home for 60 days.

The court ordered the state to provide community-based services as required by the Americans with Disabilities Act’s (ADA) integration mandate as set forth in Olmstead v. L.C. The United States argued in a brief filed on May 25, 2010, that Haddad would suffer irreparable harm if forced to enter a nursing home to receive necessary services.

The court issued this order in the week that marks the 11th anniversary of the landmark Olmstead decision.

“In the Olmstead case, the court recognized that the unnecessary segregation of individuals with disabilities stigmatizes those individuals as unworthy of participation in community life,” said Thomas E. Perez, Assistant Attorney General for the Civil Rights Division. “By supporting Ms. Haddad in this case, we seek to ensure that individuals with disabilities can receive services in the most integrated setting appropriate, where they can participate in their communities, interact with individuals who do not have disabilities, and make their own day to day choices.”

The U.S. government’s participation in this case is part of the administration’s efforts across the nation to affirm the fundamental right for Americans with disabilities to live independently, in what the president has deemed “The Year of Community Living.”

The full and fair enforcement of the ADA and its mandate to integrate individuals with disabilities is a major priority of the Civil Rights Division. The ADA protects individuals with disabilities from discrimination by public entities. People interested in finding out more about the ADA can call the Justice Department’s toll-free ADA Information Line at 1-800-514-0301 or 1-800-514-0383 (TTY), or access its ADA website at

Civil Rights Division

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Here is a question received from one teacher of mentally challenged persons and it is answered by another teacher.  Thought you might like to easedrop in on the conversation.

I have a question about people with mental disabilities and learning. Would you call people with mental disabilities literate learners or oral learners or both?

Do you use lessons and teachings that are basically simplfied language, lesson handouts and take home papers that they can read and think about and discuss? Or do you use basically oral communication? I am reading that information must come to oral learners through stories, drama, song, and other similar formats.

Do you have any reference material in this area? Do you use simple versions of the Bible for those who can read or do you use a Dramatized version of the Bible they can hear being read? We are working on a one year Christian Education curriculum for people with low functioning mental disabilities. We have simplified the language to their basic level of understanding. How would you create a curriculum for oral learners?

ANSWER:  I think of there being three types of learners:

1. Auditory (what I think you are calling Oral)

2. Visual

3. Kinesthetic

These are the pathways into the brain (ears, eyes and touch). You see this play itself out in the way people spell. If you ask some people how to spell a word they sound it out (Auditory). My wife will tell me how to spell a word then want to come look at it (Visual). Yet others will need to write it themselves (Kinesthetic).

So for auditory learners hearing the Bible read is fine, but a dramatized reading of a Bible story even better. For visual learners, seeing a video of the Bible story helps. For a kinesthetic learner acting out the Bible story is helpful.

Question, if someone is a visual learner does acting out the story help? In acting out the story they cannot SEE the whole and do they miss the forest for the trees (so to speak)? I think in developing a lesson every lesson needs to address each type of learner.

The literate learner I think is what I would call a concrete learner (do not really know the term literate learner). I think this is a totally different discussion. Before the discussion is about pathways into the brain and now we are talking about the ability of the brain to process information.

I do think mentally challenged persons are concrete learners and we have to be careful to teach that way. I think it is a major problem in what I often see people do in teaching mentally challenged persons. I was at a camp last year for mentally challenged folks. They had a speaker who spoke on how God sees us. The speaker had a lot of different types of glasses. Most of them were funny goofy glasses. He was very funny. People had a good time. But I do not think they had a clue about the point he was trying to make. It was too abstract.

At Special Gathering, we use the term symbolic object lessons vs concrete object lessons. If the object we are using in an object lesson represent something else we do not use that object lesson. An object has to be what it is.

As an example – I use to have a set of chemistry tubes that I used in my sermons. I would talk about sin entering the world and pour one tube into a second tube turning the second tube black. Then I had a third tube that was red. I would talk about how Jesus came into the world and died to take away our sin. I would pour the third tube into the second tube. As the red liquid hit the black liquid it turned clear. It was really cool, but I do not think it helped anyone (but the volunteers) understand anything. It was too abstract. You have to cognitively connect one tube to Satan, one tube to people and yet a third tube to Jesus. Not only does that not help the learning process I think it harms the learning process. Just my two cents worth.

Bethesda group homes has written this letter regarding the situation we face with Medicaid.  You will find it important.
Medicaid .

Most individuals with developmental disabilities receive funding through the Medicaid program. Medicaid was established in 1965 through Title XIX of the Social Security Act in order to provide health coverage for low-income children and adults, as well as medical and long-term care coverage for people with disabilities and low-income senior citizens. It currently funds 78 percent of total developmental disability services expenditures nationwide.
The federal government and the states jointly fund the Medicaid program. Each state administers the program under broad eligibility, quality and funding guidelines established by the Centers for Medicaid and Medicare Services (CMS). CMS matches state Medicaid expenditures through Federal Medical Assistance Percentages (FMAP). The FMAP varies by state and is attached to per capita personal income in each state.

Current rates vary from 50 percent to 77 percent, meaning the federal government contributes between $1.00 and $3.17 for every dollar a state spends on Medicaid programs.

Because Medicaid is the nation’s healthcare safety net, its costs grow rapidly during economic downturns. Recent studies indicate that a one percent increase in the national unemployment rate results in an increase in Medicaid costs of $3.4 billion due to an increased number of people who have become eligible for Medicaid. That same one percent unemployment rate increase results in a four percent decrease in state general fund revenues that subsidize the system. Adding to the crisis is the pending retirement of baby boomers. Federal Medicaid funding is expected to be about $216 billion in fiscal year 2009 or about seven percent of federal spending. By 2013, the costs are expected to increase to $287 billion or 8.4 percent of the federal budget.
The increase in costs and decrease in revenues have caused the federal government and some states, including many in which Bethesda operates, to look at drastic methods to balance state budgets. The current administration is proposing more than $17 billion in Medicaid cuts over the next five years, including $10.1 billion in FMAP reductions that will shift these costs onto states that are already ill equipped to absorb the added costs.

States are now in crisis mode. Gov. Pat Quinn of Illinois recently threatened social services providers with a 50 percent rate cut. In California, the state faces a $26 billion budget deficit and has already cut state Medicaid spending by $1.31 billion. Michigan addressed a $1.7 billion deficit by cutting rates to physicians who support Bethesda clients. Medicaid rate cuts are being threatened in virtually every state

in which Bethesda provides supports.  And with the looming influx of retirees, the situation promises to become even more dire. The Medicaid system is in crisis with no easy fixes on the immediate horizon. To address these important government-funding issues, Bethesda has launched the grassroots advocacy initiative, Bethesda Voices, which aims to unite like-minded supporters in an effort to protect the much needed funding for agencies like Bethesda.







Of course, everyone is all for removing people from institutionalized settings.  In the state of Florida I don’t believe there are thousands of people in institutions, unless you are talking about group homes–which are now homes with a maximum of six people living together with staffing.  Pretty sure this would not qualify as an institution.

Is the only alternative is putting mentally challenged persons into an apartment by themselves, where they are isolated and lonely, with minimal staffing, in the worst sections of town?   Then, yes, I believe–from the horror stories I’ve seen first-hand–this is irresponsible social work.

As an alternative, senior citizens have found that living independently when you are weak and vulnerable is a recipe for disaster, even if it is much more cost effective for the State. That is why we now have communities for senior citizens.

Shouldn’t we copy something that is proven to work, rather than doing social experiments on our most vulnerable population? I’m not sure that it wouldn’t be just as cost effective as living independently. People would be able to choose whether they would live there or not and full-time oversight could be provided by pooling State resources.

Many families are beginning to feel that this paridiam would be a win-win for everyone.  What do you think?

This is an e-mail I received regarding the Johnson resignation.  This person has held a statewide position in advocacy.  I didn’t get permission from this person because I felt s/he may want to remain unknown.

May 2, 2008, 1:19 pm

Today, Jane Johnson resigned her position as Director of the Agency for Persons
with Disabilities (APD). Ms. Johnson submitted her resignation this morning and
it is reported she will remain in the position through the end of the month.
The Agency has been plagued with budget deficits and problems implementing
legislation limiting disabled consumers to tiers. Many of the problems existed
prior to her taking over as director. The issues were compounded when the
Legislature once again cut funding for the vulnerable population APD serves.
This session, funds were cut by over $120 million, on top of July’s special
session cuts, leaving a nearly impossible task for any successor.

This leaves the Agency in a very precarious position as Senate lawmakers try to
pass legislation to do away with the APD and move the responsibility and budget
over to AHCA, or the Agency for Health Care Administration. Thus far, the
legislation has failed.

There has also been an attempt by managed care proponents to allocate the APD
budget to HMO’s to administer the program. This effort continued until this last
week of session and is being promoted to legislators by a former senate staffer,
now employed by the managed care industry.

The developmentally disabled and providers of services to the disabled, who will experience the agony of the budget cuts, are encouraging Ms. Johnson to leave a powerful message to legislators and the Governor, who failed to rescue the many vulnerable people who will be put in harm’s way as a result of the extraordinarily deep cuts.

We received an e-mail yesterday late in the evening regarding changes The Centers for Medicaid and Medicare Services (CMS) is proposing in regard to State Medicaid agencies.  While I am a neophyte, CMS appears to be the federal agency that manages funding allocations which are appropriated to the states.  CMS has proposed what would be equivalent to private insurance plans. 

Perhaps most important, CMS proposes 11 exemptions to needy populations that would probably cover most of our rider clientele.  Mike LaVoie, who has worked in the system for more than 30 years, writes, “In case, you missed this buried in some of the documents from Agency for Persons with Disabilities, pay particular attention to CMS recommendations cited in the email- from Department of Transportation to eliminate the requirement for Medicaid to provide transportation to and from Medicaid Services.  Needless to say, this could be devastating to the provision to transport to access Adult Day Training and Supported Employment services. “

LaVoie continues, “CMS suggestions that this could take years may be misleading as we all know, CMS has approved equally impactful decisions faster than that lately”

Lsia Bacot suggests that interested parties should comment by clicking onto this link:  http://www/

The comments should were due Monday, March 26, 2008 which is the day before this posting.  Everyone apologized about the short turnaround.  However, this was an important decision that was made public much too late for most people to react.

Here are a couple of the emails that were sent yesterday:

From: Mike

Sent: Monday, March 24, 2008 2:23 PM

Subject:FW: CMS Proposed Rule- Important

 Hey folks,In case you missed this buried in some of the documents from APD.Pay particular attention to CMS recommendations cited in the email from Dept of Transportation,to eliminate the requirement for Medicaid to provide transportation to and from Medicaid Services.Needless to say, this could be devastating to the provision of transport to access ADT and Supported Employment services.Suggestions that this could take years may be misleading as we all know CMS has appoved equally impactful decisions faster than that lately.Mike 

From: Johnson, Karen E.

Sent: Monday, March 24, 2008 9:06 AM

Subject:FW: CMS Proposed Rule- Important


—–Original Message—–
From: Mack, Heather@Career & Technical Education

Sent: Monday, March 24, 2008 8:58 AM

To: Johnson, Karen E.

Subject:FW: CMS Proposed Rule- Important

  Although many of us get these from Paula, I think there are many on our ICB list that do not.  Please forgive if this is redundant for you. HeatherHeather Mack, Special Populations
Career and Technical Education
2700 Judge Fran Jamieson Way
Viera, Florida  32940
321-633-1000 ext. 379

From:Davis, Paula []
Sent: Monday, March 24, 2008 7:46 AM;;;;;;;;;;;;;;; Davis, Lacie;;;;;;;;;;;;;;;;;;;;;;;;;; Lewis, Eva@Exceptional Education;;; Lowe, Kathy; Mack, Heather@Career & Technical Education;;;;;;;;;;;;;;;;;;;;;;; Tolson, Sharon@Viera;;;;;;; Wickham, Cindy@Viera;; Davis, Paula; Becker, Brenda J; Becker, Jason L; Breslin, Brian R; Bryant, Stephanie L; Dettra, Samuel R; Ford, Suzanne; Golden, Ian J; Hansen, Christine; Harris, Tammy J; Herriott, Carl J; Holt, Leigh R; Howell, Cheryl; Ingalls, Joyce L; Joiner, Chenita M; Langan, Judy; Parks-Martin, Donna; Mcdonald, Michael E; Mcguffie, Glenn A;; Parks-Martin, Donna; Reich, Rosa M; Singleton, Lesley D; Spiller, Laverta; Urban, Sandra; Williams, Gay N; Wright, Pam

Subject:FW: CMS Proposed Rule- Important

 FYI – regards M-NET 

PaulaPaula C. DavisHuman Services Planner IIBrevard County Housing and Human Services2725 Judge Fran Jamieson Way, Suite B103Viera, Florida  32940 
Disclaimer: “This e-mail is for information purposes only and does not necessarily reflect the views of the Brevard County Board of County Commissioners nor Brevard County Housing and the Human Services Department.”

From:Bacot, Lisa M. []
Sent: Thursday, March 20, 2008 4:25 PM
To:CO-CTD Staff
Subject:CMS Proposed Rule- Important
Importance: High

 TO:  Entire TD Distribution List 

The Centers for Medicaid and Medicare Services (CMS) has issued a proposed rule relating to allowing State Medicaid agencies the opportunity to create benchmark packages that would be equivalent to private insurance plans.  We appreciate that CMS is looking outside the box, however, one of the proposed plans in this rule is to allow Medicaid agencies the opportunity to “relieve States of the responsibility to assure transportation to and from providers.”  Before a state could act on this (if it becomes final rule), the state plan would have to be adjusted, so it would be a year or two down the road.  In addition,  CMS proposes 11 exemptions to needy populations that would probably cover most of our rider clientele.   Regardless, it does have the potential of making very significant changes to Medicaid Transportation services to certain clients. If you do want to comment, please click on this link:  You can then enter your contact information in and either type in your comments or revise the attached sample letter and upload it into the system.  Comments are due Monday, March 24, 2008.  I apologize for the short turnaround.  I do not have a copy of CTAA’s response, but when I get it, I will send it to you. Thank you.  Lisa M. BacotExecutive DirectorFlorida Commission for the Transportation Disadvantaged605Suwannee Street, MS 49Tallahassee, FL 32399-0450lisa.bacot@dot.state.fl.usDirect Line (850) 410-5711Toll Free (800) 983-2435TTY (850) 410-5708Florida Relay System Dial 711 (Florida Only)FAX (850)  

I received this email and thought it was worth passing on.  Agency for Persons with Disabilities in Florida does not want managed care.  I’m not sure what would be best for our members.  Do you have any comments?  

Governor Charlie Crist’s Fiscal Year 2008-09 Budget RecommendationsGovernor Charlie Crist’s Fiscal Year 2008-09 Budget Recommendations were released on Thursday.In the proposed budget, services for individuals with developmental disabilities provided by the Agency for Persons with Disabilities (APD) and the Bureau for Exceptional Student Education Services are not slated for further reductions or eliminations at this time.You can examine the Governor’s complete budget by clicking here.The Governor’s office based its budget on the October 2007 estimating conference. Since October, however, Amy Baker, head of the Office of Economic and Demographic Research, has recommended that between $400- $600-million more dollars be cut from the budget, in order to better reflect the state’s continuing decline in revenues. In addition, various financial experts have warned that by the time the 2008 legislative session is over, the Florida Legislature will need to cut almost $1-billion more dollars in order to balance the state’s budget.With this information in mind, the Legislature will be studying suggestions to further reduce the costs and administration associated with serving people with developmental disabilities. Some members of the Senate, in particular, have publicly suggested that major changes need to be made to the Agency for Persons with Disabilities administratively and with regard to the prioritization of how people are served off the waiting list. As this Alert is being written, proposals for managed care solutions to controlling costs are being seriously considered.So, what can you do?The Florida Developmental Disabilities Council, Inc. strongly opposes managed care “solutions” for the implementation of Developmental Disability Home and Community Based Waiver Services and proposes expanding the Consumer Directed Care Program designed to allow consumers and families the ability to choose their services and providers, while having to live within their budgets.Please contact the members of the Senate Health and Human Services Appropriations Committee and the members of the House Healthcare Council and voice your opposition to managed care “solutions” that will take dollars away from needed services and put them in the pockets of large and impersonal managed care corporations.Share Your StoriesThe Council wants to hear from those among you willing to share your stories with the media about the importance of these services in your life and also how last session’s service reductions and eliminations have adversely affected your life and the lives of those you love.Please email Ms. Vanda Bowman at or call Ms. Bowman, toll-free, at 800-580-7801 with details and current contact information. Your information will not be released without your permission.