Question:  Where can I find out more about the Florida Freedom Initiative?
Answer:  http://apd.myflorida.com/ffi/

Question:  What is direct provider billing?
Answer: Direct provider billing is a new billing process for Developmental Services Home and Community-Based (DS/HCBS) Medicaid Waiver service providers that will replace the current system of submitting claims to Waiver Support Coordinators for processing. Direct provider billing will require all providers to complete and submit their own billing.  Waiver Support Coordinators will no longer be responsible for processing provider billing once this new process takes effect.
2. When will direct provider billing begin?  Direct provider billing will begin on Monday, March 3, 2003.
3. When will providers receive training on direct provider billing?  Training for direct provider billing will begin January 2003, or possibly as early as December 1. Providers will be notified of the specific date, time and place of all training by mail at a later date. Training will be provided using a team approach with representatives from the local Medicaid Area Office, ACS(formerly known as Consultec), and the local Developmental Disabilities district.  Note: It will be necessary for all DS/HCBS providers to participate in the training. Waiver Support Coordinators and a few other providers currently billing electronically using the ABC system will need to attend the training to learn the new electronic claims submission process.
4. How will claims be submitted for direct provider billing?  There are 3 options for direct provider billing:
a. Electronic claims submission – providers enter each claim electronically, using free WINASAP2000 software*
b. Paper claims submission – providers mail claim forms to ACS for processing
c. Private billing agent – providers submit claims information to a private billing agent who will process their claims for a fee

QUESTION:  What is the AHCA definition of Medical Necessity?
Answer:  "Medical Necessity:  Waiver services may only be provided when the service or item is medically necessary. Chapter 59G-1.010(166) of the F.A.C. defines medical necessity as:
1.  "Medically necessary" or "medical necessity" means that medical or allied care, goods or services furnished or ordered must meet the following conditions:
     (a)  Be necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain;
     (b)  Be individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the patient's needs;
     (c)  Be consistent with generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational;
     (d)  Be reflective of the level of service that can safely be furnished; for which no equally effective and more conservative or less costly treatment is available statewide; and,
     (e)  Be furnished in a manner not primarily intended for the convenience of the recipient, the recipient's caretaker, or the provider.
2.  "Medically necessary" or "medical necessity" for inpatient hospital services requires that those services furnished in a hospital or an inpatient basis could not, consistent with the provisions of appropriate medical care, be effectively furnished more economically on an outpatient basis or in an inpatient facility of a different type.
3.  The fact that a provider has prescribed, recommended, or approved medical or allied care, goods or services does not, in itself, make such care, goods or services medically necessary or a medical necessity or a covered service."

QUESTION:  Do you have any other information on resources for mental illness?
Answer:  Positive Minds Inc., Family Resource and Advocacy Center offers advocacy for consumers, families, and friends of people with mental health issues.  They can offer guidance, support and resource listings. 1) Resource Materials 2) Self Help environment 3) Family Support Groups AND 4) Family Mental Health Education. For more information please call Positive Minds Inc., 1348 East Vine Street, Kissimmee, FL 34769, 407-847-8520

QUESTION:  I am moving to Broward County.  My daughter  is 10 years old and mentally disabled.  She does not talk, nor is she toilet trained, but she walks with a brace.  I was wondering if you know of any long term care facilities?   She is in school during the day, so we  would need help getting her on and off the bus, and watching her until I get home from work.  Ideally a live-in care-taker would work out best.  Please get back to me with your thoughts or suggestions.  Thank you. (Today 2006, there is approximately a 5 year waiting list.)
Answer:
Ms. Brown--
     I am sorry to hear about the problems you had trying to receive services for James here in Florida.  I don't know if you are (or were) aware of the problems Florida has experienced in this area for years and years, but to put it bluntly, we were ranked 48th out of 50 states in our funding for persons with developmental disabilities.  Many Florida residents with developmental disabilities have not had all of their needs for too many years.   Several lawsuits later, we now have significantly more funding but we also have identified many more needs from more people than we were expecting.
     The situation currently in Florida for persons moving to our state (or living in the state and never having received services before) is that they are placed on a waiting list.  We hope to begin serving the people on the "new" waiting list around January 2003.  However, prior to serving new people, we must meet the needs of all persons waiting for services prior to 7/1/2000, as well as meet all of the needs of current clients.  I tell you all this to prepare you for the wait you more than likely will experience if you move back in July 2002.
     In reading your email and doing some research, I believe that the services James was receiving were funded through the school system and that James was never a client of the Department of Children and Families, Developmental Disabilities Program.  You do mention, however, that you applied for services sometime between September 2000 and April 2001.  Do you have any documentation of that?  Like a copy of your application or maybe a letter from the department acknowledging your application.  If you do, possibly you can use that to re-establish your initial position on the "new" waiting list.  Otherwise, when you move back you will need to immediately apply so that you can be put on the list.  Also, you cannot apply for services until you have a residence in Florida.
     Bottom line - if I were you and if James is receiving services where you are now, I'd stay there as long as I could.  Otherwise you risk moving back to Florida and again having no services until sometime in 2003.  I wish I could be more optimistic about your move back and getting services for James.  The most positive thing that is going on in Florida right now is a waiver redesign.  Consumers, families and department staff are looking very closely at how we have managed our waiver in the past and how we can better meet the needs of consumers while complying with federal regulations.
     I hope my information is helpful.  Good luck and let me know if I can do anything else.

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Melinda Coulter, Developmental Disabilities Program Office
Winewood Building 3 Room 314i,Tallahassee, FL  32399-0700
850.488.4877 extension 132, 888.633.2301 extension 132