FW: Suggestions For Surviving The Tiers

[Guest guest]

--- Rich La Belle wrote:

>

> Dear All:

>

> Here are some very helpful tips regarding the tiers

> and some great

> resources. Time is of the essence in deciding which

> way to go once you get

> a placement letter. While we don't endorse any

> opinions that may be

> expressed below, this is very good information.

>

> Take care,

> Rich

>

>

> La Belle

>

> Executive Director

>

> Family Network on Disabilities of Florida, Inc.

>

> 2735 Whitney Rd.

>

> Clearwater, FL 33760

>

> /

>

> Fax:

>

> <http://www.fndfl.org/> www.fndfl.org

>

>

>

> _____

>

> From: Nangle

> Sent: Tuesday, September 09, 2008 8:00 AM

> To: richlabelle@...

> Subject: Suggestions For Surviving The Tiers

>

>

>

>

>

>

>

>

> Tiers Tips

>

> Suggestions For Surviving The Tiers

>

>

> Questions,

>

<http://click.icptrack.com/icp/relay.php?r=7823425 & msgid=174908 & act=DAHP & c=1

>

60084 & admin=0 & destination=http%3A%2F%2Fwww.bulletinboards.com%2Fv2.cfm%3Fcom

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> Message Boards

>

> 1. Understand how you got into your assigned tier.

> Read

>

<http://click.icptrack.com/icp/relay.php?r=7823425 & msgid=174908 & act=DAHP & c=1

>

60084 & admin=0 & destination=http%3A%2F%2Fapd.myflorida.com%2Fwaiver%2Ftiers.ht

> m> 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!

>

>

>

>

> ADVERTISE

>

<http://click.icptrack.com/icp/relay.php?r=7823425 & msgid=174908 & act=DAHP & c=1

>

60084 & admin=0 & destination=http%3A%2F%2Fwaiverprovider.com%2Fadvertise.html>

> With WaiverProvider.Com

>

> Still

>

<http://click.icptrack.com/icp/relay.php?r=7823425 & msgid=174908 & act=DAHP & c=1

>

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>

>

>

> 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

>

<http://click.icptrack.com/icp/relay.php?r=7823425 & msgid=174908 & act=DAHP & c=1

>

60084 & admin=0 & destination=http%3A%2F%2Fapd.myflorida.com%2Fwaiver%2Ftiers.ht

> m> 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.

>

>

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