Archive for APD Waiver

Florida – APD Announces A Schedule of Cuts

From Aaron Nangle of

October 19, 2011

Director Mike Hansen presented an update on the agency’s cost-containment efforts today to the House of Representatives Health Care Appropriations Subcommittee.

The Legislature approved $810 million for APD’s Medicaid waiver for the 2011-12 state fiscal year that began on July 1. APD customers received $930 million worth of services last year.

The agency has been working to bring its waiver expenditures within the Legislative appropriation this fiscal year. The agency is also looking for opportunities to increase waiver flexibility and equity for customers, while continuing to protect their health and safety.

Earlier this month, APD shared five cost containment
initiatives with various legislative committees that would reduce APD’s waiver obligations. The director was asked to bring back a proposed timeline for implementing the changes.

The timeframes may be contingent on developing new rules or federal approval from the Centers for Medicare and Medicaid Services (CMS).

At today’s meeting, Hansen announced plans to standardize payment rates for intensive behavior residential habilitation beginning January 1, 2012. Also on that same date, the agency will begin collecting fees from APD customers who have income to offset some of their costs of living in a group home.

APD plans to reduce the rates it pays for therapy assessments and all nursing services to the standard rate paid by the Medicaid State Plan beginning April 1, 2012.  Currently, the APD Medicaid waiver pays higher rates for most of these services.

Also on the same date, APD will reduce the difference it pays between solo providers and agencies for waiver services to no more than 20 percent. Currently, those rates may differ up to 43 percent.

There was no timeline announced today for implementing cost sharing for parents who have children on the Medicaid waiver. APD is working with the Agency for Health Care Administration on this issue.

The change to the waiver requires federal approval.

After pursuing these cost-containment initiatives to APD’s Medicaid waiver, the agency expects to realize more than $14 million in reduced expenditures on an annual basis. 


Keep raising your voices and squeaking your wheels.  We can not let those who are them most vulnerable suffer from these cuts.

Disability Rights of Florida Sues State Ove Med Waiver Wait List

This is the text of a letter from Philip Pearson, Vice Chairperson, FCC12

Families waiting for the Medicaid Waiver, You may or may not know this, but Disability Rights of Florida (previously known as the advocacy center) has filed a lawsuit against the state of Florida on behalf of families on the waiting list for Medicaid Waiver services. Although there are named plaintiffs, we are all included, as this is a class action lawsuit. You do not need to sign up to be a part of the class.

While at a recent Family Care Council Florida meeting, the Disability Rights Senior Attorney, Amanda Heystek, talked about the need to have families contact Disability Rights Florida to provide contact information. We, FCC representatives suggested that we could send a letter to wait list families to ask them to do this. Here are Amanda’s words:

Disability Rights Florida is engaged in a lawsuit regarding the waitlist for home and community based services through the Developmental Disabilities Waiver. Disability Rights Florida would like to hear directly from those on the waitlist. Please fill out the survey on the link provided.
You can fax, mail or email your survey to Disability Rights Florida. By filling out the survey you are only agreeing to be contacted by our staff for further inquiry as to your needs and purpose for registering on the waitlist.
If you have computer and web access, please go fill out the questionnaire.

Download the short survey, fill it out and send it in to
Amanda Heystek
Disability Rights Florida
2728 Centerview Drive, Suite 102
Tallahassee, Florida 32301
If you don’t have access, please contact disability rights directly to provide them your information. If you would like more information about the lawsuit, please contact:
Sylvia W. Smith, Director of Legislative and Public Affairs
850-488-9071 ext 9725


We need to end the wait list and get our citizens with disabilities services.

Keep squeaking those wheels.

Share The Blessing for The Disabled

Disabled Left Behind in Florida

Guest blog by Mike Coonan, President Left Behind in the USA   

In Florida, 21,000 people (mostly children) with a developmental disability, such as mental retardation, autism, cerebral palsy and related conditions are living at home and are waiting for the Medicaid Waiver services.  They have been on the waiting list for the last eight years. Across America, more than 370,000 people (mostly children) with the same conditions are also lingering on similar waiting lists. We are told by our state elected officials that there is no end in sight for ending the Medicaid Waiver waiting lists.

At the same time, many families receiving Medicaid waiver services tell us that they are willing to share these precious resources.  Those of us on the waiting list are thankful for their thoughtful consideration of our plight. Their gracious words of support have encouraged us to work towards a more equitable situation.

To that end, Left Behind in the USA is proposing that the Developmental Disability Community review policy and organizational barriers preventing Medicaid Waiver services and supports from being shared with families in need.  Left Behind in the USA is now on a quest to learn more about the following:


  • How the Medicaid Waiver rules can be restructured to allow for the voluntary sharing of support services from families getting services to families on the waiting lists.          For example, if a family is receiving $14,000 worth of Medicaid Waiver services, how            can they share         10% of these services to help someone on the waiting list?
  • When the Medicaid Waiver program is restructured to allow for sharing, how do families who are willing to share with those in the greatest need get connected?
  • How can we implement this program with virtually no costs?
  • Who is willing to help families on the Medicaid Waiver waiting lists obtain more help in Sharing the Blessings?
  • Assure that families who may choose to share services do not suffer a reduction in their service level as a result of their generosity.

Our expectation is that the Sharing the Blessings program will benefit thousands of families who are presently not receiving any help.  In addition, we firmly believe our program will shine a little light of hope in a bleak world for the families lingering on waiting lists.

Keep squeaking your wheels – One day they will listen to us.

Yet More Cuts and Reductions to the APD Budget In Florida

Our friend Aaron Nangle of has provided information on the Draft Plan for APD’s HCBS Waiver – Home and Community Based Services Waiver Expenditure Reductions.

These will impact all persons with disabilities in Florida.

Publish Standardized IB Rates for future with lower rates retained, expected savings $1,549,764 standardizing rates based on individual Rate Rule needs rather than negotiated contracts required. This Rate Matrix is in development. Savings dependent on effective date.

  Eliminate Res Hab quarter hour as other options available for in home supports. $917,290 Eliminates the quarter hour unit, as it is usually used in their own home, Would need Rate rule change. This may increase IHSS use, reducing service array.

Fee Collection by Residential providers, estimate $8,401,147 Form would be created to calculate recipient responsibility to be deducted from Waiver service bills, monthly surplus frozen or swept by service, Would need method developed and procedures to monitor, would be late in year before implementation.

 12.5% required match as State share, savings not determined, This would leverage current spending to decrease GR effort and would need long term research with AHCA and CMMS and unknown if local effort applicable.

Core Service models– savings not determined, would limit waiver services to only those services considered core to prevent institutionalization, Would need Waiver amendment.

 Service Limits-not determined, would reduce service limits for each Waiver service and would be limited to only essential elements within the budget.

 Limit individual cost plan to not greater than average ICF/DD estimate of $3,300,000 savings and some thought it could be up to as much as a possible 17 million realized if limited, Alternative supports would be necessary for adversely impacted clients. Would need Waiver Amendment.

Three days of blogging just listing the cuts.  And who knows if they are done.

Keep squeaking those wheels on your wheelchairs.  We need to draw attention to the cuts and to those who receive no services and are left behind.

More APD Cuts and Reductions in Florida

Our friend Aaron Nangle of has provided information on the Draft Plan for APD’s HCBS Waiver – Home and Community Based Services Waiver Expenditure Reductions.

These will impact all persons with disabilities in Florida.

Collapse Behavior Analyst rate from level 1-2, estimate of $2,580,874 Rate for level 2 is $50 per hour for solo and agency is 20% above on an average, this would need a Handbook and Rate Rule change. Currently behavior analyst rates are based solely on years of experience not client need or outcomes.

Rate reductions to Medicaid State Plan nursing and therapies assessments. savings with an estimate of $ 1,530,476 Would need a Rate rule change that is currently being sought.

  Res Hab reduction of rate levels from 9-4 with savings expected of  $21,113,087 This would need redefinition of level of supports and associated rates as well as revision of staffing levels in the handbook, Would need Handbook and Rate Rule change- APD is seeking provider input for alternative savings.

Collapse IHSS quarter hour above live in rate, expected savings $2,714,937 Would delete use of quarter hour above the day rate and use QSI 1,2,3 and eliminate IHSS 1/4 hr. above day rate. Rationale is that Individuals with level of need 1,2,3, do not require additional supports beyond a daily rate for IHSS.

Utilization management of behavioral services possible ? $3,000,000  6 month increment with reapplication and approval required after each increment: declining hours based on matrix scores and the Implementing of on site reviews for continued stay in intensive behavioral programs. Additional utilization reviews ongoing to match services to level of need of client.

More reductions on our next blog.  Remember to keep squeaking those wheelchairs.

APD Proposed Cuts and Changes to Budget In Florida


Our friend Aaron Nangle of has provided information on the Draft Plan for APD’s HCBS Waiver – Home and Community Based Services Waiver Expenditure Reductions.

These will impact all persons with disabilities in Florida.

Consideration to Move Specialized Mental Health Therapy to Medicaid State Plan (adults) Detail: remove expenditure from waiver through

amendment for the long term because service is provided by DCF/AHCA Savings Expected would be about $1,395,703 This would need Handbook change, Rate Rule change, Waiver Amendment. While waiting for waiver amendment, case by case transition of services to Medicaid State Plan. Waiver would be amended this Fiscal Year

 Moving Skilled nursing to Medicaid State Plan(adults) Savings expected would be $1,615,650Remove expenditure from waiver and do waiver amendment for the long term because skilled nursing is provided by MSP Would need Handbook change, Rate Rule change, Waiver Amendment. While waiting for waiver amendment, case by  case transition of services to MSP. Waiver will be amended this FY.

 Rate adjustment for all ADT recipients and reduce burdensome regulations. Savings TBD Would need Handbook change, Rate Rule change with reduced paperwork and regulation, looking for alternative savings in this category.

Eliminate Behavior Assistant services with ResHab and ADT ? $5,000,000. savings, Would need Handbook change for clarifying policy, Rationale: Behavior Assistance services are duplicative of the services and training provided in Res Hab and ADT.

Agency Rate premium set to a maximum of 20% above solo rates for all services with agency rates, Savings expected $3,712,169 Currently there is a range of 5% to 45% over solo rates as agency premium. This would need a Rate rule change. currently rate premiums vary fro 5% to 42% depending on the service category.

More proposed reductions in our next blog.  Remember the squeaky wheelchair gets noticed.