Date  ____________

 To:  ___________________________

          (Individual or Guardian)


The 2007 Florida Legislature required the Agency for Persons with Disabilities to adjust your cost plan as described in Section 393.0661(6), Florida Statutes (2008).  A copy is included with this Notice.  As a result your total cost plan amount is adjusted from $_______________ to $______________.


The Amendment Request Form reflecting your adjusted cost plan is attached.


Your “Notice of Hearing Rights” and “Cost Plan Rebasing Hearing Request Form” are also attached.


If you need any further information or assistance please call your Waiver Support Coordinator or your area office.  More information on the cost plan adjustment required by the Florida Legislature may be found at the Agency for Persons with Disabilities website:   http://apd.myflorida.com .



Enclosures:  Amendment Request Form

                    Notice of Hearing Rights

                    Cost Plan Rebasing Hearing Request Form

                              Section 393.0661(6), F.S.(2008)


Section 393.0661(6), Florida Statutes (2008)


(6)  Effective January 1, 2009, and except as otherwise provided in this section, an individual served by the home and community-based services waiver or the family and supported living waiver funded through the Agency for Persons with Disabilities shall have his or her cost plan adjusted to reflect the amount of expenditures for the previous state fiscal year plus 5 percent if such amount is less than the individual's existing cost plan. The Agency for Persons with Disabilities shall use actual paid claims for services provided during the previous fiscal year that are submitted by October 31 to calculate the revised cost plan amount. If an individual was not served for the entire previous state fiscal year or there was any single change in the cost plan amount of more than 5 percent during the previous state fiscal year, the agency shall set the cost plan amount at an estimated annualized expenditure amount plus 5 percent. The agency shall estimate the annualized expenditure amount by calculating the average of monthly expenditures, beginning in the fourth month after the individual enrolled or the cost plan was changed by more than 5 percent and ending with August 31, 2008, and multiplying the average by 12. In the event that at least 3 months of actual expenditure data are not available to estimate annualized expenditures, the agency may not rebase a cost plan pursuant to this subsection. This subsection expires June 30, 2009, unless reenacted by the Legislature before that date.


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Notice of Hearing Rights


The Florida Legislature requires the Agency for Persons with Disabilities (APD), to rebase (adjust) cost plans as described in Section 393.0661 (6), Florida Statutes (2008).


If you believe that the APD’s adjustment of your cost plan is wrong, you may be entitled to an administrative hearing as provided in Sections 120.569 and 120.57, Florida Statutes (2008) and 42 CFR 431.220.  A hearing will only be granted if your hearing request states facts that demonstrate APD erred in adjusting your cost plan.  Mediation is not available in this proceeding.


If APD determines you have a right to hearing, you may represent yourself or use legal counsel, a relative, a friend, or other spokesperson in a hearing on this matter.  If you are not representing yourself, proof of guardianship or other written proof of your representative’s authority to act on your behalf is required with the request for hearing.


Section 393.125(1)(c), Florida Statutes (2008), states that you must make your hearing request to the agency, in writing, within thirty (30) days of receiving your revised cost plan.  The request must be signed by you or your authorized representative.  Information about some sources of possible legal assistance maybe found at:  http://apd.myflorida.com/customers/legal/resource-listing.htm. 


If you file your request within ten (10) days of receiving your revised cost plan, your services will continue at the existing level until the final decision on your request for hearing. 


The Hearing Request Form for Cost Rebasing, which may be obtained from your Waiver Support Coordinator, the area office or from our website, may be used when requesting a hearing on your cost plan rebasing.  At a minimum, your hearing request must include the following information: 


1.     The name, address, and telephone number of the party making the request and the name, address and telephone number of the party’s counsel or representative upon whom service of pleadings and papers must be made;

2.     A statement that you are requesting an administrative hearing;

3.     A list of any facts and circumstances on which you rely to assert an error in your cost plan adjustment;

4.     A reference to, or copy of your Notice of Rebased Cost Plan  and your Amendment Request Form;

5.     A statement indicating the date you received your revised cost plan, and  

6.     If someone is making the request for hearing on your behalf, a document, such as an Order Appointing Guardian or a written statement of authorization, establishing the representative’s authority to act on your behalf.


To request a hearing mail or deliver your completed request to the local APD area office.


You may contact your local APD office if you have questions or need assistance in completing a hearing request.  You may also view the Administrative Hearings Rights brochure located at http://apd.myflorida.com/customers/legal/docs/administrative-hearings-guide.pdf  

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If you are adversely affected by the adjustment of your cost plan required by Section 395.0661(6), Florida Statutes (2008), you may request a fair hearing.  You may use this form for the request.  Please remember to provide facts that show how APD erred in calculating your new cost plan service levels.  File the completed form with your Area Agency for Persons with Disabilities office.


Petitioner’s Name:



Phone Number:

Social Security Number:


Representative’s Name:



Phone Number:


[If using a representative, please provide written authorization, guardianship order, or other documentation for this person to represent you.]


I am requesting a hearing on APD’s rebasing adjustment of my cost plan pursuant to Section 393.0661(6), F.S. (2008).  I received notice of the adjusted cost plan amount and my new cost plan from my waiver support coordinator on _______________, 2008.


APD is adjusting my cost plan from $______________ to $_______________. 


During the period July 1, 2007, through June 30, 2008, the total waiver expenditures for services for me were $__________________.


I did or did not [please circle one] have a single change of more than 5% to my cost plan on July 1, 2007 and June 30, 2008.  The change was on [provide date]  ________.


I did or did not [please circle one] have 3 months actual expenditure data during the period from July 1, 2007 and June 30, 2008.


APD erred in reducing my cost plan because __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

[please add additional pages if necessary]




____________________________________                        ___________________

[consumer or representative]                                          [date]

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