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Thursday, November 17, 2011 9:30 A.M.
401 NW 2ND AVENUE, SUITE N-1011, MIAMI, FL 33128
Meeting began at 9:40 a.m. Area Administrator Ms. Evelyn Alvarez welcomed I. CALL TO ORDER
everyone and requested that all phones be silenced to avoid interruptions. Special Announcement: Hillary Jackson is on extended medical leave until
further notice. She is doing better and on was discharged from the hospital yesterday is with her family and on the road to recovery. She has sent you al a message through Tangy her Assistant that was emailed to you yesterday thanking you for your prayers, love, support and well wishes. Please continue to pray for Ms. Jackson as she gets stronger every day. You can send any cards to our office and we will be sure to get them to her. In the interim Ms. Gonzalez will be supervising the MW Area. All inquiries Introductions: Al Management staff and other staff at the front of the room
were asked to Introduce themselves: Ivonne Gonzalez, Kirk Ryon, Sharon Powell, Maria Springer, Carolyn Eleby, Montrese Albury, Michael Cardello. Friendly reminder: This room is the DCF District Administrator’s conf room and we are very appreciative that it is made available to APD for our Provider Meetings. However, the room is only available to until about 11:30am. When we adjourn please be reminded to do so promptly, quietly and pickup al of your belongings. If you need to meet with one of your col eagues we ask that you do so in the 4th floor cafeteria. Thank you for your cooperation New Staff Announcements: none
New Provider Announcements: none
Guest Speakers: Amy Kay, ARNP- University of Miami Neurology Intrathecal
1. APD Announcements:
Provider Meeting Schedule for 2012 will be posted on the APD A11 AND APD UPDATE
web page at the end of the month. Reminder December meeting  For more information about the will be held on 12/15/11. We will start of the year with the first Provider meeting date on January 12, 2012. Please pay special attention to the dates since some meeting will be the second Thursday of the month due to conference room availability. 2. APD Appointments:
• Director Hansen was appointed by the Governor to Commission on Jobs for Floridians with Disabilities. Term began 10/21/11. • Bryan Vaughn was appointed by the governor to the Transportation Disadvantaged Commission.
2. Cost Containment Plan 2011-2012 Update –The Director’s Weekly
Reports to the Legislature on Cost-Containment Plan Status Report may -status of cost plan review initiative for A11: As of last night we had 1,431 completed reviews out of 4,228. Three HSPS and 5 QSI staff are working on completing the reviews. Completion Due date is 12/31/11. -Standardize payment rates for intensive behavior residential habilitation -Agency will begin col ecting fees from APD customers who have income to offset some of their cost of living in a group home effective 1/1/12. -APD plans to reduce the rates it pays for the therapy assessments and all nursing services to the standard rate paid by the Medicaid State Plan -APD wil reduce the difference it pays between solo providers and agencies CONTINUED STATE /
for the waiver services to no more than 20%. Effective 4/1/12. AREA AND APD

3. ibudget Florida Update- for updates please visit new website ibudet A Consulting company called North Highland Consultants, Inc. wil be conducting interviews for the ibudget application program, client central record, making assessment and recommendations on how to proceed at this time. This will be ongoing though the end of this week. ibudget implementation will continue in Area 1 & 2. The assessment will yield a Functionality Business Report on Future needs, agency integration best methods to future implementation. 4. Disability Mentoring Day On Oct 4th Attorney General Pam Bondi
introduced a Cabinet resolution declaring October as Disability Employment Awareness Month in Florida. Thank you for the referrals that were made for DMD day on past October 19, 2011. Thank you to provider and APD staff for volunteering to be mentors. Mike/ Montrese will be speaking more in detail about this event.
5. Delmarva Quarterly Meeting: Please let us know of any concerns
6. CDC+ Updates:
• AHCA has posted the CDC+ Draft Handbook on their internet site at the following link:
• Notice of proposed rule for Developmental Disabilities CDC Plus as it was submitted for publication in the Florida Administrative weekly was published Nov 4th . The hearing is scheduled for Monday November 28th, 10-12 noon APD Office in Tallahassee. Ms. Alvarez on behalf of all APD staff wished all a very Happy Thanksgiving Holiday, good health and many Blessings. Mrs. Ivonne Gonzalez spoke on Medicaid Waiver updates and CDC+ Program: Please continue to submit your Purchasing plans by the 10th of the month to be approved for the fol owing month. The PP’s effective for December have been processed already. Also remember to submit your QU, 8821 Forms, etc.
2. Crisis requests:

Remember to submit your Crisis packets to my attention. We review them here local y and request for additional documentations. The procedure again is to have a QSI assessment and either the Medical Case Management Team needs to do a face to face visit or if the consumer has Behavioral concerns, Dr. Molina goes out and does a face to face visit and report his findings. The Crisis team reviews all the documents and sends it up to Central Office for final review. If the consumer comes in through the Waiting List as a Crisis, the area office can approve 3 months of their needed service.
Al change of provider requests, cost plan adjustments, or Respite request
will go directly to Beverley Alexander. Please submit your requests 10 days Cost plan adjustment service requests require the determination of medical necessity being made by our office. Support coordinators, you are still required to provide us with supporting documentation to justify the service
4. Cost Plan Reviews:
Staff members are finishing up the cost plan reviews for more than 1200+ waiver consumers that receive residential habilitation. The next service to review is In Home Support about over 1800, and then fol owed by consumers having other services, which is about another 1800 reviews. We are asking for the support plans and supporting documentation for the services on the cost plan which are to be in the consumer's central record file. We need to complete this assignment by December 31, 2011. We have taken staff from the QSI department to assist us with these reviews so if you receive a phone cal from one of them, please submit your support plans within 3 business days via zixmail or bring the documents in to our office. If you receive a due process letter, the consumer guardian must reply within 10 calendar days according to 65-2.048 (Action to Reduce or Discontinue Assistance or Service). A copy of the due process request will be faxed to the Waiver Support Coordinator. ABC will be updated after 20 days of no receipt of hearing request. If the consumer accepts the reduction, please send me a document signed by the guardian/consumer accepting the reduction and we can update ABC. A due process letter wil be sent out to the consumer also giving them due process rights for the voluntary reductions that were made
5. Please note that we are looking to fil 3 more QSI positions, so if you know
someone that meets the Bachelor’s degree & 2 years in the developmental disabilities field, please email me their resume. Thank you so much for your continued cooperation and support. • Ms.Carolyn Eleby advised that Austin Dean, provider enrol ment specialist, has returned from Medical Leave. However, due to his 8 week absence we now have somewhat of a backlog in the provider enrol ment area. She asked that providers continue to send all there requests for updates to Carolyn Eleby and Yugoslavia Marte. Ms. Eleby also asked that to assist in completing the requests timely that providers send all documentation and information timely to avoid • Carolyn Eleby also reported that Area 11 will continue to post a quarterly classroom training calendar and registration is on-line through • Ms. Eleby advised additionally that there is a proposed Supported Living Quarterly meeting scheduled for Dec 12, 2011 at 1:00 PM. She strongly suggested that waiver support coordinators, in home support providers and all other providers who serve supported living consumers should attend this meeting in order to be familiar with all the requirements that each provider must adhere to in assuring the appropriate services are provided to our consumers as members of their circle of support.
American Association Heart Walk:

Thanks to al providers who participated in the American Heart association walk on October 29th. The walk was a successful we were able to contribute $700+ to the association through your generous donations, and for the providers and family members who joined our team and came out and Medication Error Report:
Medication error reports, please to remember to complete all medication error reports in its entirety, as soon as you identify the error, whether it was a documentation error, family error, wrong medication, wrong dosage and or medication not given. Also, we would like you to include on the form the name of the medication trainer and validator. We are planning to address these topics in more detail in the coming year with providers who are having difficulties with medication compliance. Diabetes:
This month the focus is on Diabetes with greater emphasis on prediabetes. In 2010 25.8 million people in the US were diabetic and an estimated 79 mil ion people were considered pre-diabetic. Diabetes is the seventh leading cause of death in the US. Diabetes is a chronic degenerative condition, is a leading cause of renal failure, can lead to blindness, heart For persons who are told that they are prediabetic, they can prevent diabetes through increasing physical activity and healthy eating. It is important to have complex carbohydrates which wil not peak your blood sugar resulting in increase work on the pancreas. Education is key to curtail
Most common symptoms are:
• Wounds that take longer to heal especially on the feet. Types of diabetes:
• Type 1 known as juvenile diabetes or insulin-dependent normal y affects • Type 2 also known as adult onset-diabetes, occurs when the body creates a resistance to insulin. This is the most common form of diabetes and affects 1 in every 10 adults. • Gestational diabetes also known as pregnancy diabetes, this condition Information taken from Miami Herald Sunday, November 13, 2011 and • As far as our waitlist consumers I am happy to report that thanks to the partnerships that have been built by our Community Relations Coordinator Mrs. Rosa Llaguno, and the generous donations of Centrocampesion Farmworker Center and Construction Catering ,this year we will be able to provide over a dozen families with Thanksgiving • Ms.Springer also mentiones Also via these partnerships we have placed on the table Discount Prescription Drug Cards that can be used by the • We are continuing our effort to enplane our community partnerships, and by doing so assist our waitlist families with the local resources. Our General Revenue Units have been successful in assisting families when they phone by providing them with information on useful community resources as wel as guiding them in obtaining State Medicaid Benefits. • Kirk Ryon, POA for Quality Assurance/Licensing and Monitoring discussed current issues with the Delmarva Foundation reviews. Mr. Ryon noted that there have not been any specific complaints concerning the Delmarva review process during the past several months. Mr. Ryon noted that most of the reviews in Area 11 have been completed for the 2011 calendar year. All Area 11 Plans of Remediation and Plans of Corrective Action must be submitted no later than December 31, 2011. • Kirk Ryon re-distributed all previously issued memorandums concerning Incident Reporting. There have been some issues with non-reporting, late reporting or hand written reports that are illegible. Mr. Ryon reminded all present that a writable template of the State Wide Incident Reporting form is available on the APD web site. Reporting deadlines and categories of reports are clearly written on the Incident Reporting • Kirk Ryon distributed guidelines for incident reports for customers who have been Baker Acted. It was noted that a study conducted by Enrique Molina, Ph.D., revealed that between 100 and 200 Area 11 customers are Baker Acted every month. Providers of residential services were directed to the Baker Act Manual available on line for prevention techniques for avoiding using the Baker Act for customers with mental illness. This topic will be revisited in upcoming meetings as the study of Baker Acts for APD customers in Area 11 is refined to include specific residential settings and customers. III. ADJOURMENT


Jorge Villalon , Mariana Abraham, Betty Seltzer, Milagros Aniceto, Claudia Perez, Argeo Rodriguez, Mayan Wiltz, Christine
McAnrt,Roberto Pire,Yirlank Rivero, Maurren Winter,Olimpi Omir, Lillian Rangelm Wilma Johnson, Arnold Coats, Maria Garcia,Tatiana Cortez, Gloria Fortune ,Cristina Schwarz, Dora Guzman, Mable Burger, Janice Thurston, Carmen C Roberts, Luz Ortiz,Muriel Cuadro, Aileen Phelan, Nse Essiet, Mario Valdes, Rene Gomez, Carlos Rocha, Pascale Maneette,Veronica Oliver, Mathew Zosnick, Rosaire Olivier, Aglyam Olivier, Kathlyn Morman, Diane Gelpi, Viveen Brooks,Reynold Stewart, Manuel Achong,Chanelle Alavarez, Jooly Cox , Luis Rodirguez, Natalia Laver, Velma Fulger,Dianne Barton,Monica Cruz,Isis Espino, Ray Bell, Xiomara Margothes,Jason Mendoza, Elsbeth Arce, Steven Kuster, Cherie O’Geen, Marianela Wata Wara, Estrella Granda, Laura Vinent, Eddie Danta, Monica Martinez, Eduardo Martin, Jerome Silverberg. *Kathleen Mulkey*Portia Jame*Penny Schueneman*Josephine Livingstone*Neftali Pernas*Martine Ossaghae*Lixon Nelson*Jacqueline Coats*Nadege Arinad *Edna Arroyo*Derick Toro
* Denotes tardiness of more than 15 minutes



T. M. Glaus, G. Wess, Band 152, Heft 3, März 2010, xxx – xxx © 2010 by Verlag Hans Huber, Hogrefe AG, Bern Originalarbeiten 1 Linksherzhypertrophie bei der Katze – „wenn eine hypertrophe Kardiomyopathie keine hypertrophe Kardiomyopathie ist“ T. M. Glaus1, G. Wess2 1Abteilung für Kardiologie, Klinik für Kleintiermedizin, Universität Zürich, 2Abteilung für Kardiologie,

MINISTERO DELLA DIFESA DIREZIONE GENERALE PER IL PERSONALE CIVILE 3° REPARTO 8^ DIVISIONE 1^SEZIONE Viale dell’Università 4 - 00185 Roma Tel. – fax. 06.49862475 M_DGCIV Prot. Nr68 Del 20/02/2009 PARTENZA A U.D.G. – U.R.P. OGGETTO : candidature di dipendenti civili a posti a “status internazionale”. Legge 27 lug

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