Sep 23, 2011

APD's new chief questions whether funding can sustain its mission

The Agency for Persons with Disabilities usually is under the microscope for financial reasons. Significant financial deficits and long waiting lists for waiver services have plagued APD since its inception and, in two presentations before the Legislature this week, newly hired APD Director Mike Hansen told legislators why.

The money the agency is given, he said, isn't enough to fulfill its mandate from the Legislature to provide community-based services to developmentally disabled people so they can live in communities and not in institutions.

"I think we may have a discrepancy, or difference of approach, between what the law says and the amount of money that's available to fund the things (required services) in the law," said Hansen, who was named APD director by Gov. Rick Scott on July 28.

Hansen suggested to both the House Health & Human Services Access Subcommittee and the House Health Care Appropriations Subcommittee that legislators may want to "look at the requirements and the funding, and reconcile the issues."

Specifically, Hansen noted the law directs the state to give the "greatest priority" to develop community-based programs and services that "enable individuals with developmental disabilities to achieve their greatest potential for independent and productive living, enable them to live in their own homes or in residences located in their own communities, and permit them to be diverted or removed from unnecessary institutional placements."

Hansen said the language was "broad" given the current funding the agency receives.

Since 2004 the agency has been charged with providing services to the state's developmentally disabled people. It was separated from the Department of Children and Families and made into a freestanding department in 2004 by then-Gov. Jeb Bush. The agency provides home and community based services to nearly 30,000 Floridians through a Medicaid waiver. Another 20,000-plus Floridians are on a waiting list to obtain the waiver services.

Autism Society of Florida President Ven Sequenzia doesn't like Hansen's approach, saying if the agency narrows its scope and limits services, "you're doing exactly what you say you don't want to do. It's going to lead to more institutionalizations."

Hansen, who has spent the past decade in the governor's budget office as well as in the House and Senate budget committees, was brought on board to help set APD aright. The agency has been bedeviled by budget deficits in recent years. This past session the Legislature OK'd a law requiring the agency to bring its spending in line with its appropriations, which for fiscal year 2011-12 amounted to $810 million, or about $120 million less than what the agency spent the previous fiscal year. The Legislature also required the agency to cut provider rates by 4 percent and to freeze services so costs wouldn't go up.

Additionally, the 2011 Legislature required the department to submit a cost-cutting plan to it and Scott detailing how it would further cut spending. The report -- submitted Sept. 1 -- outlined a number of reductions the agency took during the summer, such as limiting transportation options to one round trip per day and reducing state payments for companion care.

Despite the Legislature's mandated rate cuts and the reductions APD identified this summer, the agency still will have a $55.2 million projected deficit at the end of fiscal year 2011-12. As of September the agency had a $7.5 million deficit.

Hansen outlined 10 additional options APD was considering to bring spending in line. Those include reducing rates APD pays for therapy assessments and nursing services to the same rates paid by the state Agency for Health Care Administrations for its Medicaid patients; reducing the rates it pays to home health agencies to 20 percent above the rates APD pays to solo practitioners who don't work for an agency; and to implement cost sharing requirements for parents of children who are served on the APD waiver.

Hansen also is submitting to the Legislature monthly reports of the agency's running surplus or deficit. Hansen, however, characterized the figure as an estimate he said is always wrong.

"I don't know if it's too high or too low," he said.

story by: Christine Jordan Sexton