Where can I find out more about the CDC+ program?
Question: Where can I find out more about
the Florida Freedom Initiative?
Question: What does it mean,
the money follows the person?
There have been, for the last five years, vacant nursing home beds in
every state in the country. For advocates fighting for
community-based services and particularly for advocates that are
urging their State to use a "Money Follow the Individual" program, the
nursing home vacancy rates are important to understand. HHS Secretary Thompson suggested the "Money Follow the Individual" was an innovative model
to increase community services. Texas is successfully using it. Simply stated, the "Money follows the
individual" means that when an individual in a nursing home or
other institution chooses to leave that facility, the funds necessary
to support the individual's service needs in the community are
transferred from the budget of the institution to the community. In the federal budget for FY 2004 that
will be announced next week, there will be a "Money Follows the
Individual" Rebalancing Demonstration -- $1.75 billion over five
years, with $350 million proposed for FY 2004. This five-year
demonstration would assist states in developing and implementing a
strategy to "re-balance" their long term care systems so
that there are more cost-effective choices between institutional and
community options, including financing Medicaid services for
individuals who transition from institutions to the community. Federal grant funds would pay the full
cost of home and community-based waiver services for one year, after
which the participating states would agree to continue care at the
regular Medicaid matching rate. This significant demonstration
would build upon existing state success stories and also provides
incentives to states for increased use of home and community-based
services and would help provide information on costs of different
The exact percentage is not even critical. Given vacancy rates
of any size, as well as the national uproar about increasing Medicaid
costs, tell your States to save money, do the right thing, give people
a REAL CHOICE, and let the nursing home "money follow the
person" into the community so they can live in their own
Julie Shaw, ADA Working Group
Question: What is direct provider
Direct provider billing is
a new billing process for Developmental Services Home and
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
(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
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.)
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.
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