Budget Florida

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Budget Florida
The Waive(r) of the Future
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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
  2010then 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
• Speakers suggested principles for approval in
  tomorrows 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 make the 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 application1st 90 day
  clock ends 12/12/10
• Online iBudget Florida system well into
  development1st 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 graduallyover 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
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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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Services
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Services
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Services
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Waiver Support Coordination

• Waiver Support Coordinators 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 Dexters 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 Review
Review 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 cant meet an
individuals needs?

• Extraordinary need funding is available if
  critical health and safety risk
• Temporary or permanent increase for significantly
  changed needs that current iBudget cant
  accommodate
• One-time funding is availabledurable 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 dont

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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?