july 1, 2010 ibudget florida stakeholders’ group workgroup meeting—for discussion purposes only...
TRANSCRIPT
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July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only
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iBudget FloridaStakeholders’ Group Meeting
July 1, 2010
Workgroup on Services, Providers, Waiver Support Coordinators &
Administrative Issues
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July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 2
Introductions• Workgroup members
• Staff
• Guests
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July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 3
Review of Minutes from Previous Meeting
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Meeting Objectives
• Share information
• Receive input on preferred options, potential improvements, implementation considerations, and other relevant issues
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Overall Goals
Simplify the system
Enhance:
– Self-direction
– Sustainability
– Equity
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• 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
iBudget Paradigm
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• This is a starting point
– We’ll be testing the system through an initial phase-in.
– Intend to refine system over time
• Are seeking the best solution among the alternatives
– All have pro’s and con’s
Keep in mind . . .
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• Waiver submitted by early August
• Draft rules by mid-July
• Draft operating procedures by late July
• Training developed by late August; begin training in early September
Target Implementation Plan
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• Collect baseline data for evaluation by late September
• IT system implemented by early October
• Start communicating w/ phase in area consumers, WSC’s, providers, and staff as soon as phase-in site announced
Target Implementation Plan
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• Completed initial review of rules and operating procedures that need revising and development.
• Phase-in area not final. – Will have a coordinated system of publicizing to
ensure accurate information.
• IT system design progressing; coding beginning soon.
Updates
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• Waiver drafting in progress
• Hired iBudget Florida Operations Project Manager.
• Will release RFQ for evaluation soon.
• Initial flowcharting/system design completed
Updates
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Overview of Proposed System
• Budgets determined through algorithm • 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• Behind-the-scenes reviews for health & safety, provider manipulation, and fraud• Process for determining budgets for consumers with exceptional needs
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Overview of Proposed System
• Electronic/automated as much as possible—virtually paperless• Phase-in over a reasonable time period—e.g., number of consumers (say by geography) and budget amounts
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Topics for Today
• Policy on Waiver Support Coordination services
• Rate/service negotiation guidelines
• Service family groupings
• Provider use of technology
• Obtaining timely service information
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Service Families
• Groupings: – Issues:
• Facilitating functioning of online system to streamline approval of requested services
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Service Families
• Groupings: – Plan:
• Listed 8 service families– Law:
• Did not mention service families
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Service Families
• Groupings: – See handout for suggested revised
groupings
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Waiver Support Coordination
• Issues:– Match rate to work required – Match work and responsibility to needs of
consumer, and allow to change as needs change
– Ensure health and safety
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Waiver Support Coordination
• Levels of support coordination available:– Current situation:
• Limited—all children and adults who choose
• Full—all adults, unless they choose limited
• Transitional—consumers who are transitioning from an ICF/DD
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Waiver Support Coordination
– Plan: • Levels of support coordination available:
–Limited–Full–Enhanced
• Funding in consumer’s iBudget:–Adults funded at full–Children funded at limited
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Waiver Support Coordination
– Plan:
• Consumer or caregiver must receive orientation:
–For adult to move to limited
–For child to stay at limited
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Waiver Support Coordination
– Plan: • Adults:
–Required to use full during 1st 6 months on iBudgets
–May choose limited thereafter and shift funds to other services if individual or caregiver gets iBudget Orientation
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Waiver Support Coordination
– Plan: • Children:
–Receive limited support coordination during first six months
–Required to use full support coordination thereafter if caregiver does not get iBudget Orientation
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Waiver Support Coordination
• Service elements: – Contacts with consumer– Contacts with providers– Consumer/family training– Coordination of community and natural
supports
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Waiver Support Coordination
• Service elements: – Support planning– Service review/approval responsibilities– Assess service quality– Budget management
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Waiver Support Coordination
• Service elements: – 24/7 on call– Ongoing eligibility determination– Advocacy on consumer’s behalf
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Waiver Support Coordination
• Defining levels of support coordination: – See handout
• A: Define by tasks• B: Define by hours
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Waiver Support Coordination
• Limitations on Choice of WSC level: – Plan: consumers required to use full WSC:
• Are newly-enrolled in the waiver.• Have had forensic involvement.• Have complex medical needs.• Have complex behavioral needs.
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Waiver Support Coordination
• Limitations on Choice of WSC level: – Plan: consumers required to use full WSC:
• Will soon be or are transitioning from school.
• Are changing their residential setting to group home or supported living from a different setting.
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Waiver Support Coordination
• Limitations on Choice of WSC level: – Plan: consumers required to use full WSC:
• Have a recent alcohol or drug abuse history.
• Are having difficulty managing their care or funding.
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Waiver Support Coordination
• Limitations on Choice of WSC level: – Discussion: consumers required to use full
WSC:• Living in licensed homes • In supported living
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Waiver Support Coordination
• Orientation requirement for receiving limited WSC : – Current situation:
• No orientation/training required
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Waiver Support Coordination
• Orientation requirement for receiving limited WSC : – How administered?
• A: Online.• B: By waiver support coordinator.• C: By area staff.
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Waiver Support Coordination
• Orientation requirement for receiving limited WSC : – Topics covered:
• Types of waiver services offered• Use of iBudget system• Emergency backup planning and
procedures• Community and natural supports
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Waiver Support Coordination
• Orientation requirement for receiving limited WSC: – What if caregiver refuses to take
orientation/training, but funding is insufficient to receive full WSC?
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Waiver Services
• Rate/service negotiation:– How might consumers and providers be
able to tailor services to consumers’ needs?
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Waiver Services
• Rate/service negotiation: eligible services– Plan: Review on a case-by-case basis.– Law: APD may allow negotiation for “any or
all” services except for residential habilitation.
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Waiver Services• Rate/service negotiation:
– Current situation: • Most consumers do not negotiate rates;
however, CDC+ consumers can.• Nearly all rates are set by rule.• WSC’s may negotiate rates for
consumable medical supplies or adaptive equipment.
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Waiver Services
• Rate/service negotiation: – Issues:
• Want to provide flexibility to tailor services better to consumers’ needs and budgets
• Want to ensure quality services, particularly for residential services and professional services
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Waiver Services• Rate/service negotiation:
– Services for which consumers should be able to negotiate rates• A: Higher-cost non-facility-based, non-
licensed services (supported employment, supported living)
• B: Any 1:1 non-facility based, non-licensed service except waiver support coordination.
• C: Any service except residential habilitation and waiver support coordination.
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Waiver Services• Rate/service negotiation:
– Service elements that are negotiable• A: None.• B: Documentation requirements• C: Availability of service (may fill in if
cancellation, or may not be on call)• D: Specific content of service
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Waiver Services
• Rate/service negotiation: – Documentation required
• A: “Job description”/contract; area approval required.
• B: “Job description”/contract, in file.• C: None.
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Waiver Services
• Billing units: – Should we maintain quarter-hour billing for
all services in which it’s currently used?
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Waiver Services• Billing units:
– Should we maintain quarter-hour billing for all services in which it’s currently used?
• Issues:–Simplicity of billing and documentation–Flexibility for families
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Waiver Services
• Billing units: – Should we maintain quarter-hour billing for
all services in which it’s currently used?
• Current situation: see chart.
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Waiver Services
• Billing units: – Should we maintain quarter-hour billing for
all services in which it’s currently used?• Plan and law: did not discuss
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Waiver Services• Billing units:
– Should we maintain quarter-hour billing for all services in which it’s currently used?• Options:
–A: Keep all quarter-hour billing.–B: Use only for therapies/nursing;
discontinue use for non-professional services.
–C: No quarter hour billing.
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Providers
Communication– Short and long-term, what are reasonable
expectations for providers’ technology infrastructure (email, fax, use of computers, etc.)
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ProvidersCommunication
– What are reasonable expectations for providers’ technology infrastructure (email, fax, use of computers, etc.)• Current situation:
–Varies among providers (online billing access?)
–APD does not require use
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Providers
Communication– What are reasonable expectations for
providers’ technology infrastructure (email, fax, use of computers, etc.)• Plan:
–Highlights use of technology to speed work and facilitate tracking and analysis
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ProvidersCommunication
– What are reasonable expectations for providers’ technology infrastructure ?
– Issues:–Maintaining providers to facilitate
consumer choice–Efficient functioning and simplicity of
system–Security of data
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ProvidersCommunication
– What are reasonable expectations for providers’ technology infrastructure?
– Issues:–Timeliness and accuracy of records–New quality assurance system may
require provider data entry
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ProvidersCommunication
– What are reasonable expectations for providers’ technology infrastructure (email, fax, use of computers, etc.)• Options:
–A: Require email address–B: Require fax –C: Require online submission of
forms
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Providers
Communication– Short-term, how do we get accurate
information on expenditures within current system?
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Consumer & Family Control• Budget Management
– Short-term, how do we get timely, accurate information on expenditures within current system? • Issues:
–System sustainability requires accurate budget tracking
–Providers are at varying levels of sophistication
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Consumer & Family Control
• Budget Management– Short-term, how do we get timely, accurate
information on expenditures within current system?
• Issues:–APD technology still in development–Will have to rely at minimum on
combination of encumbrances through service authorizations and billing data
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Consumer & Family Control
• Budget Management– Short-term, how do we get timely, accurate
information on expenditures within current system? • Current situation: use a combination of
billing information, service logs, and personal contacts with providers.
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Consumer & Family Control
• Budget Management– Short-term, how do we get timely, accurate
information on expenditures within current system? • Plan: described need for such
information but acknowledged technical challenges
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Consumer & Family Control
• Budget Management– Short-term, how do we get timely, accurate
information on expenditures within current system? • A: Rely solely on encumbrances and
billing data (up to a year lag), along w/ telephone contacts
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Consumer & Family Control
• Budget Management– Short-term, how do we get timely, accurate
information on expenditures within current system? • B: Require basic service information to
be submitted within 15 days of quarters’ end (by telephone/IVR, fax of paper to WSC’s, online form, ???)
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Consumer & Family Control
• Budget Management– Short-term, how do we get timely, accurate
information on expenditures within current system? • C: Encourage submission of bills close
to date of service
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Questions?Suggestions?Comments?
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Thank you for your time!