iBudget Appeal Information I sent to my consumers
As your support coordinator, I want to make you aware of the letter you (and / or parents, guardians, guardian advocates and authorized representatives) should receive from APD around March 15, 2014 concerning your approved budget for services. Basically, APD was sued, which is known as the Moreland Lawsuit, over the initial consumer iBudget reductions that were implemented by APD in October 2012. You are part of the Settlement Class as a Class Member because you received a notice of reduction to your tier cost plan during your past transition to iBudget. APD will reinstate Class Members’ cost plans on a prorated basis to the level they were prior to transition to iBudget. A recent mediation agreement between parties requires APD to take another look at the reductions they made in the past if an appeal was made and pending. If the appeal was voluntarily withdrawn, then another appeal would need to be filed for APD to consider eliminating the reductions. However, APD will not retroactively reduce these past iBudgets, even though technically they have the right to do so if they prevail in a hearing.
The upcoming APD letter will explain what factors APD used to determine your budget and any reductions. APD will clarify what documentation they utilized for the reductions, such as the Allocation Implementation Meeting (AIM) spreadsheet form I completed. This was done with your input and your provider(s), if you included them. APD determined your reduced iBudget based upon a complicated …“Allocation Algorithm, which is a mathematical formula based upon client characteristics (variables) and client’s level of need for services provided through the Medicaid Waiver program.” APD’s analysis of this legisl atively formulated base budget was determined by weighted values for your age, living setting, and specific scores obtained on your Questionnaire for Situational Information (QSI) assessment. This past assessment was conducted with you. The specific weights on these elements may be reviewed in the Florida Administrative code 65G-4.0210.
To obtain a iBudget increase, we requested an amount above the reduced APD target allocation on the (AIM) spreadsheet. This increased amount, along with other submitted documentation, was intended to demonstrate an ***“extraordinary need” for which the reduced iBudget would otherwise not have been sufficient to meet your Medicaid Waiver funded needs.
***”Extraordinary Need is only considered when establishing the initial iBudget for a client. An extraordinary need would place the health and safety of the client, the client’s caregiver, or the public in immediate, serious jeopardy without the provision of services or supports that would relieve the immediate, serious jeopardy and the iBudget Florida allocation algorithm amount is insufficient to fund, and includes”… life-threatening behaviors… complex medical conditions… comorbid condition… total physical assistance… a need caused by characteristics intrinsic to a client’s diagnosed condition, or the natural progression of their diagnosed condition… unique circumstances or condition of the caregiver… health and safety of the client or the client’s caregiver, or the public safety would be in immediate, serious jeopardy. (65G-4.0210 Definitions)
Below, I have included an excerpt about Hearings from the c
• “If you previously requested a hearing, and did not withdraw the request, you will not need to request a new hearing. APD will honor that request unless you ask to have it withdrawn in writing
– If you do not request a hearing per the Amended Notice your iBudget amount will be reduced to the amount stated in the Amended Notice
• If you did not previously request a hearing you can request a hearing once you receive the Amended Notice
• If your hearing was postponed until this lawsuit was resolved, the hearing will be scheduled once you have received your Amended Notice.
• You have up to 30 days from receipt of your Amended Notice to submit your Hearing Request Form and maintain your current budget level until a final hearing decision is reached
• Once 30 days have passed without a hearing request your budget will be changed to reflect the iBudget amount in your Amended Notice
• If you have already requested a hearing and your budget was restored to your previous amount, your budget will remain at that restored amount until the conclusion of your hearing and a final order is issued”.
Please carefully review the APD letter you should receive around March 15, 2014.about your iBudget and any appeals required within 30 days thereafter. Let me or APD (407) 245-0440 know ASAP if you do not receive such a letter. I am available to discuss your options and decision.
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