Accessibility Information
My provider says they are going to stop being a Medicaid waiver provider if the rate cut is implemented. What should I do?
- You should contact your Waiver Support Coordinator immediately. Together you should select another provider of the service and make sure everything is in place so there is a smooth transition.
How can a service be reduced that has been determined to be medically necessary?
- Once placed in a waiver with a cap for spending, the cost of services cannot exceed the cap level. This is the same as the current Family and Supported Living (FSL) waiver with a $14,792 cap on expenditures. The WSC will not reduce the cost plan or services. The WSC will assist the individual and/or their family to reprioritize services so that the total cost falls within the cap for the waiver. The individual and/or family should decide what services are most important to them.
If someone needs to adjust the cost plan because of the tier cap, what is the procedure to change to a service they do not currently have?
- Each individual will work with their waiver support coordinator to identify services on the cost plan. This information will then be shared with the appropriate area office and a new cost plan devised. If the plan contains new services, the cost plan will have to be reviewed by the PSA contractor for medical necessity. Each area office will have procedures for processing cost plan changes that they can share with individuals, families, or waiver support coordinators.
When will the Waiver Support Coordinator get the tier information for each person they support? Will WSCs get copies of the tier letters?
- APD does not have a firm date for notification of a person's tier assignment due to the current rule challenge. This information will be shared when known. The WSCs will get information on tier assignments for people on their caseload. The tier assignment will also be in the enrollment file in ABC. Each individual will receive the required 30 day notice prior to the effective date of the tier assignment.
Is each "Tier" going to be a Waiver?
- Each Tier is a separate waiver.
Not every service is available on the FSL (Tier 4) waiver; will any services be added to the FSL waiver?
- Not at this time. APD had requested to add Adult Dental services to the FSL or Tier 4 waiver, but this was not approved by the legislature.
Will providers have to be changed if Tiers are changed and a provider isn't available on a specific Tier?
- Providers will be able to provide services on Tiers 1, 2, or 3 if they have a current DD Waiver provider number. Providers of services on Tier 4 will have to have an FSL provider number. Providers may simply apply for a new locator code to add a DD or FSL number if they would like to provide services to people on all four waivers. The provider may contact the Area Provider Enrollment Specialist for instructions and information.
Do families have any recourse if they are not happy with the tier assignment?
- Yes. Everyone has due process rights, however, the criteria for the tiers was mandated by the Legislature.
What is the definition of "Adaptive Needs"on Tier 1?
- Adaptive needs relate to "functional"abilities such as ambulation, self-care or daily living, etc.
What does "greater than 5 hours"mean on Tier 2?
- This section of 393.0661 F. S. was modified for clarification during this legislative session to match up with APD's revised residential habilitation rate system. This criteria is now defined as Adults or children receiving standard Residential Habilitation at the moderate level or higher who do not meet the criteria for Tier 1, or Behavior Focus Residential Habilitation services at the minimal level or higher who do not meet the criteria for Tier 1. Someone receiving Live-in Residential Habilitation services in a licensed home of 3 or less people would also meet this tier requirement since "live-in" is considered 8 or more hours a day.
What is APD's plan to move forward while there is an injunction pending?
- APD will continue to review preliminary tier assignments and any recommended changes for verification and finalization of tier placement. When appropriate, the individual will receive a notice of his or her tier placement.
What is the connection between QSI and tiers?
- At this time, there is no direct connection as not all waiver recipients have been assessed using this particular tool and it is not being used to make the tier assignments.
When will the QSI assessment come into play to determine a tier?
- Later, when all people have been assessed using that QSI tool.
Will changes in service (due to Tier) have to go to PSA?
- Some changes will be approved at the APD Area Office. New service(s) or additional hours of an existing service will have to go through PSA.
WSCs need procedures for moving their customer to a new tier.
- There is currently information on moving from one tier to another in the draft rule. This will be finalized when the rule is promulgated.
Is there going to be certain mechanisms in place to move a consumer from one tier to another?
- Yes. The draft rule for the tiers gives a brief overview of that process. More detailed information will be sent out from the central office once tier assignments are implemented.
Are the consumers allowed to be moved to a higher Tier if their needs change drastically?
- The need or desire for additional services is not a criteria for a Tier change. If the person has a significant change in circumstance or condition that warrants consideration for a different tier, a request to move to another tier may be made to the Area office.
Are all providers being notified as to changes being made and when?
- We have put out general information on the tiers and have asked the Areas to assist with providing information to providers in their area. There will not be a direct mailing to each provider.
Can WSCs get access to the revised tier information? Will the website be updated?
- The APD web site will be updated as new or revised information is available.
Can WSC have ABC access ( to the cost plan) reinstated for the duration of this project?
- Not at this time. The WSC should be able to view the cost plan and update demographics as needed. The cost plan may also be printed.
Are the WSCs going to receive a copy of the letter sent to those individuals affected (obligated to reduce the cost plan)?
- The WSC will get a copy of the letter or will be otherwise notified of the tier assignment for those on their caseload.
Are support coordination rates being reduced again?
- The support coordination rate will be reduced by 3% as part of the mandatory rate reduction passed into law by the legislature effective July 1, 2008. This rate reduction is less than the majority of rate reductions for other waiver services since the support coordination rate was reduced in the previous fiscal year.
When age changes during the Cost Plan Year (from 21 to 22), will their "Tier" be changed on their birthday or at the end of the Cost Plan Year?
- If services are affected by a change to the person's age, a significant change in condition or circumstance as described in the Tier Rule - Section 65G-40021 (4), a cost plan amendment should be submitted before the person's birthday in order to insure no service interruption.
Are there any services that consumers are not allowed to eliminate?
- Support Coordination is a required service. Adults may opt for limited support coordination if they choose.
Will there still be CDC+ if PCA for children is going under ACHA?
- CDC+ will continue and PCA for children will be picked up under the Medicaid State Plan after July 1, 2008. CDC+ participants will receive instructions on how the services being picked up by Medicaid State Plan will be implemented.
How will a tier be determined when a crisis tool has been approved?
- The Crisis team will recommend a tier when an individual is approved for enrollment on the waiver.
Is ACHA going to cover PCA for individuals under the age of 21?
- AHCA will pick up PCA as a state plan service effective July 1, 2008. Affected individuals will receive information from APD and AHCA about the transition and any instructions for continuing PCA services. Initially, this service will continue to be billed as a waiver service with state plan funding the service instead of waiver dollars. As procedures are finalized by AHCA for the actual transition to state plan, these will be shared with all stakeholders.