Florida Medicaid 5010 Implementation

Therap is 5010 Compliant:

Therap 5010 Support

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Better Health Care for All Floridians

A Division of the Agency for Health Care Administration

Health Care Alerts & Provider Alerts Messages
December 2011

Provider Type(s): All

Reminder – Florida Medicaid 5010 Implementation Schedule

The FMMIS will be frozen from 8:00 p.m. January 1, 2012 until 4:00 a.m. January 2, 2012 for inbound transactions.

4010 versions of X12 transactions will no longer be accepted after 8:00 p.m. January 1, 2012.

Please disregard the following if you or your billing partner have already converted to X12 5010 for outbound X12 transactions before December 30, 2011.

If you have not converted to 5010 before December 30, 2011 you will receive X12 Outbound batch and or real-time for 820, 834, 835, 271, 277, 277U transactions as follows:

  • Transactions submitted to the FMMIS before January 3, 2012 will be provided on the outbound transaction in the current 4010 X12 version.
  • Transactions submitted to the FMMIS after January 2, 2012 will be provided on the outbound transaction in new 5010 X12 version.

New Florida APD Director, “Setting The Course”


Setting the Course for APD

APD Director Mike Hansen

I am happy and excited to be the new director of the Agency for Persons with Disabilities. I look forward to continuing to offer needed services to Floridians with developmental disabilities. That is the agency’s number one priority—protecting the health and safety of the people we serve.

The biggest challenge before the agency is keeping Medicaid waiver expenditures within the legislative appropriation this fiscal year. I have a great team here to help me tackle this issue.  I also plan to reach out to all stakeholders, especially customers, to find solutions.

The agency must continue to move ahead. A boater’s analogy to new leadership is that APD will continue to move forward, however the rudder may take us in a slightly different direction. We need to embrace and accept change.

APD is here to help Floridians with developmental disabilities be a part of their communities. The agency is part of the equation, but community resources and, most importantly, families, are critical to ensure an individual is fully active in their neighborhood.

I want to ensure APD is providing the tools needed to help someone achieve all their goals like holding a job and living in a comfortable home.  As a runner, I want to encourage our customers to do some type of exercise each day.  I hope to get involved in Special Olympics. I think it is good for everyone to compete against themselves. It is rewarding and healthy at the same time.

I hope to develop better relationships with the business community and more opportunities for employment for our customers. I want to know that the agency is doing the right things to help prepare people to go to work.

My plans include restructuring the agency. I want to move decision making to the local level where employees know best how to meet people’s needs.  I will hold the area offices accountable for their performance.  The area offices must live within their budgets while also protecting the health and safety of customers. The agency will be transparent in its activities.

The toughest challenge for the agency is determining how to help people waiting to enroll in the Medicaid waiver.  There is no easy solution.  APD will continue to assist people on the waiting list with some services, like transportation and supplies, during this fiscal year.  Down the road once the agency has balanced its budget and expenditures, I am hopeful we can offer waiver services to some individuals on the waiting list.

I look forward to working with customers, providers, employees, and stakeholders to address the many challenges facing the Agency for Persons with Disabilities. Working together, we will be able to meet these challenges successfully.

Travelling the Florida Panhandle

A quick stop in Panama City this week as I travel the Florida Panhandle.

Panama City

St Andrew Bay!  A BEA-utiful sunset glow!  Headed East this evening toward Daytona Beach and the off to Port St Lucie for a “Wedding”!  There must be something in the air.

If you are looking at Therap Services for the first time, visit our Website at www.TherapServices.net where you will find an abundance of information about Therap.  There are over 700 organizations using Therap Services across 45 States, and 5 States are using Therap Statewide to manage their Disability Systems.  What do they all know that you don’t?  Check us out and find out!

Electronic Documentation for I/DD providersTherap Services…The “Paperless” standard in electronic documentation for organizations and States serving developmental disabilities!


For Immediate Release:
Tuesday, July 13, 2010
Contact: CMS Office of Public Affairs


Secretary Sebelius Announces Final Rules To Support

‘Meaningful Use’ of Electronic Health Records

WASHINGTON – U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced final rules to help improve Americans’ health, increase safety and reduce health care costs through expanded use of electronic health records (EHR).

“For years, health policy leaders on both sides of the aisle have urged adoption of electronic health records throughout our health care system to improve quality of care and ultimately lower costs,” Secretary Sebelius said.  “Today, with the leadership of the President and the Congress, we are making that goal a reality.”

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives.  One of the two regulations announced today defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology.

Announcement of today’s regulations marks the completion of multiple steps laying the groundwork for the incentive payments program.  With “meaningful use” definitions in place, EHR system vendors can ensure that their systems deliver the required capabilities, providers can be assured that the system they acquire will support achievement of “meaningful use” objectives, and a concentrated five-year national initiative to adopt and use electronic records in health care can begin.

“This is a turning point for electronic health records in America, and for improved quality and effectiveness in health care,” said David Blumenthal, M.D., National Coordinator for Health Information Technology.  “In delivering on the goals that Congress called for, we have sought to provide the leadership and coordination that are essential for a large, technology-based enterprise.  At the same time, we have sought and received extensive input from the health care community, and we have drawn on their experience and wisdom to produce objectives that are both ambitious and achievable.”

Two companion final rules were announced today.  One regulation, issued by the Centers for Medicare & Medicaid Services (CMS), defines the minimum requirements that providers must meet through their use of certified EHR technology in order to qualify for the payments.  The other rule, issued by the Office of the National Coordinator for Health Information Technology (ONC), identifies the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

As much as $27 billion may be expended in incentive payments over ten years.  Eligible professionals may receive as much as $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.

The CMS rule announced today make  final a proposed rule issued on Jan, 13, 2010.  The final rule includes modifications that address stakeholder concerns while retaining the intent and structure of the incentive programs.  In particular, while the proposed rule called on eligible professionals to meet 25 requirements (23 for hospitals) in their use of EHRs, the final rules divides the requirements into a “core” group of requirements that must be met, plus an additional “menu” of procedures from which providers may choose.  This “two track” approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers’ needs and their individual path to full EHR use.

“CMS received more than 2,000 comments on our proposed rule,” said Marilyn Tavenner, Principal Deputy Administrator of CMS.  “Many comments were from those who will be most immediately affected by EHR technology – health care providers and patients.  We carefully considered every comment and the final meaningful use rules incorporate changes that are designed to make the requirements achievable while meeting the goals of the HITECH Act.”

Requirements for meaningful use incentive payments will be implemented over a multi-year period, phasing in additional requirements that will raise the bar for performance on IT and quality objectives in later years.  The final CMS rule specifies initial criteria that eligible professionals (EPs) and eligible hospitals, including critical access hospitals (CAHs), must meet.  The rule also includes the formula for the calculation of the incentive payment amounts; a schedule for payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs, eligible hospitals and CAHs that fail to demonstrate meaningful use of certified EHR technology by 2015; and other program participation requirements.

Key changes in the final CMS rule include:

Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use.  The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012.  This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.

  • An objective of providing condition-specific patient education resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
  • A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which  conforms to the Continuing Extension Act of 2010
  • CAHs within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

CMS’ and ONC’s final rules complement two other recently issued HHS rules.  On June 24, 2010, ONC published a final rule establishing a temporary certification program for health information technology. And on July 8, 2010 the Office for Civil Rights announced a proposed rule that would strengthen and expand privacy, security, and enforcement protections under the Health Insurance Portability and Accountability Act of 1996.

As part of this process, HHS is establishing a nationwide network of Regional Extension Centers to assist providers in adopting and using in a meaningful way certified EHR technology.

“Health care is finally making the technology advances that other sectors of our economy began to undertake years ago,” Dr. Blumenthal said.  “These changes will be challenging for clinicians and hospitals, but the time has come to act.  Adoption and meaningful use of EHRs will help providers deliver better and more effective care, and the benefits for patients and providers alike will grow rapidly over time.”

A CMS/ONC fact sheet on the rules is available at http://www.cms.gov/EHRIncentivePrograms/

Technical fact sheets on CMS’s final rule are available at http://www.cms.gov/EHRIncentivePrograms/

A technical fact sheet on ONC’s standards and certification criteria final rule is available at http://healthit.hhs.gov/standardsandcertification


The following is an excerpt from the FFDDnews.com website at:

Visit the link to email your Florida Legislators!


The House and Senate are working on the budget now and can not agree on funding of the “Resources to Address Waiver Deficit” funding.
The House has added an additional $110,376,456 to cover those currently receiving services under the DD waiver for next fiscal year, the Senate has not added this additional funding.

We must encourage the Legislative Leadership to adopt the House position.

Since the issue was not resolved at the committee level, it was bumped up to Rep. Denise Grimsley and Sen. JD Alexander, Appropriations Chairs.
From there it will go to the House Speaker Dean Cannon and Senate President Mike Haridopolos.

Thank you for your advocacy and for taking action. It really does make a difference!

Susan Goldstein

UCP National Conference in “The Big Easy”, New Orleans

Last week I represented Therap Services as an Exhibitor at the United Cerebral Palsy 2011 Annual Conference.  It was an excellent conference as UCP Affiliate Executives and other organization staff  attended very meetings around the theme of  Its All Local!

It's All Local

Stephen Bennett

The CEO of United Cerebral Palsy, Stephen Bennett said

On behalf of the Board of Trustees of UCP and myself, thank you for attending Life Without Limits: It’s All Local, UCP’s 2011 Annual Conference.  Your participation in New Orleans this week helped strengthen UCP’s network of close to 100 affiliates across the globe that are advancing the civil rights movement for people with disabilities.

We learned a great deal from one another over three days in the “Big Easy.”

Glen Harger

Congratulations Glenn!

During the reception on the first evening my esteemed colleague and  good friend, Glen Harger, CEO of UCP of Mobile was honored:

2011 Kathleen O. Maul Leadership Award was presented to Glenn Harger, CEO of UCP of Mobile, for his leadership and strong commitment to UCP. He joined the affiliate of UCP of Mobile in 1989 and has grown the affiliate from a budget of $400,000 and 12 employees to a budget size of $4.1 million and 75 employees. He served in a leadership role as Chair with the National Administrators Council and as the first chair of the Professional Council following the reinvention of the management structure for UCP. He has offered his expertise to the planning and logistical support of several UCP annual conferences and has faithfully participated in Regional Administrator Council meetings. He currently serves as the Chair of the Program Advancement Ad Hoc Committee. Glenn previously served on the Affiliate Services Committee and was the Chair of the Interagency Coordinating Council of Alabama for Early Childhood Intervention. Throughout his time with UCP he has been a respected, vocal executive director who not only has Southern charm and a booming voice but a great passion for people with disabilities.

The conference was also attended by long time supporter and Actress, Cheryl Hines.  She took time to dance the night away as she was swept off her feet by this incredible interactive Robot, built and presented by:

Picture of Diane Wilush, Executive Director, in UCP National Conference

Original Picture is Unavailable

The conference was a great time as I had the opportunity to visit with many of my long time colleagues including some of Therap’s current UCP customers like Diane Wilush, Executive Director, UCP of Georgia and South Carolina along with Brad Beasley, Assistant Executive Director, UCP of South Carolina.  Many of the UCP affiliate directors and program staff were so excited when they saw some of what Therap can do for them.  And with our new mobile app for IPhone and IPad, it was a thrill to demonstrate how simple it is for staff to document services from anywhere while Therap pegs the staff providing the services, time and location without having to enter that information.  For more information about Therap Mobile Apps go to: https://www.therapservices.net/apps/

Picture of Therap Booth in UCP National Conference

See y’all next year!

Catastrophic Rate Cuts for Floridians with Developmental Disabilities Lifted!

From the Governors Website:

Governor Rick Scott Lifts Emergency Rule for APD

4/14/2011; Tallahassee;

Reaches deal with House and Senate to release funds for services

Governor Rick Scott today announced an agreement with the House and Senate that would provide an infusion of cash that will prevent the Agency for Persons with Disabilities from discontinuing services.

“I thank Senate President Mike Haridopolos and House Speaker Dean Cannon for joining me to protect the community APD serves, and I applaud the hard work of the staff at APD for finding a solution to this problem,” Governor Scott stated. “After years of deficit spending that put these services at risk, I’m glad that we’re taking steps to finally bring responsible financial management to this agency and the people they serve.”

After an Inspector General report disclosed that the agency would likely run out of cash to pay for needed services in early May due to an unprecedented $174 million budget shortfall, Governor Scott issued an emergency order stretching funds through the end of the fiscal year to avoid any cutoff of services.

The Governor’s Office worked closely with the Legislature to find a way to provide immediate funding so that the Emergency Order could be lifted and to find a long term solution to the problem. Governor Scott also continues to work with the Legislature and members of the disability community to develop strategies to prevent future shortfalls in APD’s budget.

Today’s deal lifts a hold on approximately $30 million that will cover the agency’s provider costs through the end of the fiscal year.

Gov. Scott hoping Legislature will ante up to help disabled Floridians

Gov. Scott to aide APD

Gov. Rick Scott speaks to Agency for Persons with Disabilities employees Tuesday, April 12, as Lt. Gov. Jennifer Carroll and Bryan Vaughan, acting director of APD, listen. / Bill Cotterell / Pensacola News Journal

TALLAHASSEE – Gov. Rick Scott, who ordered an across the board spending cut by the Agency for Persons with Disabilities to address a projected $174 million budget shortage, said today he hopes the Legislature will put up “emergency funding” to prevent disabled Floridians from losing services.

“It’s real frustrating to come to office and within the first few months have to do an emergency order to figure out how we get a handle so we don’t run out of money before we get to the fiscal year,” Scott told about 100 APD employees after a tour of their agency. “Hopefully, we’ll see if the Legislature will give us some emergency funding. But we have to live within our means.”

Scott ordered a 15 percent reduction in state payments to providers who care for developmentally disabled people. More than 6,000 providers statewide are reimbursed for in-home or group-home services through the Home and Community Based Services waiver program. This year’s budget appropriates $806 million for the program but costs were projected to be $980 million. The program also has a $50 million deficit from last year.

Advocates for providers and clients say the impact of the 90-day cut will be 20 to 30 percent – or more – because companies providing attendants to clients also lost allowances for many administrative services.

Scott said after his APD visit that he has notified the Legislature of the $174 million shortage, which has been snowballing since about 2005. Then, APD added about 5,000 clients to its service rolls but has never received legislative funding to cover the additional services. The agency serves about 35,000 people, about 30,000 of them through the Medicaid waiver program that was reduced by Scott’s order.

Scott said he could “withdraw the executive order” and restore full payment to service providers, if the Legislature covers the funding gap. But he said he doesn’t want it to happen again in future fiscal budgets.

“The other thing that we’ve got to do is, we’ve got to make sure this doesn’t continue,” said Scott. “As we all know, this was the worst year, being $174 million over, but it’s been going on since the agency started. So we’ve got to come up with a funding mechanism and a management team that’s going to make sure we take care of this very vulnerable group of people but also make sure we live within our means.”

Florida ARF Develops a Website to Track Impact from Funding Cuts!

Logo of SOS Florida

On March 31, 2011, the Agency for Health Care Administration (AHCA) filed Emergency Rules to cut DD Medicaid Waiver provider reimbursement rates for 90 days. The emergency rules implement a plan developed by AHCA and the Agency for Persons with Disabilities (APD) in response to a projected $170 million APD deficit. While the rate reductions are expected to reduce state General Revenue expenditures by $16.3 million over a 90 day period, they will result in the loss of another $30 million dollars in federal Medicaid funding. The reductions were effective April 1, 2011.


The APD deficit is not a recent event. Analysis shows it is primarily attributable to APD’s FY 05-06 decision to add 5,000 individuals to the waiver late in the year without adequate funding to support the annualized cost of services. The legislature provided temporary relief, particularly in FY 07-08 with non-recurring funds, but funding levels have declined and simply do not cover the cost of care for all of the 31,000 enrollees. Current funding for the DD waivers is at $805 million and is only slightly higher than it was at the beginning of FY 05-06; yet, about 5,000 more individuals are being served at an average annual cost of $30,000, thereby creating a $150 million funding gap.

A March 2011 report by Governor Scott’s Chief Inspector General, Melinda Miguel, indicated: “The state had no system or standards to assure that per-client community care was cheaper than services in an institutional setting, and this may have contributed to budget overruns.” The report concludes APD provided client services without concern for available dollars and, “There are no financial controls to assure approved client cost plans match the amount available to APD to provide the services.” Miguel’s report went on to say that: “This disconnect has resulted in authorization of expenditures in excess of the amounts authorized to carry out the HCBS waiver program and may have violated Section 216.311,F.S., which provides that no agency or branch of state government shall contract to spend, or enter into any agreement to spend, any moneys in excess of the amount appropriated to such agency unless specifically authorized by law.” Also, lawmakers have recently acknowledged that: “While APD may have poorly managed payments to hundreds of contracted, private caregivers, the legislature may be at fault by underestimating state needs.”

Please note that providers do not control cost plans, do not approve enrollees, do not determine service rates, and do not establish units of service. All services have to be deemed medically necessary and approved by the state before reimbursement can be claimed by any provider.

Some point blame at individuals and advocates (about 5,000) who exercised their due process rights several months ago when they were placed into tiered waivers that were enacted as cost control measures. Due process is a fundamental right in our society and is an important checks and balances system within the DD Medicaid waivers to ensure that recipients are receiving the services they need. By the end of this fiscal year, most if not all of the appeal hearings will be resolved, the state will have determined if its tier waiver placements are meeting the needs of individuals with developmental disabilities, and the true savings from the tiered waivers will be known.

The real problem is the state is trying to serve too many individuals with too few dollars. True resolution of the deficit will require either reduced enrollment, which is not a desirable option, or allocation of additional dollars to cover the cost of care combined with strict utilization management principles so more waitlist individuals can be served. Also, please note that until the last few years, increasing enrollees resulted in corresponding appropriations and were determined by the Florida legislature. We must return to this practice.


The rates that are being cut were established in 2003 as a result of a legislative mandate to implement a uniform rate system and were based on the Mercer Rate Study. These rates are primarily based on direct care staffing funded at the 25th national percentile for average wages, and they have been reduced by 15-25% since 2003 and prior to the April 1 emergency rules. Our provider members are reporting that the new rates will not cover minimum wage rates for direct care staff.

The April 1 emergency rules cut rates for 27 services, and the cuts range from a minimum of 15% for 8 DD waiver services to as high as 30-40% for another 19 services. While the rate reductions are being described as a “15% cut for all rates,” they also eliminate the separate rate structure for independent and agency providers and result in a “triple net effect” for many community agency providers who will lose their agency rates, absorb an additional 15% cut on the new lower independent rates, and receive both of these reductions on multiple services.

The agencies who will receive the “triple net effect” were encouraged by APD to transition to community-based services and supports because this was considered to be the preferred model. Unfortunately, these cuts will force closure of the same agencies that were encouraged to offer supported employment, supported living, in home supports, and other services that enable higher levels of independence.

APD indicates the rate cuts have the: “Least impact on clients and insures their health and safety while still significantly addressing the deficit in the most expeditious manner.” Further, “The temporary plan has been designed so that providers absorb the reductions over the short term of the plan, from April 1, 2011, through June 30, 2011.” However, about 1,000 individuals and families served via the Consumer Directed Care program are being told to reduce their expenditures by 15%, meaning either fewer services or families will have to absorb the reduction.

Based on national Medicaid calculations, the emergency reductions will likely result in the loss of 1,278 jobs if agencies cannot find the resources to subsidize the cuts. Sustainability will be difficult since most DD Medicaid waiver provider agencies are heavily dependent on Medicaid funding. Also, most are not-for-profits and adhere to strict funding guidelines that limit cost shifting. While some may be able to survive for a short time as a result of local contributions, this is not a viable strategy in this current economic climate. Over the next 90 days, provider agencies will be challenged to meet staffing standards and comply with stringent program requirements contained within the DD Waiver Handbook.

By June 30, 2011, APD hopes to generate $48 million in savings from rate cuts, collapsing of independent and agency rates, and cost plan freezes. However, the plan is time limited and offers minimal long-range cost controls. Regrettably, the state did not accept suggestions to address this matter over a 15 month period even though deficit spending has been rolling forward for several years.

Four days after implementation of the emergency rates, reports show that agencies are closing, clients can no longer be served, and individuals are losing services. For providers who were already struggling to survive in this current economic climate, 15-40% reductions cannot be absorbed for even 90 days.


This deficit was not caused by providers, nor was it caused by the individuals who receive their services. Ultimately, there is a cost of care that must be paid and cutting rates because it is an “easy” way to respond to a deficit is not acceptable public policy. Furthermore, any lack of control and oversight over the last several years is not the fault of the individuals served or community provider agencies who act on behalf of the state to meet the needs of individuals the state would otherwise have to serve, and typically in more expensive institutional settings. Providers and individuals with developmental disabilities should not be expected to pay the price for poor public policy and lack of state budget controls.

By early May, the legislature will have passed its General Appropriations Act for next fiscal year. Senate Bill 2000 proposes to reduce the DD waiver by another $90 million dollars. If the Senate bill prevails, funding for this program will be reduced to $715.5 million; and, if the deficit must be eliminated expenditures will have to be reduced by $215 million which equates to a 25% program cut. If the House position (HB 5001) prevails, the DD Waiver program will be funded at approximately $862 million next fiscal year which is a $67 million increase. HB 5001 also identifies $169 million that can be used to cover this year’s APD deficit.

Realistically, the APD budget needs to be funded at $900 million to meet the needs of those who are currently enrolled. For this to occur, the legislature will need to add an additional $95 million (state and federal funds) for next fiscal year. If this occurs, the program can be stabilized and APD can turn its attention to serving additional individuals from the wait list.

Information* received from the Agency for Persons with Disabilities (APD):

Governor’s Chief Inspector General Report*:

Information* gathered from Florida Providers:

*You must have Adobe Reader to view documents


APD Takes Action to Prevent Elimination of Services

March 31, 2011
Melanie Mowry Etters
Communications Director
(850) 488-4257

TALLAHASSEE – The Agency for Persons with Disabilities (APD) and the Agency for Health Care Administration today submitted an emergency plan to reduce provider payment rates by 15 percent for the next three months. This emergency action is to address APD’s more than $170 million deficit in the Medicaid waiver program. Florida law (Chapter 393.0661(7) and (8) Florida Statutes) requires these agencies to take action when it is determined that APD is spending more money than was allocated by the legislature. APD received $805 million for waiver services this year.

The plan will also eliminate the differential between agency and solo rates. In addition, the agency will not increase cost plans through Prior Service Authorizations or annual reviews without review and approval by the director of APD. In the case of an emergency affecting an individual’s health and safety, APD will review a request for additional services using the criteria applied to crisis determinations. The emergency rule will be in effect until the end of the fiscal year which is June 30.

APD Chief of Staff Bryan Vaughan said, “These actions are necessary to comply with statutory obligations so that we are not forced to eliminate services to this vulnerable population. APD is committed to protecting the health and safety of Floridians with developmental disabilities while living within our budget.”

The agency annually serves about 35,000 Floridians with developmental disabilities of mental retardation, autism, cerebral palsy, spina bifida, and Prader-Willi syndrome. For more information on the agency, call 1-866-APD-CAREs or visithttp://apdcares.org.

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