Talking Points on Tier Waivers
- The Agency for Persons with Disabilities (APD) is committed to protecting the health and safety of the people it serves by helping them receive the services they need.
- Over the past year, there have been many changes to the Medicaid waiver program. The changes have been difficult for both APD customers and employees.
- Last year, the Legislature changed the law to require a four-tier waiver system for individuals receiving Medicaid Waiver services from APD.
- The Legislature created four waiver tiers for people who receive services under the Developmental Disabilities Waiver, the Family and Supported Living Waiver, or the Consumer Directed Care Program. The Legislature also created eligibility criteria for the waivers.
- APD has developed a rule that will help assign customers to a tier as required by the Legislature.
- APD is notifying customers of their tier assignment in September.
- The Legislature imposed annual limits on how much the state will spend for services for people in three of the tiers.
- The Legislative limits are: Tier 1 – no limit; Tier 2 - $55,000; Tier 3 - $35,000; and Tier 4 - $14,792.
- Most people will not be affected by their tier assignment. But for some people, the tier assignment will mean that the state will not be able to pay as much for services as it has in the past.
- If a customer's Tier Waiver assignment results in a spending limit lower than the amount that is annually spent on services, he or she should work with their support coordinator to prioritize the services in his or her cost plan so they do not exceed the limit and that the services most important are supported.
- APD is supplying waiver support coordinators with information on how to help customers in prioritizing their cost plan to stay within the spending limit, if necessary.
- APD plans to implement the Tiers on October 15, 2008.
- The Agency for Persons with Disabilities has additional information about the Tier Waivers on its Web site (http://apd.myflorida.com). Contact your Waiver Support Coordinator or the local APD office if you have questions.
Specific Criteria for the Waiver Tiers
Tier 1 Waiver – No cap
Formerly the Developmental Disabilities Waiver
- The individual has intensive medical or adaptive needs that are essential for avoiding institutionalization, and the individual's needs cannot be met in Tier 2, 3, or 4
- The individual has behavioral problems that are exceptional in intensity, duration, or frequency and present a substantial risk of harm to themselves or others, and the individual's needs cannot be met in Tier 2, 3, or 4
Tier 2 Waiver – A new waiver capped at $55,000 a year
- The customer cannot live in the family home
- The customer's service needs include placement in a licensed residential facility and authorization for a specified level of residential habilitation services
- The client is in supported living and is authorized to receive more than six hours a day of in-home support services
Tier 3 Waiver – A new waiver capped at $35,000 a year
- The customer resides in a licensed residential facility and is not eligible for Tier 1 or Tier 2
- The client is 21 or older, resides in their own home and receives In-Home Support Services and is not eligible for Tier 1 or 2
- The customer is 21 or older and authorized to receive Personal Care Assistance services at the standard or moderate level of support as defined in the Developmental Disabilities Handbook
- The client is 21 or older and authorized to receive Skilled or Private Duty Nursing Services and not eligible for Tier 1 or Tier 2
- The customer is 22 or older and is authorized to receive services of a behavior analyst and/or a behavior assistant
- The client is under the age of 22, and authorized to receive the combined services of a behavior analyst and/or a behavior assistant for more than 60 hours a month and is not eligible for Tier 1 or Tier 2
- The customer is 21 or older and authorized to receive at least one of the following services: Occupational Therapy, Physical Therapy, Speech Therapy, or Respiratory Therapy
Tier 4 Waiver – Capped at $14,792 a year
Formerly the Family and Supported Living Waiver
- Customers who are currently assigned to receive services through the Family and Supported Living Waiver unless there is a significant change in condition or circumstance
- Customers who are not eligible for assignment to Tier 1, 2, or 3 shall be assigned to the Tier 4 Waiver
- Customers who are under the age of 21 and reside in their own home or the family home
- Clients who are dependent children who reside in residential facilities licensed by the Department of Children and Families
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