Tag Archive for med waiver

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

www.waiverprovider.com

Our friend Aaron Nangle of waiverprovider.com 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

www.waiverprovider.com

Our friend Aaron Nangle of waiverprovider.com 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

 

www.waiverprovider.com

 

Our friend Aaron Nangle of waiverprovider.com 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.

Left Behind – The Disabled Without Services

From http://leftbehindintheusa.org/

Mike Coonan runs an organization called Left Behind in the USA.  He speaks for the millions of disabled who have no services – those who have been left behind by our government.

Here is a link to a video on what it is like to wait for services.   Video

Mike spends a lot of time and effort advocating for the disabled.  Mike we all appreciate your efforts.

One day we hope that no one will  – Be Left Behind

Like Mike we keep making noise and squeaking our wheels to bring awareness of those with disabilities.

 

Video interview with Secretary Elizabeth Dudeck, Agency for Health Care Administration – (AHCA)

Aaron Nangle from WaiverProvider.Com & Florida Unites Interviews Elizabeth Dudeck, The Secretary of The Agency For Health Care Administration. – (AHCA)

Click here to see the video

Change to APD’s Respite Services & the Creation of Respite Pool.

New changes regarding APD’s respite services. There will be cost plan changes for your people that receive respite services. CDC+ consultants, this will mean a new purchasing plan with the new monthly budget effective October 1, 2011 will need to be submitted to your local APD office. As additional details are shared with us, we will provide them to you.

Effective 9-1-11, respite in cost plans will be  reduced by 50% the remaining cost plan approved amount less the amount used in July and August.

Notice of change to respite service authorization and creation of the new respite pool

Notice of change to respite services that affect CDC+ monthly budgets