support coordination


Thanks to guest columnist and Executive Director of Special Gathering, Richard Stimson for this article

Many people within the mentally challenged community are receiving phone calls about the iBudgets.  This is a new thing from the Agency for Persons with Disabilities (APD).

One of the major differences is that APD may ask you to give up some money.  Perhaps they want you to give up $3,000 from your home-care services for which they will pay.  Under the iBudget, you can say back to them, “What about $1,000?  What if you give me $1,000, instead of $3,000?”  Then you must wait to see what APD says.

APD calls this a negotiation.  You will still be able to appeal; but APD is hoping they can find an amount you can agree to give up through these negotiation.  If you ask for an appeal, it will mean that you might win your appeal and you will get everything for which you have asked.  However, if you lose, then you will get nothing.

I have been to two of these negotiations.  These meetings feel like buying a car.  When you want to purchase a car, once you get a price from the sales person, you can ask for a lower price.  Then the sales person has to go and get their boss to sign off on the amount.

I really do not have any good advice.  If you just say, “No,” to the cuts and decide to appeal them it is all or nothing.  You may want to negotiate with APD and try to get something rather than chance getting nothing.

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This is a comment to the entry, APD Changes.  This gives some clarification and slightly different point of view.  Thanks for your comment.

I have received this email as published at APD Changes also. I would also look at the descriptors. Your support coordinator can give you a copy.

I do know that the agency that operates the group home where my brother lives has had clients Res Hab reviewed. (This includes minimal level clients which means the possibility of clients being bumped down to basic level.) The email you posted did not have that rate for basic level but I think it is someting like 1,100 dollars.

I have heard that it is APD’s view that the organization APD had contracted with to approve services (and the level of those services) had been approving services incorrectly. APD no longer contracts with that agency and is approving services on there own (I think).

It appears from the email you posted that group home clients are being warned to review their support plans to make sure the support plan justifies the level of Res Hab. There appears to be an assumption that there is a problem with the way support plans are written.

I do not understand the line, “but the judge will only be looking at what was actually submitted. You will not be allowed to give the judge more documentation during your hearing”

If the problem is a support plan that was written incorrectly by a support coordinator and wrongly approved, why can’t a client inter new information that shows they need the service? It does make you wonder about the recent requirement on insurance (a long standing requirement that was never inforced). Will support coordinators become responcible for the loss services because of poorly written support plans?

One other thing. I wonder why the email you posted (unless I missed it) does not include supervision of self administration of medication under minimal Res Hab (the copy of the descriptors I have list that). In that every group home I know of administers the medication I would think this requirement would be met.

On Friday, June 3, 2011, there was a web meeting that District 7 Support Coordinators had with Tallahassee Agency for Persons with Disabilities (APD).  This meeting may have included Support Coordinators from around the state.  However, we have not knowledge of that.  Below is a statement that a support coordinator sent to Richard Stimson, Special Gathering Executive Director, about the meeting.

Hey, call me if you have time tomorrow.  The Host home issue is going to be BIG!  They (APD) talked about it in the web training on Friday. Anything to save a buck.  If people are not looking appropriate for Res Hab (residential habilitation) or NOT making progress, they are heading to the host home just like the good ole days of HRS (Health and Rehabilitative Services).  Hate to say it; but I think you were right.

You need to check this out with Support Coordinators you know, but it appears that the state is going to try to move clients that do not want to live in supportive living or who are unable to live in supportive living into host homes (foster homes).

While host or foster homes are not proposed in other states, Florida, like California, is known as a pace-setter across the nation.  This is a move backwards for people who are mentally challenged.  Having served on the Local Advocacy Council for several years, I learned that there is little or no oversight in this type of home.

As a ministry within the mentally challenged community, it is important that we be people of prayer for our members.

Good news for the mentally challenged community in Florida.  Thanks to the self-advocates who lobbied long and hard to make this happen!
It appears APD folks were left out of Medicaid reform!

This is from the

http://weblogs.sun-sentinel.com/news/politics/dcblog/2011/05/last_day_of_session_will_mean.html
The one group that is excluded from managed care is Medicaid recipients who are developmentally disabled, roughly 30,000 people. Developmental disabilities advocates lobbied lawmakers for months to exclude them from that plan and let them use the “iBudget,” an individualized spending plan that is capped. The House plan had originally looped them into the managed care plan, but the Senate insisted that they be allowed to use the iBudget.

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

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.

Linda Howard’s note:  This is from an email I received this morning.  The first part of the entry contains comments  from Richard Stimson regarding the article.  I quoted the entire article but I also referenced it.  Go to the original article  to input your comments with the Miami Herald.

You know, it is like a horror movie, every time you think things have gotten as bad as they can, it gets worst.  This is the Miami Herald and they sound like they are supporting Governor Scott.

First statement in RED by Kingsley Ross – Is this saying agencies will stop providing services?  I got an email from another FARF person that said something similar.  It basically said at these rates services could not be provided in a safe way.

First statement in GREEN by Brian Burgess – Is this saying that these cuts are this bad because of what happen in the past?  I think so.  Also from reading the article it appears they blame all of the appeals too (see second part in GREEN).  I also find the word use of “neediest” interesting.  I do not think they are talking financially because all waiver clients are on Medicaid.  I think they are talking about a new way to prioritize who gets services.  What would that look like?  Folks in Group Homes?  What happens to those in supportive living?

First statement in PURPLE by Miami Herald – Makes it sound like Scott had no other choice.  He had to do this.  I would take this to mean that the paper thinks Scott is within his authority to do this as an Emergency Rule!

Linda Howard note:  This is an article is from the Miami Herald.  Here is the web address.  Go there to input your comments regarding this latest action:

 http://www.miamiherald.com/2011/03/30/2142265_gov-scott-to-call-for-deep-cuts.html#storylink=addthis

AGENCY FOR PERSONS WITH DISABILITIES

Gov. Scott to call for deep cuts at agency for disabled

A $170 million deficit in the agency that serves the most needy in Florida has left Gov. Rick Scott with a tough call.

By Marc Caputo

TALLAHASSEE — Due to a shockingly large deficit, Gov. Rick Scott is planning to invoke his emergency powers and make deep cuts to the rates charged by group homes and case workers who help the developmentally disabled.

Scott could announce a 15 percent rate cut as early as Thursday to close the $170 million budget gap in the Agency for Persons with Disabilities, according to lawmakers who were briefed Wednesday.

The deficit — which exceeds the agency’s spending authority by nearly 20 percent — is partly the legacy of lawsuits, poor planning by the Legislature and a nearly $20 million veto by Scott’s predecessor, Charlie Crist, who starved the program of savings when he refused to trim provider rates last summer.

SYSTEM SHUTDOWN

Those who provide services to the nearly 30,000 Floridians with cerebral palsy, autism and Down Syndrome said they aren’t concerned with the origin of the deficit as much as the effect of deep rate cuts.

“This would be a catastrophe,” said Kingsley Ross, an advocate and lobbyist for Sunrise Community, a Miami-based group home operator.

For the past three years, Ross said, providers have shouldered rate cuts. They’re now operating on the thinnest of margins.

“The system can’t take this,” Ross said. “Eventually, we will have to cut jobs and reduce services.”

Scott’s spokesman, Brian Burgess, said the governor doesn’t want to harm the developmentally disabled. However, he said the state has put off tough choices for too long and the bill is due.

Burgess said paring the budget now will put the state in a better position to pay future expenses on the neediest. “Yes it’s painful,” Burgess said. “But we’re trying to alleviate the pain long term.”

Florida has a constitutional requirement for a balanced budget, but federally created Medicaid-related entitlement programs can go into deficit from time to time if the number of recipients increases or costs for needed services rise.

The Legislature estimated that next year the entire state budget will have a $3.75 billion shortfall. So lawmakers are trimming programs.

Troubled by the deficit in the Agency for Persons with Disabilities, Scott ordered an inquiry. The results of the investigation are scheduled to be released Thursday.

RECIPE FOR DISASTER

The Legislature tried to cut the program for the developmentally disabled last year, but Gov. Crist refused. He vetoed a 2.5 percent provider rate reduction.

Meantime, lawmakers didn’t budget enough money for the program to account for the fact that thousands of recipients had sued to block a system of service reductions and cuts to the program.

When times were flush five years ago, legislators expanded the rolls of the Medicaid program by about 5,000 — a move that brought cheers from advocates for the disabled. They had fretted that about 15,000 developmentally-disabled people were on a waiting list but unable to receive services.

But the waiting list has only grown. Medical costs have increased. But state tax collections plummeted and then flat-lined.

Add all those factors together, and the deficit in the $850 million program for the developmentally disabled is about $170 million, according to the Florida House’s proposed budget. The budget proposes to fix this year’s deficit by shifting money from special accounts. But the Senate offers no such solution, leaving Gov. Scott few choices. Neither he nor his fellow Republicans want to raise taxes to fill the deficit.

Scott’s proposal to reduce rates by 15 percent should save about $34 million. The rest of the deficit would be plugged by shifting agency money and reducing the rates of South Florida providers who get slightly higher reimbursements.

Sen. Joe Negron, a Stuart Republican who chairs the Senate’s health budget committee, and Rep. Matt Hudson, chairman of the House health budget committee, said they were briefed on the plan and support Scott.

 To record your input with the Miami Herald, please go to:  http://www.miamiherald.com/2011/03/30/2142265_gov-scott-to-call-for-deep-cuts.html#storylink=addthis

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