APD > Information on the Governor's Requested Budget Reduction Exercise

Overall goal is to minimize impact on services to consumers and families who have already been adversely affected by reductions to service levels.

Increase waiver support coordination caseloads and transition needs assessment and cost plan establishment to state FTEs

• Revised proposal offered in lieu of previous Agency schedule VIIIB submission to transition all waiver support coordination functions to state FTEs.



• Maintains private waiver support coordination for case management activities but transitions needs assessments and cost plan development to state FTEs. The revised proposal also provides for increased maximum caseload for waiver support coordinators to 1:50 and limited support coordination for individuals receiving supported living coaching. Individuals receiving limited support coordination are paid at half the amount provided for individuals receiving full support coordination and are counted as half a case in determining caseload ratios.



• Current maximum income potential per support coordinator remains at $69,552.



• Savings of $4.1 million in General Revenue and $6.1 million in trust funds.



• This will expedite implementation of the provisions of Senate Bill 1124 which require use of a valid assessment instrument.



• Will allow for equitable and consistent treatment of consumers through validated needs assessment to be administered by trained state employees. The assessments will be used to establish a budget for each individual which will then be managed by the individual (or family) with professional assistance from the support coordinator.



• Consumers will no longer have a reason to hire or fire support coordinators based on the size of the cost plan. Accountability will naturally shift to performance as it relates to support coordinators' ability to assist individuals to achieve their personal goals. This will provide greater incentive for the support coordinator to help their customers maximize all available resources, including natural community supports.



• The current role of waiver support coordinators as independent advocates for their clients will continue.

Provide services through Medicaid state plan in lieu of home and community based services waiver

• Since its creation on October 1, 2004, APD has funded Personal Care Assistant (PCA) services for persons under 21 through the HCBS Waivers. Recent interpretations of federal law indicate that PCA services for individuals under the age of 21 should be billed to and paid under the State Medicaid plan.



• AHCA has, based upon further review of State and Federal Medicaid law, determined that it is responsible for services for persons under 21 years of age.



• This will result in State Medicaid taking responsibility for payment of services for approximately 1900 current APD clients resulting in a savings to the APD Medicaid waiver of $12.4 million in General Revenue and $16.3 million in Trust Fund .



• APD is working with AHCA to provide an orderly transition for these clients to avoid any gaps in services. Priority is being given to those clients who are affected by the 2007 legislative limitations and eliminations in order to maintain their level of care.



• Allows for potential continuation of PCA services over the 180 hours a month specified in SB1124, but from a more appropriate funding source since the waiver is required to be the payer of last resort. Individuals under 21 will have to undergo a medical necessity determination from Medicaid State Plan in order to determine and receive Personal Care services.



• Provides trust fund savings to the waiver and allows the agency to reduce the projected waiver deficit.



• Will allow the agency to more appropriately direct waiver dollars to purchase services that are not available through other sources.

Create Alternative Medicaid Funded Placement Options for Forensic Clients

• Will open 50 existing ICF/DD licensed beds in the Developmental Disabilities Centers to serve clients who would otherwise be in the Mentally Retarded Defendant Program (MRDP).



• Savings of $888,123 in General Revenue while generating $2.4 million of new federal funds since the ICF/DD beds are eligible for Medicaid match.



• Currently there are clients in the MRDP program who are not likely to have their competency restored. The law requires these clients, and those who have served the maximum length of sentence that would have been imposed had they been convicted of the crime, to be served in non-secure settings.



• This will move clients out of secure placements which will provide space for clients confined to county jails that have been court ordered into the MRDP program. This will help the Agency comply with the statutory mandate to place these individuals within 15 days.



• Public safety will be increased since these individuals will not be in community settings.

Provider Rate Reduction to June 30, 2006

• General Revenue savings of $9.2 million from reversing a 2.8 percent price level increase provided to waiver service providers other than Waiver Support Coordinators.

Eliminate Funds for Workload for Individual and Family Supports

• Eliminates $1.8 million of a $2 million workload increase provided for FY 2007-08 from the Social Services Block Grant.



• Eliminates supported living subsidies that were planned for 250 individuals and supported employment services to another 300.



• This would have been for new clients and will not impact anyone currently receiving services.

Additional Provider Rate Reduction

• Additional 7 percent reduction to rates paid to providers of waiver services. General Revenue savings of $23.4 million and $30.9 million.



• The combined effect of this reduction and the roll-back to June 30, 2006, levels would equal a 10 percent rate reduction.



• This could cause substantial disruption of services to clients and was offered by the agency as an option to achieve the full $49.8 million reduction target.



• The agency does not recommend adoption of this reduction.