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Volume I Fall Issue III December 20, 2007

January 7, 2008 - January 11, 2008 & January 21, 2008 - January 25, 2008

8:00 a.m. - 12:00 p.m. House Healthcare Council 8:00 a.m. - 12:00 p.m. House Healthy Families 1:00 p.m. - 5:00 p.m. House Policy & Budget Council Wednesday, January 9, 2008 9:00 a.m. - 12:00 p.m. Senate Children, Families and Elder Affairs 2:00 p.m. - 5:00 p.m. Senate Governmental Operations Thursday, January 10, 2008 9:00 a.m. - 12:00 p.m. Senate Health and Human Services Appropriations Wednesday, January 23, 2008 2:30 p.m. - 5:00 p.m. Senate Children, Families and Elder Affairs Thursday, January 24, 2008 9:00 a.m. - 11:30 a.m. Senate Governmental Operations

Happy Holidays and Happy New Year to everyone! 2007 certainly has been a tumultuous year, with many changes and challenges. As we close out the year, I can't help looking back on all that has happened with immense gratitude and appreciation for the extraordinary commitment demonstrated by the members of the APD family. I have learned many things about APD's programs and policies and politics since April - every day, some new situation seems to present itself and call for a solution. Through it all, the members of the APD team have demonstrated uncommon dedication to excellence.

Despite budget deficits, budget cutbacks, service reductions and service eliminations, the APD team has kept its focus on the agency's primary goal. Most organizations faced with the monumental changes in operations, policies and funding that APD has seen would do well just to weather through those disruptions successfully. However, the APD team not only tackled the myriad of challenges it faced, but at the same time, they are able to think toward the future and develop a strategic plan and vision for the agency.

This is a challenging time for APD, but the APD family is a truly exceptional organization. I do believe that the next few years will test our fortitude and our commitment, but if 2007 is any indicator of things to come, I also believe that the challenges we are facing will only make APD a better agency, equipped to fulfill its mission.

"The Agency for Persons with Disabilities is dedicated to empowering Floridians with developmental disabilities to live, learn and work in their communities."

APD Director Jane E. Johnson gave an update on the implementation of the tiered Medicaid waivers (SB 1124) to members of the Senate Children, Families and Elder Affairs Committee on Wednesday December 12, 2007. The presentation began with an overview of agency appropriations by major function which shows the vast majority, 80 percent, is being spent on waiver services. Waiver trends indicate total expenditures have increased about 329 percent between Fiscal Years 1999-2000 while enrollment has only grown by 82 percent. Both expenditures and the wait list are at or near historically high levels. Director Johnson told members that unless these trends reverse, waiting lists are likely to continue growing and deficits are likely to be a recurring problem threatening services to existing recipients.

Going into the 2007 Legislative Session the agency projected a $156 million deficit for the 2007-2008 (current) fiscal year. APD now projects a $19.3 million deficit for this fiscal year.

This represents approximately an 80 percent decrease from FY 2006-2007. Director Johnson told members many of the improvements to the agency's budget were due to the efforts of the agency's new Deputy Director of Budget and Planning, Jim DeBeaugrine, who has over 19 years of experience in the appropriations arena. Johnson said the deficit reduction is largely attributable to the generous funding increase during the 2007 Regular Session of nearly 15 percent to address the utilization increase, and some of the savings from service eliminations and reductions required by SB 1124. Johnson also stated that the full impact of the savings will not be realized until the Four-Tiered Waiver System required by the bill is put into place. Implementation of the tiers is projected to start in July 2008, pending federal approval. Therefore, estimated savings are not projected to have an impact until Fiscal year 2008-2009.

Director Johnson said the legislation also required a consolidation of the Residential Habilitation Rate structure which was developed and implemented on December 1, 2007. However, a challenge to the rule has been filed which will delay savings during the review process. The rates were simplified from 720 rate options to 18 based on level of need. 92 percent of consumers will receive "res hab" at 8 hours or less, per statute. Uniform rates for individuals with intense needs will also be implemented.

During the Special Legislative Session "C" the agency was given authority to hire 75 temporary employees to conduct needs assessments. Director Johnson said half of the Area Office have completed the hiring process and a revised standardized needs assessment process will begin in January 2008. Individuals receiving res hab services will be assessed first. All people on the wait list will be assessed over a three-year period. This will help the agency to better identify service needs and project the budget.

Other initiatives taken to implement SB 1124 include receiving federal approval to change the support/cost plan system if there are significant changes in the consumer's condition or circumstance that impacts health or safety. Crisis clients are only being served if funding is available through persons leaving the HCBS Waiver. Support plans submitted by Waiver Support Coordinators that are not in compliance with the agency's rules, policies, and procedures are flagged and sent to the local APD area office for intervention.

Other cost savings measures that have been implemented include the following:

• Instituting a recoupment policy for providers failing to comply with waiver billing and monitoring requirements. This initiative has already resulted in over $5.7 million being recouped this fiscal year.
• The agency is working closely with the Agency for Health Care Administration Medicaid Program Integrity Office to better identify and pursue suspected fraud.

AHCA will begin covering PCA services for individuals 21 and under through the State Plan.

APD has also, and for the first time, developed a Strategic Plan which will serve as a guide to improved service delivery for consumers. Existing Prior Service Authorization contracts are being consolidated and updated to reduce costs and utilization.

Other initiatives include implementing more effective internal business processes to track and update spending forecasts, which will help identify and correct problematic spending patterns faster. The current quality assurance process is being reevaluated to ensure an appropriate focus is being made on natural and community supports and to provide more relevant and practical information to management and policy makers. Director Johnson said the Support Coordinators have provided invaluable insight and feedback on the QA review process.

The presentation in its entirety may be found on the APD web site at http://apd.myflorida.com/

Committee members followed the presentation with several questions regarding the wait list and crisis enrollment criteria. Director Johnson explained the different categories of individuals who are waiting to be enrolled into the HCBS waiver as individuals who are on the Family and Supported Living Services waiver who will eventually move up; individuals who do not need services now but will in the future and individuals who are eligible and cannot currently be located but might resurface and need to be enrolled. She said there are approximately 16,000 individuals currently on the wait list (not including those on the FSL) and will provide the committee more detailed information. Sylvia Smith, with the Advocacy Center for Persons with Disabilities, told members that the agency needs to conduct a "robust" review of the wait list because the public is entitled to make application whenever they choose. Smith said conducting assessment of these individuals will help the agency with long-term planning efforts.

Representatives of Florida ARF and Arc Florida urged members not to move too quickly and allow APD the necessary time to carefully construct the changes required in the recent legislation. Suzanne Sewell, Florida ARF, told members the agency has made lots of improvements, and the changes required in SB 1124, especially those related to the tiers, need to be slowed down. Deborah Linton, the newly appointed Executive Director of Arc Florida, echoed the need to move with full deliberation, and said stakeholders are trying to offer solutions and identify more funding streams.

The House Committee on Healthy Families met on December 1, 2007. The committee considered HB 3, addressing Children's Zones focuses on meeting the needs of children and families by providing a variety of services located in the community where the family lives. The bill would establish a pilot of this program in Miami-Dade County.

The committee also considered HB 121 which would designate the second Monday in May as Child Welfare Professionals Recognition Day. The purpose of the bill is to recognize those who work with families and to promote awareness of the child welfare system.

Secretary Bob Butterworth, from the Department of Children and Families (DCF), provided an update on the Task Force for Child Protection. He indicated DCF had implemented many changes to make services more available to individuals. They have also worked very closely with community leaders to identify issues and address them. Representative Nick Thompson stated he has been very pleased with the progress in his district (Area 8).

The House Healthcare Council met on December 11, 2007, and conducted a workshop on Self-Directed Care (SDC). The Department of Children and Families gave an update on the SDC pilot project implemented in Area 4 and Area 8. The program allows individuals receiving mental health services to manage their own funds, similar to APD's CDC+ program. The report indicated that individuals in the SDC program had a higher rate of employment than those in the comparison group. The report also indicated that while the SDC program participants had a higher rate of being prescribed atypical antipsychotic medications, they had higher incomes, and were more likely to live independently. The report suggested the cost for those in the SDC program was lower than for those in the comparison group.

Healthcare Council Chairman Aaron Bean indicated it is projected that the state will experience a $9.9 million revenue shortfall during FY 2007-2008 and a $2.2 billion shortfall in FY 2008-2009. He stated this would present a difficult task to the Council during the 2008 session as they work on the budget.

The Agency for Persons with Disabilities will be hosting the "Planning for the Future - Unity in the Developmental Disabilities Community" summit on Thursday, January 17, 2008. The summit will be held in Tampa, Florida to bring key legislators, policy makers, and stakeholders together to provide a public discussion on where we have been and where we are going in the Developmental Disability community.

This informative event will include an update on the state's revenue forecast and its impact on APD's budget. Key legislators for DD issues will participate including Senator Ronda Storms, Chairman of the Senate Children, Families and Elder Affairs Committee; Representative Bill Galvano, Chairman of the House of Representative Healthy Families Committee; Senator Nan Rich, Vice Chair of the Senate Health Human Services Appropriations Committee and member of the Senate Children, Families and Elder Affairs Committee; and Representative Loranne Ausley, member of the House Healthcare Council. Members will give their perspectives on potential legislation impacting the DD community.

APD staff will review recent changes in service reductions and eliminations; the assessment process and the impact of the budget deficit on future services.

Stakeholders will be represented at a "Round Table" discussion of pressing issues of the day. Public input will be taken throughout the meeting.

If you haven't already, call Jennifer Silva today to RSVP (850) 922-7733.

Featured Legislator Senator Ted Deutch

Date Of Birth: May 7, 1966 in Bethlehem, PA
Education: University of Michigan University of Michigan Law School
Occupation: Attorney
First Elected: Elected to the Senate in 2006
Local Delegations: Broward, Palm Beach
Committees: Fiscal Policy & Calendar, Finance and Tax, Economic Opportunities Policy and Calendar, Agriculture, Banking and Insurance, Judiciary, Rules, Education Pre-K - 12

Senate Health and Human Services Appropriations Committee staff presented an Interim Monitor Project on the status of the Home and Community Based Services Waiver on December 13, 2007. Project objectives were to review and monitor the APD budget deficit and progress towards implementing SB 1124, as well as the related proviso in the General Appropriations Act. The report also reviewed APD's plan to remain within the appropriation as required by statute. According to staff, in the six year period from Fiscal Year 2002-03 to Fiscal Year 2007-08, $589.4 million additional funds were provided to consumers currently receiving services, including individuals on the wait list. This represents a 158 percent increase in funds.In the same timeframe, APD served an additional 590 consumers through the HCBS waiver, or a 2.5 percent increase in the number of persons served on this waiver. Of the 589.4 million increase, Senate staff estimates that $521 million was used to fund utilization increases; $22 million was used to fund the additional HCBS waiver consumers; and $46.39 million was used to fund the FSL waiver clients.

Staff reported APD was given $175 million additional funds for FY 2007-08 to "eliminate the forecasted budget deficit" along with the projected savings from implementation of SB 1124. This was actually a $116 million increase for FY 2007-08 with the balance of the $175 million being provided to offset the deficit in FY 2006-07. Funds were not provided to reduce the wait list and crisis cases could only be enrolled through attrition.

A review was provided on the status of the implementation of SB 1124 and the 2007 Appropriations requirements including the Four Tier System and service reductions and eliminations. The presenter indicated that the bulk of the projected savings will come from the implementation of the tiers, approximately "$170 million", but this will not be implemented until July 2008. The agency has projected savings from the tiers to be $107 million. It was mentioned that there has been a surplus in the FSL waiver for several years. The Legislature has allowed APD to transfer this money in the past to help offset the deficit in HCBS waiver.

Regarding the agency's "plan" to reduce the deficit, staff said it does not eliminate the forecasted deficit for FY 2007-08 and does not keep the agency's expenditures within the appropriation - a point acknowledged by APD. Staff did say the plan comes close, but it is still $19 million ($8.3 million General Revenue) short of being a balanced budget. In summary, staff concluded that utilization increases, not the savings estimates from the new initiatives, are causing the current deficit and that it is too early to expect any significant fiscal impact from the changes. APD's deficit forecast for FY 2007-08 and FY 2008-09 are primarily driven by two unknown and related variables: future utilization rates and; the savings from implementing SB 1124 and appropriations directives. The report stated minor deviations in these variables will significantly impact APD's deficit in FY 2008-09.

APD Deputy Director of Budget and Planning, Jim DeBeaugrine, provided points of clarification about the report. DeBeaugrine said a key point of agreement is that the deficit is driven by utilization. The Legislature could enact bills like SB 1124 every year, but as long as utilization continues to grow it will not control the deficit. He told members that the actual anticipated savings from the tiers is $107 million rather than $170 million and is another key component in getting close to reducing the total deficit. He also pointed out that despite staff's understanding that the supplemental funding would cover the deficit; the waiver program inherited a $31 million deficit from FY 2006-07 that is contributing to the projected deficit in FY 2007-08. Mr. DeBeaugrine assured members the agency is continuing to "brainstorm" internally, and with committee staff to resolve the deficit issue. One of the major obstacles is the lack of historical data to assess the actual impact of the reduction initiatives in SB 1124.

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