Re: Fw: History of APD Medicaid Waiver Cuts: The DD System Needs Stability

[Guest guest]

I'm calling or emailing all the time. The bottom line is that you are right, they are continuing to give corporate tax cuts etc instead of using the money to fund APD and to help our DD community be all that they can be in an inclusive community setting. I know that Sen. Rich & Rep. Soebal are always fighting the fight for us. I wish that they would just rip off the bandage instead of letting us bleed a little at a time. I just got my letter yesterday cutting respite services in half. So, the time I can have to myself to grocery shop or take a walk or something to regroup to be a better parent has just been sliced in 2. We have to talk about the funding - that's the only thing they listen to - case in point - look at all the parents, advocates and the DD population

have shown up in person, written letters, called etc beseeching them in Tallahassee to no avail. To: "deniseslist " <deniseslist >Sent: Wednesday, August 17, 2011 7:12

PMSubject: Fw: History of APD Medicaid Waiver Cuts: The DD System Needs Stability

----- Forwarded Message -----To: Undisclosed List Sent: Wednesday, August 17, 2011 1:59 PMSubject: History of APD Medicaid Waiver Cuts: The DD System Needs Stability

Dear Parents, Advocates, WSC's and Providers,

FYI message and History of APD Medicaid Waiver Cuts below.

A very sad eye opener for all of us.

Please call your local State Senators and local State House Representatives (Not U.S.) and voice your concerns by phone and by email as soon as possible. If you click on the link below and type in your email address this site will identify your local state Senator and local state House Representative with their contact information. http://www.flsenate.gov/senators/find

If you don't know who your House Rep is, click on the gray bar on the top left side of the page that reads "FIND YOUR REPRESENTATIVE" and fill in the information requested. Please do this as soon as possible! We must speak up now before our FL children and adults lose all of their services.

Regards,

Phyllis

*******

I think that a simple message on why APD has a deficit can be made that is supported by the data. That message is that we are serving 4,800 individuals more than we served five years ago with the same funding that we had five years ago and that is why APD has a deficit.

The bottom line is that what the legislature and executive branches are doing represents a devaluation of people with developmental disabilities. The value people place on a population (e.g. college students) or an issue is often translated into an appropriation, but the underlying reason has little to do with money. Trying to argue the technical dollar issues only distracts from the more fundamental issue – how much does Florida value people with disabilities. At this point we are headed toward system of only custodial care; not one the provides an opportunity to grow and become as independent as possible. We don’t place a high enough on their needs. If we did we would be going a different direction.

Parents and self-advocates are in a unique position to make the case that people with developmental disabilities deserve more than custodial care. No professional can do it as well as you can. While I recognize your experience and skill, I urge not to get caught up in the technical arguments but to keep pressing the case that regardless of whether or not APD is running a deficit, people are not getting the services they need, and it is getting worse not better.

*****************************************************************************************

History of APD Medicaid Waiver Cuts:

The DD System Needs Stability

· In July 2003, the State of Florida adopted the Mercer Rate system that contained up to 720 billing options for residential habilitation rates and new rates for most of the 30+ services funded by the Home and Community Based Services Waiver. Transportation, Special Medical Homes and Intensive Behavior services continued to have negotiated rates. The legislature basically bought a reimbursement system that was based on direct care wages funded at the 25th percentile compared to national averages for wages.

· In November 2003, the Agency reduced Residential Habilitation rates by 14.3% and Live In Residential Habilitation by 7%. Also, billable days were limited to 350 per year for homes having more than 3 individuals. ADT rates were reduced by about 9.5%. The actions were taken to prevent deficit spending although the state actually realized a surplus at the end of the fiscal year. The annualized reductions totaled about $45 million for three services. According to Medicaid claims data, the Agency realized a $37 million surplus for the same year.

· In 2004, the Agency implemented a residential habilitation matrix approach which limited billings by looking more at the number of hours needed per home to adequately staff it. The impact was significant in that in many cases the last two admissions to a six-bed group home received reduced hours (typically 2).

· In 2006, agencies received a 2.81% Cost of Living Adjustment that applied to all waiver services. This action added about $21 million back into the system.

· During the 2007 Legislative Session, the Florida Legislature mandated changes in Senate Bill 1124 that resulted in limitations and eliminations of Developmental Services Home and Community Based Services (HCBS) Waiver services funded through the Medicaid program. Although implemented, the limitations and eliminations have resulted in little if any savings in waiver expenditures because clients often shifted to other services to meet their needs

[Guest guest]

I too will be using all my respite - pool included. Since they cut PCA services, I have no choice. I know APD has been trying to cut out our support coordinators for the past few years and many have left due to the turmoil. As for me, I won't stop pushing for disability assistance until everyone has the same access as the legislators do with medical care, respite, inclusion etc until I'm in my grave. Which after all this stress is putting me there much quicker. ;)To: sList Sent: Friday, August 19, 2011 11:19 AMSubject: Re: Fw: History of APD Medicaid Waiver Cuts: The DD System Needs Stability

Re. respite and 50% reduction. You are correct. Supposedly we can access the other 50% through the pool. But as you say, how easy will this be? Our support coordinator has no clue as to how this will work, and they are the ones we are supposed to be going through to access it.As for going through the cost plans and removing hours for people not using them; They tried to do this through rebasing. A judge threw out their case for rebasing, and I guess this is their answer.Personally, I intend to access the respite pool every month for the other 50% of respite. If it's a paperwork nightmare, maybe they will get enough complaints and end it. I hope every other family does too. If they see they can get away with giving much less

respite, they will.EileenSubject: Re: Fw: History of APD Medicaid Waiver Cuts: The DD System Needs StabilityTo: sList Date: Friday, August 19, 2011, 8:57 AM

As for your respite care, it has not been cut 50%. If you read the information from APD, if you need additional services you can access them from the new respite pool. The situation was this: They had $19 million in cost plans that hasn't been being used by families and APD needs to access the unused portion to help alleviate the shortfall in funds. In my opinion, it would have been better to go through the cost plans and determine who used all of their respite over the last year and leave their funding in tact and then look at all the cost plans of those who didn't use all their funds and remove those funds. Then, they wouldn't have to deal with more paperwork and have to approve those who already are using the entire amount. But, it was easier for them to say, okay we are cutting respite by 50% and putting money in a pool for those who are approved already and need more than the 50% we are allotting you. I think they are banking on the

fact that many will think like you did lose half of your funding and not go to APD for the additional funds.

Theoretically, if you are approved for say 12 hours a week for respite and they have cut you to 6. If you need the additional 6 you can still use it, but you have to go to the pool to access it. That being said, I am unsure how you go about accessing it and I don't know if you are going to have to go through more bureaucracy or what. Based on previous experience, I doubt it will be as easy as APD states it is. You can let me know when you have to deal with it.

Regards,

Ven Sequenzia

President

Autism Society of America

State of Florida Chapter

History of APD Medicaid Waiver Cuts: The DD System Needs Stability

Dear Parents, Advocates, WSC's and Providers,

FYI message and History of APD Medicaid Waiver Cuts below.

A very sad eye opener for all of us.

Please call your local State Senators and local State House Representatives (Not U.S.) and voice your concerns by phone and by email as soon as possible. If you click on the link below and type in your email address this site will identify your local state Senator and local state House Representative with their contact information. http://www.flsenate.gov/senators/find

If you don't know who your House Rep is, click on the gray bar on the top left side of the page that reads "FIND YOUR REPRESENTATIVE" and fill in the information requested. Please do this as soon as possible! We must speak up now before our FL children and adults lose all of their services.

Regards,

Phyllis

*******

I think that a simple message on why APD has a deficit can be made that is supported by the data. That message is that we are serving 4,800 individuals more than we served five years ago with the same funding that we had five years ago and that is why APD has a deficit.

The bottom line is that what the legislature and executive branches are doing represents a devaluation of people with developmental disabilities. The value people place on a population (e.g. college students) or an issue is often translated into an appropriation, but the underlying reason has little to do with money. Trying to argue the technical dollar issues only distracts from the more fundamental issue – how much does Florida value people with disabilities. At this point we are headed toward system of only custodial care; not one the provides an opportunity to grow and become as independent as possible. We don’t place a high enough on their needs. If we did we would be going a different direction.

Parents and self-advocates are in a unique position to make the case that people with developmental disabilities deserve more than custodial care. No professional can do it as well as you can. While I recognize your experience and skill, I urge not to get caught up in the technical arguments but to keep pressing the case that regardless of whether or not APD is running a deficit, people are not getting the services they need, and it is getting worse not better.

*****************************************************************************************

History of APD Medicaid Waiver Cuts:

The DD System Needs Stability

· In July 2003, the State of Florida adopted the Mercer Rate system that contained up to 720 billing options for residential habilitation rates and new rates for most of the 30+ services funded by the Home and Community Based Services Waiver. Transportation, Special Medical Homes and Intensive Behavior services continued to have negotiated rates. The legislature basically bought a reimbursement system that was based on direct care wages funded at the 25th percentile compared to national averages for wages.

· In November 2003, the Agency reduced Residential Habilitation rates by 14.3% and Live In Residential Habilitation by 7%. Also, billable days were limited to 350 per year for homes having more than 3 individuals. ADT rates were reduced by about 9.5%. The actions were taken to prevent deficit spending although the state actually realized a surplus at the end of the fiscal year. The annualized reductions totaled about $45 million for three services. According to Medicaid claims data, the Agency realized a $37 million surplus for the same year.

· In 2004, the Agency implemented a residential habilitation matrix approach which limited billings by looking more at the number of hours needed per home to adequately staff it. The impact was significant in that in many cases the last two admissions to a six-bed group home received reduced hours (typically 2).

· In 2006, agencies received a 2.81% Cost of Living Adjustment that applied to all waiver services. This action added about $21 million back into the system.

· During the 2007 Legislative Session, the Florida Legislature mandated changes in Senate Bill 1124 that resulted in limitations and eliminations of Developmental Services Home and Community Based Services (HCBS) Waiver services funded through the Medicaid program. Although implemented, the limitations and eliminations have resulted in little if any savings in waiver expenditures because clients often shifted to other services to meet their needs

[Guest guest]

Will definitely follow up on this.

Subject: Fw: History of APD Medicaid Waiver Cuts: The DD System Needs StabilityTo: "deniseslist " <deniseslist >Date: Wednesday, August 17, 2011, 11:12 PM

----- Forwarded Message -----To: Undisclosed List Sent: Wednesday, August 17, 2011 1:59 PMSubject: History of APD Medicaid Waiver Cuts: The DD System Needs Stability

Dear Parents, Advocates, WSC's and Providers,

FYI message and History of APD Medicaid Waiver Cuts below.

A very sad eye opener for all of us.

Please call your local State Senators and local State House Representatives (Not U.S.) and voice your concerns by phone and by email as soon as possible. If you click on the link below and type in your email address this site will identify your local state Senator and local state House Representative with their contact information. http://www.flsenate.gov/senators/find

If you don't know who your House Rep is, click on the gray bar on the top left side of the page that reads "FIND YOUR REPRESENTATIVE" and fill in the information requested. Please do this as soon as possible! We must speak up now before our FL children and adults lose all of their services.

Regards,

Phyllis

*******

I think that a simple message on why APD has a deficit can be made that is supported by the data. That message is that we are serving 4,800 individuals more than we served five years ago with the same funding that we had five years ago and that is why APD has a deficit.

The bottom line is that what the legislature and executive branches are doing represents a devaluation of people with developmental disabilities. The value people place on a population (e.g. college students) or an issue is often translated into an appropriation, but the underlying reason has little to do with money. Trying to argue the technical dollar issues only distracts from the more fundamental issue – how much does Florida value people with disabilities. At this point we are headed toward system of only custodial care; not one the provides an opportunity to grow and become as independent as possible. We don’t place a high enough on their needs. If we did we would be going a different direction.

Parents and self-advocates are in a unique position to make the case that people with developmental disabilities deserve more than custodial care. No professional can do it as well as you can. While I recognize your experience and skill, I urge not to get caught up in the technical arguments but to keep pressing the case that regardless of whether or not APD is running a deficit, people are not getting the services they need, and it is getting worse not better.

*****************************************************************************************

History of APD Medicaid Waiver Cuts:

The DD System Needs Stability

· In July 2003, the State of Florida adopted the Mercer Rate system that contained up to 720 billing options for residential habilitation rates and new rates for most of the 30+ services funded by the Home and Community Based Services Waiver. Transportation, Special Medical Homes and Intensive Behavior services continued to have negotiated rates. The legislature basically bought a reimbursement system that was based on direct care wages funded at the 25th percentile compared to national averages for wages.

· In November 2003, the Agency reduced Residential Habilitation rates by 14.3% and Live In Residential Habilitation by 7%. Also, billable days were limited to 350 per year for homes having more than 3 individuals. ADT rates were reduced by about 9.5%. The actions were taken to prevent deficit spending although the state actually realized a surplus at the end of the fiscal year. The annualized reductions totaled about $45 million for three services. According to Medicaid claims data, the Agency realized a $37 million surplus for the same year.

· In 2004, the Agency implemented a residential habilitation matrix approach which limited billings by looking more at the number of hours needed per home to adequately staff it. The impact was significant in that in many cases the last two admissions to a six-bed group home received reduced hours (typically 2).

· In 2006, agencies received a 2.81% Cost of Living Adjustment that applied to all waiver services. This action added about $21 million back into the system.

· During the 2007 Legislative Session, the Florida Legislature mandated changes in Senate Bill 1124 that resulted in limitations and eliminations of Developmental Services Home and Community Based Services (HCBS) Waiver services funded through the Medicaid program. Although implemented, the limitations and eliminations have resulted in little if any savings in waiver expenditures because clients often shifted to other services to meet their needs