APD's > Legislative > Digest

Volume I Fall Issue II October 18, 2007

Nov. 5-9 Dec. 10-14 Jan 7-11 Jan. 22-25 Feb. 4-8 Feb. 18-22

APD has made significant progress toward managing within available resources while meeting the critical needs of Floridians with developmental disabilities.

For FY 2007-08, the projected deficit is down to $13.8 million, an 84% decrease.

Short Term Actions Update: Implementing cost reduction strategies initiated by the Agency in FY 2006-07 that were subsequently codified in SB 1124. Projected savings of $40.6 million for FY 2007-08.

Effective August 1:

• Limits to supported living coaching.
• Limited support coordination to children living with their parents on the Home and Community Based Services waiver.
• Limits to personal care assistance to adults who receive moderate or standard level of support.

Effective October 1:

• Limited support coordination to children on the supported living waiver and in the Consumer Directed Care (CDC+) waiver and limits to personal care assistance to adults receiving intensive level of support.
• Consolidated rate structure for residential habilitation services and implementation of 8 hour limit for most adults. Assessments will start for adults over 8 hours to determine whether they will be exempted from the limit.
• Documents filed with the Federal Government in July for additional changes requiring their approval. Estimated implementation date is January 1, 2008.
• Began recouping overpayments and unused funds and strengthened fraud prevention efforts. Over $5.7 million recouped during the current fiscal year.
• Proposing to maximize existing resources by transferring $12 million from General Revenue in the supported living waiver to the Home and Community Based Services waiver (subject to Legislative Budget Commission approval).
• Analyzing current provider rate structure to identify options to further simplify and consolidate provider rates.

Long Term Actions:

• Implementing standardized needs assessments as required by law. Computer application to support the new process moving into testing phase approximately 5 months ahead of the original schedule.
• Requesting Legislative authority to hire new state FTE to expedite completion of independent consumer assessments.
• Developing proposals to fundamentally restructure the waiver by establishing consumer care budgets based on the results of the needs assessment.
• Developing proposals to consolidate and update existing prior service authorization contracts to reduce contract costs and more effectively control utilization.
• Working with the Agency for Health Care Administration to ensure that services available through the state plan are not billed to the waiver.
• Implementing more effective internal business processes to track and update spending forecasts on a regular schedule to more quickly identify and correct problematic spending patterns.
  Reevaluating current quality assurance process to ensure appropriate focus on natural community supports and to provide more relevant and practical information to management and policy makers.

Results:
Final deficit figures for FY 2006-07 of $88.5 million required a supplemental appropriation from Legislature that only partially addressed the problem.

For FY 2007-08, the projected deficit is down to $13.8 million, an 84% decrease.

Substantial Progress and Real Results have been accomplished despite legal challenges. This progress will continue if the Agency is allowed to take responsible, proactive measures to more effectively manage its programs.

Carve Out of Intensive Services from PCA Roll Back (SB 12 C)
Amended section 393.0661, Florida Statutes to allow for additional hours of personal care assistance above the current 180 hours per month limit for persons who have intensive physical, medical, or adaptive needs if such hours are essential for avoiding institutionalization. This bill takes effect upon becoming law and is currently awaiting the Governor's approval. Proviso language in the FY 2007-08 General Appropriations Act was also amended to conform to this change.

Change in Waiver Support Coordinator Duties
Approved 75 temporary OPS state positions to conduct customer needs assessments and prepare the initial cost plans. Positions will be assigned to APD area offices based upon number of customers served. These individuals will be required to have a bachelor's degree and four years of experience in social services working with people with developmental disabilities. They will also be subject to inter-rater reliability standards. Hiring will begin in the next month.

The APD approved needs assessment process and instrument is being revised and a new system will begin operation in January 2008. A new web-based system is currently being developed and training should begin later this fall for administrators of the assessment and other employees who will be using the information.

Did not Reduce the Projected Surplus in the Family Supported Living (FSL) Waiver as initially proposed
Projected surplus of $28.5 million in the FSL waiver will be available to offset the projected deficit in the Developmental Disabilities Home and Community Based Services waiver. With these funds, the projected deficit drops to $13.8 million, a reduction of nearly 84 percent from last year. The transfer is subject to Legislative Budget Commission approval.

Transfer of Funds to ICF/DD Civil Program
Approved APD proposal to transfer money from secure forensic services to the civil ICF/DD program. Net General Revenue savings to the state are $444,061. This will allow the state to move individuals in county jails to more appropriate settings.

PCA Rate Reduction
Approved a 4 percent rate decrease to personal care assistance services. This will provide savings of $1.7 million and take effect on January 1, 2008.

Proviso language is in the budget to direct the Agency for Health Care Administration to review rates for personal care assistance services in consultation with APD in time for legislative consideration during the regular session. The purpose of the review will be to design a rate structure that will ensure continued access to these services for children once the funding responsibility is shifted from the waiver to the Medicaid state plan. This is expected to occur on July 1, 2008.

Managed Care
There was no proposal relating to managed health care for people with developmental disabilities introduced during the special session.

Update on Other Issues
Residential Habilitation Rate Restructure The provider information and procedures for Residential Habilitation rate changes were distributed October 1, 2007. The rate revisions will take effect December 1, 2007. Providers should be working with their APD area offices on the changes at this time. Due to the rate consolidation for residential habilitation services, some providers will experience a rate reduction. In addition, APD re-evaluated and revised the geographic differential that is received as an add on to the rate in some areas.

Many thanks to Margaret Hooper, Director of Government Relations, Florida Developmental Disabilities Council, and everyone who worked so hard to secure passage of the amendment to exempt intensive services from the PCA roll back. This was a priority issue for the FDDC and Ms. Hooper was able to secure three DD champions Rep. Bill Galvano, and Sens. Ted. Deutch and Don Gaetz as sponsors.

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