1 / 39

Rick Scott, Governor Barbara Palmer, Director

Geraud Moreland II, et al v. Palmer, Case No. 4:12-cv-00585-MW-CAS (N.D. Fla.). Rick Scott, Governor Barbara Palmer, Director. Geraud Moreland II, et al v. Palmer, Case No. 4:12-cv-00585-MW-CAS (N.D. Fla.). Class Action Lawsuit filed on November 7, 2012

lilika
Download Presentation

Rick Scott, Governor Barbara Palmer, Director

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Geraud Moreland II, et al v. Palmer, Case No. 4:12-cv-00585-MW-CAS (N.D. Fla.) Rick Scott, Governor Barbara Palmer, Director

  2. Geraud Moreland II, et al v. Palmer, Case No. 4:12-cv-00585-MW-CAS (N.D. Fla.) • Class Action Lawsuit filed on November 7, 2012 • First Amended Class Action Complaint was filed on December 18, 2012 • Settlement reach on September 13, 2013 at mediation • Settlement approved and Settlement Class certified November 27, 2013 iBudget Florida APD

  3. Geraud Moreland II, et al v. Palmer, Case No. 4:12-cv-00585-MW-CAS (N.D. Fla.) Moreland settling parties engaged in extensive litigation, including but not limited to: • Written discovery • 12 depositions • A motion for preliminary injunction • A motion to dismiss • A disputed motion for class certification • Cross motions for summary judgment • Oral arguments • Evidentiary hearing iBudget Florida APD

  4. Who is a Moreland Class Member? "Settlement Class" shall mean the collective group of "All individuals who receive services under Florida's DD waiver who have received notice of final agency action of a proposed reduction to the recipient's current annual budget due to transition to iBudget" iBudget Florida APD

  5. Who is a Moreland Class Member? • “Class Member” shall mean a person who is a member of the Settlement Class • “Class Member” includes CDC+ individuals iBudget Florida APD

  6. How Will I Know if I Am a Class Member? • If you received a notice of reduction to your tier cost plan during your transition to iBudget you are part of the Settlement Class as a Class Member iBudget Florida APD

  7. Timeline for Settlement • November 27, 2013 - Settlement approved by Court • December 20, 2013 (estimated) - Reinstatement notice mailed • January 15, 2014 - budget restored • Shortly after January 15, 2014 - Amended Notice of iBudget Allocation and Reduction of Annual Funding Amount ("Amended Notice") to be mailed iBudget Florida APD

  8. Reinstatement Notice • APD will reinstate all Class Members’ cost plans on a pro-rated basis to the level they were prior to transition to iBudget iBudget Florida APD

  9. Reinstatement Notice • If you are in the Consumer Directed Care Plus Program (CDC+), and are a Moreland Class Member, please note that the CDC+ Monthly Budget for January 2014 will be increased to include the prorated reinstatement of funds • Purchasing plans will not be required for the budget increase due to the reinstatement of funds iBudget Florida APD

  10. Amended Notice • Soon after January 15, 2014, APD will issue the Amended Notice to all Class Members and at the same time to their: • Parents • Guardians • Guardian advocates • Authorized representatives iBudget Florida APD

  11. Amended Notice • Authorized representatives include: • Health care surrogates • Durable powers of attorney • Client advocates • To the extent they are authorized to receive the notice iBudget Florida APD

  12. Amended Notice • 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 iBudget Florida APD

  13. 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 iBudget Florida APD

  14. Legal Representative Information andPrimary Language • APD agreed to modify the Agency’s Allocation Budget and Contract system (ABC) to include fields for current information for: • any authorized representative and • the primary language for the client iBudget Florida APD

  15. Legal Representative Information andPrimary Language • Waiver support coordinators have been collecting all relevant addresses and primary language information for the "Settlement Class" • Your waiver support coordinator is the person responsible for verifying your address and primary language and recording the information into the APD ABC computer system iBudget Florida APD

  16. Legal Representative Information and Primary Language • Please confirm with your waiver support coordinator that she or he has done so • Waiver support coordinators with APD staff will continue to collect primary language and legal representative information for the entire DD waiver and waiting list individuals iBudget Florida APD

  17. Legal Representative Information andPrimary Language • If you have a primary language other than English, you and any identified legal representative authorized to receive a notice in the agency ABC computer system will receive two notices, one in English and the other in your primary language iBudget Florida APD

  18. What does this mean for you? • You will receive a ‘NOTICE OF REINSTATEMENT OF MEDICAID WAIVER FUNDING’ before January 15, 2014 (English Version Only) • You will have your budget restored to it's previous tier amount on January 15, 2014 iBudget Florida APD

  19. What does this mean for you? • Soon after January 15, 2014, you will receive an Amended Notice (English and Primary Language) • A Notice of Hearing Rights and a Hearing Request Form will be included in your Amended Notice iBudget Florida APD

  20. What does this mean for you? • 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 iBudget Florida APD

  21. What does this mean for you? 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 iBudget Florida APD

  22. Reinstatement of Funds • On January 15, 2014, Class Members will have their budgets restored. The restored amount will be your tier amount prior to the transition onto the iBudget waiver • The restored money will be prorated for six months and will be added to your current budget in the iBudget technology system iBudget Florida APD

  23. What Will I See In My Amended Notice? • This is the Amended Notice of your individual yearly (12 month) funding amount (“iBudget Allocation”) for your transition into the iBudget Florida Program • In addition to setting out your iBudget Allocation, it will describe the reasons for the Agency’s decision on your funding, as well as the information relied upon in reaching that decision • The Amended Notice will also include a Notice of Hearing Rights and a Hearing Request Form iBudget Florida APD

  24. What Will I See In My Notice? • Your iBudget Allocation Amount Your annual cost plan amount prior to iBudget was $______ Your annual iBudget Allocation for July 1, 2013 – June 30, 2014, is: $___________. This is the amount of funding you have available to spend in each fiscal year (which runs July 1, - June 30) absent a change in your circumstances This represents a reduction of $________from you annual cost plan prior to your transition to iBudget iBudget Florida APD

  25. What Will I See In My Notice? • The annual amount will continue until 30 days have passed without a hearing request, upon issuance of a final order after your hearing, or upon entering into a written settlement between you and the Agency iBudget Florida APD

  26. What Will I See In My Notice? • Your iBudget Amended Notice amount would continue into next fiscal year 2014 -2015 if no final order or hearing settlement has occurred iBudget Florida APD

  27. What Will I See In My Notice? • iBudget Allocation Process • Determining the Base Amount The base amount was adjusted to the amount of funds appropriated for the iBudget program by the Florida Legislature. The base dollar amount is determined by the following factors: iBudget Florida APD

  28. What Will I See In My Notice? • Your age (under 21) • Your living setting (family home, supported living, group home, residential treatment center) • The answers to QSI (Questionnaire for Situational Information) 18, 20 & 23, the total functional raw score on the QSI (questions 14-24), and the total behavioral raw score on the QSI (questions 25-30) iBudget Florida APD

  29. What Will I See In My Notice? • Your age, living setting, and your score on your QSI • The weighted factor for each of these elements (same for everyone) • How your funding was adjusted to fit the appropriation • Your adjusted base amount (“iB810 Amount”) was $_______________ iBudget Florida APD

  30. What Will I See In My Notice? 2. Target Allocation – APD calculated the amount of your currently approved services in your cost plan at the time of iBudget implementation as reflected in your sum of services included in your notice. The total for these services was $_______________ iBudget Florida APD

  31. What Will I See In My Notice? • The services included were: adult day training, behavior services, consumable medical supplies, durable medical equipment, in-home-supports, nursing services, occupational therapy, personal care assistance, physical therapy, residential habilitation, respiratory therapy, special medical home care, supported employment, supported living coaching, and support coordination • “Target Allocation” is the greater of this amount or your iB810 amount iBudget Florida APD

  32. What Will I See In My Notice? • The Allocation Implementation Meeting – Extraordinary needs review • APD directed your support coordinator to meet with you and/or your legal representative to discuss your extraordinary needs to determine whether they could be met by the Target Allocation iBudget Florida APD

  33. What Will I See In My Notice? • Together, you were to fill out an Allocation Implementation Meeting (AIM) form that was to be turned in to APD with a Recommended Cost Plan budget if you believed that an increase in the Target Allocation was necessary to meet your extraordinary needs • “Extraordinary needs” is defined in iBudget Rule 65G-4-0210(7) • https://www.flrules.org/gateway/ruleno.asp?id=65G-4.0210 iBudget Florida APD

  34. What Will I See In My Notice? • Your notice will indicate whether APD received or did not receive an AIM form from your waiver support coordinator • APD will also indicate whether other information was used to make a decision on your request for an increase in your Target Allocation iBudget Florida APD

  35. What Will I See In My Notice? • Other Information that APD could have used to determine your budget included: • AIM Form • Documents submitted with AIM Form (list) • Support Plan • QSI • Behavioral Plan • Other iBudget Florida APD

  36. What Will I See In My Notice? Based upon the information just listed, APD decided that: • You DO NOT have extraordinary needs that would require an increase in your Target Allocation amount. Thus, your iBudget Allocation is $______________ OR b. You DO have extraordinary needs that require an increase of $________in annual funds, thus your iBudget Allocation is $___________ iBudget Florida APD

  37. What Will I See In My Notice? • You will see the reason(s) why APD increased or did not increase your budget based after review of any extraordinary needs • Included in your notice will be: • Your EZ iBudget Calculator • List of Services and Annualized Amounts • AIM Worksheet (attachment) • Notice of Hearing Rights • Hearing Request Form • AIM form-if one was completed as part of the decision process for your iBudget iBudget Florida APD

  38. Additional Information • Your waiver support coordinator can amend your current service • You may request additional (new) services to be approved at your local Regional APD office • New services will need to be considered medically necessary and must be supported by all required documentation iBudget Florida APD

  39. Thank You Please direct your questions to your local Regional APD Office iBudget Florida APD

More Related