IMPORTANT!!!! Tier Issue

[Guest guest]

IMPORTANT!!! MUST ALERT PARENTS WITH CHILDREN/ADULTS ON MEDWAIVER!!

I have listed a web site that families can go to get information on the tier issue. This is time sensitive, because many families received letters and they must respond within 10 days or they lose their rights to continue with existing funding, while they appeal.

Here is a link that people should go to and also get on their list to receive updates daily http://www.ffddnews.com

I also attached a form that families can give to their Support Coordinators to request a hearing (Word Doc). Normally, they would have an attorney file it, but to my knowledge, they can do it themselves.

Here are some tips and contact information for families to address their Tier assignment.

Tiers Tips

Suggestions For Surviving The Tiers

Questions, Concerns, Information? Go to Our Message Boards

1. Understand how you got into your assigned tier. Read More About How Tiers Are Assigned

2. If you believe that you should qualify for a higher tier, understand that you have the right to appeal that assignment within 10 days after you receive your Tier assignment letter. If you do so within ten days, your services will continue. You can also file up to 30 days after receipt of your letter, but then your services will be discontinued.

3. Kathleen, a lawyer working with Arc Nature Coast clients gave these suggestions. Keep the envelope that your tier letter came in as proof of when you got it. If you are contesting your tier, do not sign a new cost plan.

4. Be aware that eliminating high cost services such as behavior analyst, occupational therapy, physical therapy, speech therapy, and respiratory therapy from your cost plan could result in you being placed in a lower tier. Dropping certain services could move you into tier 4.

5. Understand that it will be easier to move down a tier than to move up a tier.

6. Be creative in cutting costs. For example, you might consider using the companion 1-2 or 1-3 staffing option. It saves money, and might open the door for new friendships.

7. Find out if there are any alternative funding sources available. Medicaid and Medicare are sometimes an option. For example, Medicaid is responsible for covering the cost of PCA for people under the age of 21

8. If you are in tier 4, make sure your provider is enrolled as a tier 4 (formerly FSL) provider. They will need to have a certificate with a 98 number at the end. The main certificate has a 96 number at the end. If your provider is not enrolled in this waiver, they will NOT get paid.

9. Tier 4 does not include companion or PCA services. You can request that companion and /or PCA be replaced with in home supports.

10. Don't give up!

Still Not Getting Our Newsletter? Sign Up, It's Free

By Now You Should Have Gotten Your Tier Letter.

It is my understanding that all of the tier letters have been sent out. Contact your support coordinator to learn more about your assigned tier. Your support coordinator will be able to tell you whether or not you will need to adjust your services.

Read More About How Tiers Are Assigned

Not everyone will need to cut their services. The Agency for Persons With Disabilities (APD) has stated that about 7500 people will be affected.

A huge concern right now is people going into tier 4. It's a concern, not only due to the low spending cap, but also because many people are discovering that their providers are not enrolled to provide services for the tier 4 waiver (formerly FSL waiver). Also, some services such as dental and medication review are not covered.

Personal Care Assistance (PCA) For People Under 21

People Under The Age of 21 and PCA- If you are under the age of 21, and in a waiver with a spending cap, the cost for your PCA service WILL NOT be counted towards your capped spending. (The reason is that funding responsibilities for PCA services for individuals under the age of 21 has been shifted to Medicaid State Plan.)

Tier 4 Example-

Tier 4 Cap is $14,792

-Your PCA costs $10,000 per year-Your other services combined cost $12,000 per year.- Even though your services cost $22,000 per year- you are still ok. Why? Because they are not counting the cost of your PCA at this time towards your spending cap.

Eventually, PCA for people under 21 will be completely transitioned to the medicaid state plan, and you will no longer see it on your medicaid waiver cost plan.

To understand this better, we encourage you to read Approving services for people under 21 who receive personal care assistance servicesYou will find the topic about half way down the page.

Need Help Through This Process?

Understanding the tiers is not an easy thing. When you find out that your services might be cut- it's tempting to want to go right to the top and call Jim DeBeaugrine himself. A better option, if you need help from APD, is to call 1-866-APD-CARES (1-)Please remember to talk to your support coordinator first. Your support coordinator needs to know your concerns.

There are many organizations out there willing to assist and give information. Contact Them.

1. The ARC of Florida

The ARC's around Florida are making a very strong effort to help make sure that people get the support and services they need.

Suggestions From ARC and