Jack Levine headlines both the Provider Forum (Tues. Jan 3) and Advocacy Meeting (Wed. Jan. 4) the first week of new year. Jack Levine has been advocating for vulnerable people his entire life. Just two years ago he was recognized with the prestigious Chiles Advocacy Award, the top advocacy award given out in Florida. Over the years, he’s assembled a network of allies, wooed politicians and the media, and amassed an impressive email list to which he regularly dispenses his tenets. As a strict nonpartisan, it’s always been Jack’s philosophy to find those in office, irrespective of party affiliation, and create a conversation beyond just a meeting. The theme of our meetings focuses on speaking with one voice. When inviting Jack Levine to speak his response was the following, “I trust you understand the value of speaking up on public policy matters which can influence support for your program. Responsible advocacy is the heartbeat of a representative democracy. Remember....the root of advocacy is "voca"....the voice!” Mark your calendars!
Must read: The Biggest Concern of the proposed Setting Rule and the impact on ADTs. In 2014, the Centers for Medicare and Medicaid Services (CMS) announced the Settings Rule. This is a set of rules that providers and states must follow to receive funding. States must be in full compliance with the Settings Rule by March 17, 2023. Florida is currently in the process of coming into compliance with a goal to be integrated in and help provide full access to the greater community, improve self-determination and independence in making life choices, be chosen by the individual from among residential and day options, including settings that are not only for people with disabilities (called “non-disability specific settings”), and to make sure there is a choice of services and providers. The Settings Rule can be very beneficial to individuals with intellectual and developmental disabilities because the Rule’s objective is to provide choices and ensure rights and opportunities for integration. As with any federal regulation, Florida must navigate the different issues that arise when determining how Florida comes into compliance the Settings Rule. This comment addresses a concern regarding Adult Day Training and the negative impact the proposed rule could have on clients around the state. The proposed Settings Rule that AHCA proposed regarding ADT is more restrictive than the federal rule requires. The Agency for Persons with Disabilities (APD) released a document quoting language from guidance issued by CMCS in 2011. They stated that “Waiver funding is not available for the provision of vocational services (e.g., sheltered work performed in a facility) where individuals are supervised in producing goods or performing services under contract to third parties. Employment related waiver services must be provided in accordance with CMCS Informational Bulletin dated September 16, 2011.” In fact, however, the CMCS Bulletin states “Waiver funding is not available for the provision of vocational services delivered in facility based or sheltered work settings, where individuals are supervised for the primary purpose of producing goods or performing services.” The omission of the term “primary purpose” fundamentally alters the meaning and intent of the Federal guidance and limits choice to the detriment of individuals on the waiver. The Arc of Florida urges that the rule add the “primary purpose” qualifier. Although federal law prohibits “sheltered workshops” with a third-party contract in habilitation settings (for the primary purpose of the production of goods and services), it is important not to confuse a “sheltered workshop” with a facility-based program that provides day habilitation (including opportunities to earn money) and/or prevocational services. Under CMS rules, individuals in prevocational training can be paid (based on federal law). Prevocational training can also be provided in a facility-based setting. Where people choose to work varies depending on many factors and we should support the efforts of all to reach their highest potential based on their individual needs and preferences. Everyone should have the opportunity to participate in integrated employment and it must be the individual’s choice.  
 
If the proposed rule is promulgated, the following are some issues not addressed:
  • Personal supports are not always available at an integrated workplace. Some clients have ratios of 1:5 or 1:3 all through high school until the age of 22 and need continued support at their job.
  • Although this federal rule does specifically address 14(c), it is likely to have the unintended consequence of eliminating 14(c) programs without the legislature being aware and making decisions as a matter of state policy.    
  • Transportation to the workplace is often not available.
  • Capacity for some clients to do the job without on-site supervision will be an issue.
  • Some communities do not have job openings; ADT creates jobs for clients so they can have the satisfaction and pride of employment.
  • Our clients are generally only able to find part-time jobs in the community and these jobs do not pay enough for them to live independently.
  • Safety concerns: Clients could elope or become sensory-overloaded. Parents have expressed concern that their adult child lacks critical safety skills placing them at risk of abuse, neglect or exploitation.   
  • People with I/DD should have the same freedoms to work remotely, or in whatever environment they choose to work that meets their personal needs as neuro-typical individuals.

The Arc of Florida recently responded to the proposed rule through formal comments. We stated that ACHA should not implement the rule more restrictively than the federal rule requires. More restrictive implementation would result in unintended consequences, reduce choices for individuals served under the waiver, and may cause people to access costlier institutional services.
Room and Board Advisory from The Arc of Florida consistent with APD. The question routinely arises whether the Agency for Persons with Disabilities (APD) can set room and board rates for licensed residential care facilities. There are no Florida statutes or provisions of the Florida Administrative Code that authorize APD to do this. Such rates should be determined by the client or client’s representative and the facility. Social Security law and regulations require payees to use the payments they receive for the current needs of the beneficiary as well as in their best interests. Each month individuals who live in a community residential facility pay to cover the costs of providing food and rent. This arrangement is recognized by the Federal Medicaid program which prohibits room and board payments being made from Home and Community Based Services waivers. The money for room and board may come from Supplemental Security Income (SSI), Social Security Disability Insurance (SSDA), Florida Optional State Supplementation (OSS), APD room and board subsidies, or private money. Providers are responsible for maintaining and continuously improving residential properties so each individual lives in a well-maintained home. In addition, providers must manage benefits so that each individual has funds available to live a full and active life. When an individual receives a Social Security Cost of Living Adjustment (COLA), the adjustment is to benefit the individual. By utilizing the increase for both Room and Board and Personal Allowance, the individual’s home, food and personal needs will all receive a portion of the additional funds for ongoing improvements and needs.

APD during a Regional Provider meeting discussed the issue. The following question and answers were provided by APD in the chat:  
  • Q:  Is there a standard fee for room and board that every provider give to the clients? A: The formula for Room and Board on the APD website is the maximum amount that the State would pay if the individual is unable to pay based on their Social Security amount. The group home provider can determine what they charge each resident and it should be outlined on their lease paperwork.
  • Q: Can we have something in writing stating the increase for room and board to give to the families? A: APD does not have anything in the licensure rule regarding setting room and board rates.
Thank you for your advocacy! If you want additional information regarding this issues, please contact our CEO Alan Abramowitz at alan@arcflorida.org or 850.241.3232.