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Letter Medicaid Waiver
Jeb Bush, Governor Shelly Brantley, Director District 11 Office 401 N.W. 2nd Avenue, Suite South 821 Miami, Florida 33128 (3051 349.1478 Fax: (105) 349-1479 ogency for persons with disobilities State of Florida Date: May 7, 2008 Dear Medicaid Waiver Service Provider: Effective July 1, 2008, your Medicaid Waiver Service agreement with the Agency for Persons with Disabilities (APD) will expire. Each provider of Medicaid Waiver services must have a signed Agreement on file in order to be authorized to deliver services under the Home and Community Based Developmental Disabilities (HCBS) and Family and Supported Living (FSL) Waivers. Please note that this agreement will apply to both waivers if you are enrolled as a provider under both the HCBS and FSL Waivers. Please review the Agreement attached. Do not change or alter the document except to complete the following items: •:• Page 3, section VI Official Representatives. #1. (Name, Address, Telephone Number E -mai) address) •:• Page 3, #2 (Name, Address, Telephone Number and: E -Mail address) :• Page 4, (bottom left) Complete::the area.indicate.d as. Signed byNainei-Title, and Date W. There is an attachment to the Agreement if you are an enrotfed provider for -transportation services that indicates your negotiated rates for payment : A►so<attached is a report forrhaf that is.:required Eo be =submitted annually by June 1. The following documents have been incorporated by reference Core Assurances as described inthe current Developmental Disabilities Waiver Services Coverage and Limitatib;is:handtio©k. . ;: ❖ Rate Structure tlocumen#s, currently available on the APD Website at` .:.......... . httoatapd:myftarida:comlclients/s:.::`><:>::..>:�:::>:.; The Fainly and SuppQtfed Liv<ng Waiver.services directoryava(labte at APD website http://apd myflorida com/cllentsf The Developmental DlsablNes Walver Services Coaerage and Limitations Handbook, which list the requirements for Medicaid waiver Provider participationmand specific. services. It is available on the Agency for Health Care Adtninistratior(:web site httpalflbridamedicaid.acs-inc.com. Return the signed agreement to the Area 11 program office staff rstetl below no later than June 15, 2007 Austin. Dean : Human:Services Program. Specialist::. :. Developniehtal Disabilities Program 401 NW 2ndAvenue;::Suite S -82V Miami, FL 33128 After final review by the Agency for Persons with Disabilities, you will be provided with a copy of the Agreement for your records. Thank you in advance for your attention to this matter, Should you have any questions please contact me at (305) 377- 5440 or Austin Dean, Provider Enrollment Specialist at (305) 377-5736. Sincerely, Carolyn L. Eleby, __... Program Operations Administrator Cc :Evelyn Alvarez, Area 11 Program Administrator