APD - Tier 2.5% Reductions

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AGENCY FOR PERSONS WITH DISABILITIES
December 10, 2010
APD Additional Instructions to Area Offices and Waiver Support Coordinators on Tier 2.5% Reductions

·Each WSC must immediately contact all individuals on their caseload who are not enrolled in Tier One to inform them orally of the notice and how it may affect their cost plan. Some individuals will need to determine how they will revise their current cost plan and adjust their services so that the approved cost plan total is under the tier cap for the assigned tier.

·Each WSC must complete a progress note in the individual’s central record to document when the contact with the individual was made and a brief synopsis of the contact.

·If person whose cost plan will be affected has not received a notice the WSC must print a notice and provide it to the individual.

·Each WSC must submit a revised cost plan to the area office no later than close of business December 30, 2010 for those individuals who did not request a timely hearing and who are affected. Only currently authorized services can be reduced in order to come into compliance with the new tier cap. If individuals want to increase a service or change the service array to address the 2.5% reduction the PSA process must be followed. Reminder: prior to revising or adjusting any cost plans, the area office must verify claims billed and WSC should verify services that have been provided but not billed.

·The WSC must ensure that timely service authorizations are provided to the service providers once the area office has approved the cost plan.

·The only list of names being sent to the areas are the names of individuals who may be affected by the reduction in tier cap.

2.5 % Tier Reduction Lists for letters sent to individuals who might be affected. There are three separate lists per area.

1. Active, over tier cap
This list includes all individuals who should have received a notification that their cost plan appears to be over the new tier cap.

Action needed:
·Area office to verify that the WSCs have their portion of this list, and remind them of the instructions.

·PCA for children under age 21 will not be counted in the tier cap. If this service is the only service placing them over the tier cap, the person does not need to reduce their cost plan. No further action is needed by the WSC or the area office.

2. No cost plan The Tier status is active, but as of the date the data was collected, no cost plan through June 30, 2011 was present for the individual.

Action needed:
·If the tier should be closed because the person is no longer on active waiver status, please advise Margie Collins in central office by email to close the waiver status, with the appropriate date.

·If the cost plan is missing in error, a new cost plan, based on currently approved services, must be entered by the WSC and notification by email to the area office that the cost plan needs to be approved.

3. TBD The tier status is currently in TBD. No action necessary until a tier assignment occurs. The new tier caps will be in effect for any tier assignments made.