APD's > Legislative Digest

Volume I Fall Issue I
October 9, 2007

The Florida Legislature just embarked on one of the most difficult exercises a state could be called upon to do-cut spending to address the looming general revenue shortfall. If anyone can empathize with this difficult process it is certainly the Agency for Persons with Disabilities (APD). While all state agencies were asked to submit budget reductions in the amount of 4 percent, APD did not sustain further reductions.

Representative Ray Sansom (R-Ft. Walton Beach), Chairman of the House Fiscal Policy and Budget Committee gave committee members an overview of the revenue forecast and said he had been asked to use the Budget Stabilization Fund (sometimes referred to as the "rainy day" fund) to offset reductions. He said this fund is for emergencies and the state in not in an emergency mode, but rather is making responsible adjustments to avoid future emergencies. He said any money taken out of the Stabilization Fund will have to be paid back in five years, which would only put the state in further debt. He said services to the disabled were not being cut and praised Representative Aaron Bean (R- Fernandina Beach), Chairman of the House Health Care Council, and Representative Bill Galvano (R- Bradenton), Chairman of the House Healthy Families Committee, which have oversight of APD issues, for their steadfast commitment to Florida's most vulnerable citizens. He challenged people who were opposing cuts to offer solutions; a theme that was echoed by many of the chairmen who are also members of this committee.

During the special session word of possible legislation relating to managed care for the developmentally disabled swept through the DD community. Advocates from around the state came to the House Fiscal Policy and Budget Committee meeting to ask members to support APD and give the agency time to implement recent reform efforts before making sweeping changes. Dennis Haas, ARC Broward; Katie Porta, Quest, Inc.; and Dr. Julio Casa, UCP of South Florida all gave compelling testimony as to why individuals with developmental disabilities need customized care - not managed care. They asked the legislators to allow APD Director Jane Johnson to make the necessary improvements to the current service delivery system before implementing managed care programs. Additionally, other advocates such as Florida ARF, the Family Care Council Florida, family members and Representatives from all over the state sent similar messages to the Legislature. Representative Galvano also made it known he did not support Managed Care efforts during Special Session and worked extremely hard to keep it out of the debate. As part of the appropriations process, Representative Galvano and Senators Don Gaetz (R- Niceville) and Ted Deutch (D-Delray Beach) proposed an amendment, which was adopted, clarifying that individuals with intense physical, medical, or adaptive needs for personal care assistance which is necessary to avoid institutionalization were not to be included in the 180 hour PCA service cap that passed during the 2007 Regular Session (SB 1124). This also clarifies the position APD had taken in trying to implement the new law, however, there were questions about legislative intent and this amendment made it abundantly clear this particular service reduction did not apply to this population.

On the budget front preliminary conference decisions include:

The Agency received funding for 75 OPS positions to conduct valid and reliable needs assessments and develop initial cost plans for clients receiving services through the Home and Community Based Services (HCBS) waivers, and waiver support coordinator to client caseload ratios were changed to not exceed a maximum of 1:43. APD asked for these positions to effectuate change in the front end of the service delivery system to give the state the ability to manage and predict costs and provide for equitable treatment of all consumers statewide based on a validated needs assessment instrument. This proposal preserves the consumer oriented features of the current system. Families, or the individual, will still choose their support coordinator. The support coordinator will still report directly to the individual or family and continue to act as an advocate on behalf of their clients.

The Senate had originally proposed to cut the surplus in the Family and Support Living waiver and use the money to help offset the state revenue shortfall. This cut was not in the House proposal and did not get picked up. The Legislature has allowed the agency to use the surplus to offset the deficit in the APD HCBS waiver to offset any further reductions in services.

Other conference issues are as follows:

• 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 to more appropriate settings and clear space in county jails for individuals who cannot be placed in a forensic facility due to lack of space.
• Approved a 4% decrease to personal care assistance services. This will provide savings of $1.7 million.
• Proviso language is in the budget to direct AHCA 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.

Health Innovation

The House of Representative's Committee on Health Innovation met on October 2, 2007, to hold a workshop on Medicaid Fraud. Rep. Rene Garcia (R-Hialeah) chaired the meeting. Dr. Andrew Agwunobi, MD, Secretary of the Agency for Health Care Administration (AHCA), emphasized AHCA's commitment to detecting and investigating fraud and recovering funds. AHCA Deputy Secretary for Medicaid, Tom Arnold, gave an overview of AHCA's anti-fraud sections and programs. Director Rick Lober, Medicaid Fraud Control Unit, Office of the Attorney General (MFCU), then spoke about his division and their criminal investigations, arrests and monetary recoveries in health care fraud cases.

The committee members asked questions relating to waiver programs and fraud in the programs. Members were clearly interested in understanding what services were paid for by waiver programs and what services were paid for by state plan Medicaid. APD's efforts in recoupment, fraud detection and interagency anti-fraud efforts in waiver programs fits well with this continued legislative emphasis on fighting health care fraud in Florida.

APD Wins Three-Year Grant

APD Wins Three-Year Grant The Agency for Persons with Disabilities just received notification that it won a three-year grant from the Centers for Medicare and Medicaid Services (CMS) within the federal Department of Health and Human Services. The $455,419 grant will be used for a statewide initiative called Person-Centered Planning Implementation. The first phase of the grant will be to provide training to Waiver Support Coordinators and other stakeholders on how to improve the involvement of APD customers in setting goals and planning for their future.

In the second phase, APD will be holding community meetings in its 14 regions. The goal of the workshops will be to create a community network with lasting ties for each person with a disability. All stakeholders in the community will be included, such as Florida Vocational Rehabilitation and other employment resources, Department of Health, private providers, housing agencies, and transportation providers.

APD Director Jane Johnson said, "We are thrilled to have been selected to win this federal grant to focus on giving APD customers even greater voice in planning their future. APD wholeheartedly supports enhancing choice and options for people, and it is extremely important to intimately involve the local community in that planning process."

In accepting this Real Systems Change Grant for Person-Centered Planning Implementation, APD is agreeing to contribute about $22,000 in employee time toward this process for a total investment of $478,190.

The agency currently serves more than 35,000 Floridians with developmental disabilities of mental retardation, autism, cerebral palsy, spina bifida, and Prader-Willi syndrome. For more information on the agency, call 1-866-APD-CARES or visit www.apd.myflorida.com.

Healthy Families

The House Committee on Healthy Families met on October 2, 2007, to discuss the child welfare system. While the focus of the agenda was primarily on the Department of Children and Families (DCF), the information presented did involve APD. DCF Secretary Butterworth spoke about their efforts to enhance services provided to children in the child welfare system. The discussion of those children who receive services from more than one agency was of particular interest to APD. Secretary Butterworth advised the committee that he was pleased with the efforts of DCF, APD, and the Department of Juvenile Justice to coordinate services on behalf of these children. He also referenced the work of the newly formed Children's Cabinet, of which APD Director Jane Johnson is a member.

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