Special Gathering Weblog had stopped logging information about the Tier system because of several reasons.  First, the Advocacy Center has filed a lawsuit against the State thus effectively stopping the State from putting the Tiers into place.  Second, there seems to be a lot of information already available. 


However, several dozen people come everyday to view this blog for information regarding the tier system.  Also, WaiverProvider.com has reported that APD will enact the Tiers this summer in spite of the law suit.  And there will be an additional 7.21 percent reduction effective in July.


 My e-mail was buzzing yesterday regarding the Tiers.  I think there is a wealth of misunderstanding still being circulated among parents, families and providers.  Therefore, I want to share with you the things reinforced to me yesterday from two informed advocates.


 The most important thing is a reminder to all parents of children with disabilities.  It is the goal of APD to put individuals with intellectual disabilities who live at home with their parents in Tier 4.  This is the lowest Tier available. Your services will be capped at about $14,700 a year.  It is my understanding that those on Tier 4 will not be able to use all the services that those on Tier 1-3 will be able to use.  I think they will be limited to:


 Adult Day Training

Behavior Analysis Services

Consumable Items

Durable Environmental Equipment

Inhome Support

Emergency Response System


Support Coordination

Supportive Employment

Supportive Living



 Therefore, they will not even be able to use things like a Companion.  Please understand this means that those who live in group homes can have a companion.  Those people who do not live in a group home cannot have a companion.  Go figure. 


The only services available at this time on FSL which will become Tier 4 are as follows (I have included the cap per service that FSL has on each service–no word yet on whether the caps will carry over to TIER 4 but APD is not denying that it is a possibility; these are pre-December 2007 rates, by the way):


Adult Day Training —————————————- $1,000.00

Behavior Analysis Services (including Behavior Assessment and Behavior Assistant) —————————————-$4,500.00

Consumable Medical Supplies ————————— $800.00

Environmental Accessibility Adaptations ———— $2,000.00

In-home Supports ——————————————- $5,000.00

Personal Emergency Response System ————— $300.00

Respite Care ————————————————- $1,000.00

Support Coordination ————————————– $1,780.68

Supported Employment ———————————— $2,500.00

Supported Living Coaching ——————————- $3,500.00

Transportation ———————————————— $1,000.00


As we think through the implication and do the math, it means that ADT will be available for people living at home one to two days a week if these caps are enforced.  To accommodate these changes in the Waiver, Bridges of Brevard has announced plans to provide ADT services on a more limited basis.  Three or four days a week for most people. 


Transportation through funding with APD will also be extremely limited.


These are not good indications for families who pick up the bulk of the work for their children.  Parents who have sacrificed in unbelievable ways to keep their children at home are again being told that what they’ve done is not enough.  They must do more.


 Yes, everything is still in flux.  It could change for the better. However, this is the most blatant attempt the State has made to rip services from this most vulnerable population.



Week of March 24, 2008

  This week was dominated with the House and Senate budget committees finalizing their separate initial budget recommendations and proposals including budget reductions for 2008 – 2009.  Historic reductions were proposed for all agencies comprising the health and human services budget including the Agency for Health Care Administration, The Agency for Persons with Disabilities, Elder Affairs, Department of Children and Families, Department of Health and Veterans Administration. 

Within the Agency for Health Care Administration, the Medicaid program was substantially reduced including critical services for families and their children.  Among the many Medicaid programs reduced or eliminated, the House proposal released today will prohibit adult dental, optometric services, podiatric services, visual services, and hospice services  from being provided to the general Medicaid population for a two year period.  Substantial reductions were also taken in hospital and nursing home services among many others. 

Both budget proposals provide for varying reductions for the Agency For Persons with Disabilities : 


1. 5% provider Rate Reduction for all providers – total savings of $43,544,549 

2.  A $150,000 cap for Tier One clients – total savings $5,634,451 

3.    An increase of $3,135,802 in additional funding to complete all      needs assessments of consumers in 2008-2009 

4.      A proposed reduction of the Gulf Coast Center by 60 beds during 2008-09 leaving 60 additional consumers to move the following year.

5.      Reduce contracts by $1,691,039 (Discussion of re-bidding PSA contracts)   


1.     3% Rate Reduction for all providers – total savings $23,397,023

2.     Additional funding to restore waiver services on a one time basis and address the APD deficit – total increase $54,515,896

3.     Move due process hearings back to DCF

4.     Freeze cost plans at actual expenditures for the previous fiscal year 

The House and Senate will continue to refine their separate budgets throughout the coming two weeks.  A conference committee will eventually be appointed to work out any differences between the two bills prior to the completion of the Appropriations process and sending a final bill to Governor Crist. 

Additional legislation will be filed this week by the Senate which will modify the consumer cost “Tiers” which were established during the 2007-2008 Legislative Session.  We do not know at this time what will be included within these changes, but will provide that information and continue to monitor the legislation when it is made available. 

In addition to budget proposals, House Bill 333, by Rep Nehr was heard and passed by the Healthcare Council.  This bill will require the APD to prepare plans for review and comment if there is an announced intent to close or reduce census by 20 percent or more at either Tacachale or Sunland Developmental Disabilities Institution.  The bill now moves to the Policy and Budget Council for further consideration. 

We continue to meet with members of the House and Senate, and meet with the other “stakeholders” to coordinate efforts.  We maintain our mission to hold APD consumers harmless from additional reductions, and specifically advocate for support coordination within all discussions. An update of all legislation currently being tracked will be forwarded for this week when it is completed. 

I want to thank Janice Phillips for her personal assistance, and the FASC membership and Board of Directors for continued support from throughout the state.  We will continue to keep you informed as developments occur.

Here is an e-mail I received yesterday regarding Florida’s Legislative Activities regarding MedWaiver and APD budgets. 

 Subject: Legislative Update from Janice and Beth

Update from Janice Phillips and Beth Labasky. We just received word from the capital that there is a proposal to reduce all waiver provider rates by 5% for 0809. This includes Waiver Support Coordinators. Janice and Beth are working non-stop, meeting with members of both houses and attending hearings to monitor the many proposals for APD’s budget problems and the state’s financial crisis. There is still a great deal of negotiating taking place between the different branches of government. We wanted to get this word out to members as quickly as we became aware of this proposal that would significantly impact SC’s and providers statewide. 

Debbie Kahn

Advocates for Opportunity, Inc