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.

 This is an e-mail I received explaining your right to appeal your Tier Placement.  It also gives your great information regarding how and why to start the process.  As always when I cut and paste, I never know what the format will turn out to be but the information is what is needed more than a pretty entry.  Thanks for your patience.

Advocacy Center for Persons with Disabilities, Inc.
 Your Rights Regarding The Implementation Of The

APD Tier System: Challenging Tier Placements

In 2007, the Florida Legislature amended section 393.0661, Florida Statutes, to implement a four-tiered waiver system to serve clients with developmental disabilities in the DD and Family and Supported Living Waivers. APD published a set of proposed rules to implement the tiers and held a public hearing on April 24, 2008. Four waiver recipients, Southern Legal Counsel and the Advocacy Center for Persons with Disabilities, Inc., filed a challenge to the proposed rules: 

 

BACKGROUND

 

Moreland vs. APD, DOAH case number 08-2199RP. The hearing on the proposed rule challenge was held on June 24 and 25.

CONCLUSION OF THE CHALLENGE TO THE PROPOSED RULES

On August 6, 2008, the Administrative Law Judge issued the Final Order in the case finding the proposed rules valid. APD may now finalize and implement the proposed rules.

WHAT YOU SHOULD DO NOW

APD will send out individual notices informing you of your tier assignment. In the notice, APD will include information about your rights to challenge the tier assignment and about working with your support coordinator to choose the services that are most important to you to stay within the limits of your tier assignment. At the time that you receive your notice, if the tier assignment significantly affects the services you are receiving you may challenge the assignment.

If you challenge the tier assignments, services cannot be reduced until the hearing process is concluded.

APD has posted information on its website, http://apd.myflorida.com concerning the procedures they will use to implement the tier system.

YOUR RIGHTS

TO CHALLENGE YOUR TIER ASSIGNMENT BY REQUESTING AN ADMINISTRATIVE HEARING; and

TO HAVE YOUR SERVICES CONTINUE IF YOU REQUEST AN ADMINISTRATIVE HEARING WITHIN 10 DAYS.

2

DECISION TO CHALLENGE TIER ASSIGNMENTS

Some things you should consider in making the decision whether to challenge the tier assignment are:

You may challenge

the tier placement  on the basis that it does not meet your needs. You will have to show that you qualify for another tier.

 

If your tier assignment does not make a significant difference in the services you are receiving, challenging the tier assignments may not be indicated and/or successful.

 

DECISION TO CHALLENGE TIER ASSIGNMENTS

Some things you should consider in making the decision whether to challenge the tier assignment are:

You may challenge

the tier placement  on the basis that it does not meet your needs. You will have to show that you qualify for another tier.

 

 

 

 

If your tier assignment does not make a significant difference in the services you are receiving, challenging the tier assignments may not be indicated and/or successful.

 

When and if you receive a Notice of Tier Assignment, you have the right:  

 

 

Some things you should consider in making the decision whether to challenge the tier assignment are:

You may challenge the tier placement  on the basis that it does not meet your needs. You will have to show that you qualify for another tier.

If your tier assignment does not make a significant difference in the services you are receiving, challenging the tier assignments may not be indicated and/or successful.

 

If you are the parent of a minor child living at home, your services should not change and should continue under state plan Medicaid. Personal Care Assistance services for minors will continue as a Medicaid state plan service. You may want to proceed to challenge the tier assignment only if there are waiver specific services that exceed the tier limitations. APD has indicated that it will review the petitions to determine initially whether it had made a mistake on the assignment prior to forwarding the petition to the Division of Administrative Hearings.

 

WHERE TO GET HELP

The Advocacy Center for Persons with Disabilities, Inc., http://www.advocacycenter.org has instructions available to assist you regarding filing a petition and the hearing process. It is in the form of a manual and is entitled “When They Don’t Play Fair, Level the Playing Field.”

Three Rivers Legal Services, http://www.trls.org.

Southern Legal Counsel, 352-271-8890

Florida Legal Services, http://www.floridalegal.org/

Jacksonville Area Legal Aid, 904-356-8371

Advocacy Center, CARES team, 850-488-9071, 1-800-342-0823