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The Waive(r) of the Future

Budget Florida

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Why iBudgets?

• Other options raise concerns

– Managed care

– Greater institutionalization

– Continued deficits, growing waiting list, awkward legislative cost-control measures

• Legislature told us to develop a plan by February 2010—then passed a law requiring APD to implement it (s. 393.0663, F.S.)

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Why iBudgets?

• Managed Care– Bill transitioning DD HCBS services to

managed care passed House in 2010

– Speaker’s suggested principles for approval in tomorrow’s organizational session:

• Phase in the implementation of the statewide managed care program, allowing adequate time for development of managed long-term care and reserving the final phase of the implementation of managed care for persons with developmental disabilities.

• iBudget Florida is the law now (s. 393.0663, F.S.)

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Overall Goalsof iBudget Florida

Simplify the system

Enhance:

– Self-direction

– Sustainability

– Equity

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How did APD makethe iBudget Florida plan?

• Did a lot of research– Other states have similar systems - Georgia,

Minnesota, Connecticut

• Got a lot of stakeholder input– 16 dedicated self-advocates, family members,

WSCs, providers, state agency representatives, and advocates on Stakeholder Group

• Got help from consultants• Listened to consumers, families, and

providers in public meetings and via our Web site

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iBudget Florida Paradigm

•Needs met through waiver AND state plan, natural supports and community resources

•Waiver Support Coordinators freed to help get other resources

•Service review limited for many consumers, for spending up to individual iBudget maximum amount

•Requests for additional funding require thorough review

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Overview of Proposed System

•Budgets determined through algorithm and provided at beginning of plan year

• Service array revised to increase flexibility

• Waiver Support Coordination better match to family needs, shift to emphasis on service coordination from service approval processing

• Service review more limited, focused, & streamlined, focusing on health & safety issues

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Overview of Proposed System

•Consumer and family training and tools for managing budgets

•Policies for limiting risk of overspending and options for corrective action plans

•Reviews for health and safety, provider manipulation, and fraud

•Process for determining budgets for consumers with extraordinary needs

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Overview of Proposed System

•Electronic/automated as much as possible

– New online tool for creating budgets and tracking funding

•Phase-in over a reasonable time period– e.g., number of consumers (by

geography) and budget amounts

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Status Update

• AHCA has submitted waiver application—1st 90 day clock ends 12/12/10

• Online iBudget Florida system well into development—1st phase completed today

• Communication materials developed

• Rules and processes being designed

– When iBudget Florida is fully implemented, tiers will go away

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Phase 1 Implementation of IBudget Florida

• First phase-in location: Area 2B--Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla counties

• Area 2A will follow in about six months

– Bay, Calhoun, Gulf, Holmes, Jackson, and Washington counties

• Wider phase-in begins late 2011 or 2012

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Algorithm Used to Determine Individual Budgets

•Uses a statistically validated formula or algorithm– Considers consumer age, living setting, QSI

subsection sum of scores, some QSI questions– People with similar needs receive similar

funding– People with greater needs receive greater

funding

•Total of iBudgets + funds for extraordinary needs/ changed/one-time needs = total APD waiver funding

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What else is important?• Initially, some budgets will increase, others

decrease, and some stay about the same– Will phase-in gradually—over a few years

– Extraordinary need process if critical health and safety needs are unmet with budget

– Expect more system stability after initial phase-in

•Consumers may need to prioritize use of APD funding– Waiver is intended to work with other resources

– WSCs freed to help get more community resources

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iBudget Funding

Standard iBudgets

Extraordinary Need

Temporary/PermanentIncreases

One-time Expenditures

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Services

Design of service array• Services grouped in 8 service families

- Can switch among services within service family usually with minimal or no outside service review

- Easier to meet changing needs over time

• Broader services- Personal support and day activities

- One worker can do a broader set of tasks

- Allow to meet changing needs day-to-day

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ServicesGroup Service Family Service

1 Life Skills

Development

Life Skills Development (New service encompassing ADT, Supported Employment, Residential Habilitation Qrt Hr., Companion)

New Service - Person Centered Planning

New Services - Family & Guardian Training

2Supplies and Equipment

Consumable Medical Supplies

Durable Medical Equipment and Supplies

Environmental Accessibility Adaptations

Personal Emergency Response Systems (Unit and Services)

3 Personal Supports

Personal Supports (New service encompassing In-Home Supports, Respite, Personal Care & Companion)--Adults in family or own home only

Respite--children in family home only

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Services

4Residential Services*

Residential Habilitation (Standard)

Residential Habilitation (Behavior Focused)

Residential Habilitation (Intensive Behavior)

Specialized Medical Home Care

Supported Living Coaching

5

Support Coordination (Some individuals will have limitations on their ability to choose a different level of Support Coordination).

Support Coordination--Limited

Support Coordination--Full

Support Coordination--Enhanced

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Services

6Wellness and Therapeutic Supports*

Private Duty Nursing

Residential Nursing

Skilled Nursing

Dietician Services

Respiratory Therapy

Speech Therapy

Occupational Therapy

Physical Therapy

Specialized Mental Health Counseling

Behavior Analysis Services

Behavior Assistant Services

7 Transportation Transportation

8 Dental Services Adult Dental Services

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Waiver Support Coordination

• Waiver Support Coordinator’s role will shift from paper pusher to social worker

– Reduced paperwork load frees up time

• More customized level of service--most may choose support coordination level (limited, full, or enhanced)

– Children can choose full support coordination

– Adults can choose limited and use funding for other services

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Waiver Support Coordination

• More meaningful distinction between levels– Limited

– Full

– Enhanced (renaming of Transitional)

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Consumer and Family Control

• Training will be provided to consumers and families on iBudget Florida policies and choice-making

• Unless in CDC+, must use Medicaid-enrolled providers

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Consumer and Family Control

• Could negotiate some rates up to maximum

– Family & Guardian Training

– Person-Centered Planning

– Personal Supports

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CDC+ and iBudget Florida

• CDC+ option will continue

• CDC+ participants will have funding determined through their iBudgets

• CDC+ participants will “spend” iBudgets according to CDC+ policies

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WSC Screen Shots – Cost Plan

Task listed Dorothy Dexter’s Cost Plan Review

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WSC Screen Shots – Cost Plan

Review the Activity

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WSC Screen Shots – Review

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WSC Screen Shots – Review

Review the Monthly Cost Plan

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WSC Screen Shots – ReviewReview the Service Plan

Submit for Area Review

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WSC Screen Shots – Submit

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Cost Plan Building Process

•System automatically either:

– Approves cost plan OR

– Routes for area review

• All 1st plans on iBudget require area review

• Afterwards, plans are automatically approved if within basic guidelines

•Will significantly reduce time for service approval in many cases

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System Cost Plan Review

• System will approve plans if:

– Within budget guidelines

– No new services requested

– No reductions in critical services (res hab, behavior, nursing)

• Routed for area review if (examples):

– Outside budget guidelines

– Requesting non-approved services

– Reductions in critical services

• Fund request will have own process

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What if a personal iBudget can’t meet an individual’s needs?

• Extraordinary need funding is available if critical health and safety risk

• Temporary or permanent increase for significantly changed needs that current iBudget can’t accommodate

• One-time funding is available—durable medical, environmental modifications, nonroutine dental

• Thorough review of requests for more funding

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Online Budgeting Tool

• Online budget tool to create budgets and track spending if consumers and families want to do so

- Waiver Support Coordinator will handle

if they don’t

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Consumer/Family Uses of Online System

•Draft Cost Plans

•Submit Cost Plans to their Waiver Support Coordinator

•Review their iBudget Florida Account Information

•E-mail their Waiver Support Coordinator

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Questions?