something new is on the horizon… …for individuals receiving waiver services

Something new is on the horizon…

…for individuals receiving waiver services.

The Waive(r) of the Future

Budget Florida

Phase 1 Implementation of IBudget Florida

Initial locations:

• Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla counties

Area 2B

Phase 1 Implementation of IBudget Florida

• Area 2A will follow in about six months

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

• Wider phase-in begins late 2011 or 2012

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

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

What’s different about iBudget Florida?

Current System• Services decided

first• Complex system:

- WSC writes plan- PSA review- Rebasing affects- Tiers affect

• Change in services often requires new PSA review

iBudget Florida• Funding decided

first using formula

• Simpler, flexible system:

- Can spend up to individual iBudget limit

- Limited service review process

- More choice in services

Features of iBudget Florida

• More control over services—can get priority services faster and make changes easier– Budgets for services are determined up front to

allow for planning

– Wider array of services available to all

– Prior service authorization ended as we know it

• Greater support– WSCs will have less paperwork to do

– Training and tools to self-direct are available if requested

Features of iBudget Florida

• Stronger quality assurance and quality improvement– APD and QA contractor will review for

health and safety, provider manipulation, and fraud

• More stable system– Would phase-in gradually

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 exceptional/ changed/one-time needs = total APD waiver funding

What This Means to Consumers and Area Staff

•Can scale back PSA process—gives more control

•PSA process reduction and electronic records reduce WSC workload

•Computer systems help monitor budgets, services, and quality

•A chance for more consumer self-direction

What else is important?

• Initially, some budgets would increase, others decrease, and some stay about the same– Will phase-in gradually—over a few years

– Exceptional 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

Service Review

The process as we know it would go away—minimized or eliminated as much as possible while meeting federal requirements

• Streamlined paperwork

• More flexibility

• Review spread among areas, Central Office, and contracted experts

• More review for unusual situations, less (or no) review for routine decisions

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

Waiver Support Coordination

• Waiver Support Coordinator’s role will shift to more of a facilitator and guide

• Will be seeking to reduce paperwork

• Allow more customized level of service– Most will have more flexibility to choose

support coordination level (limited, full, or enhanced)

– More meaningful distinction between levels (for example: more limited support in limited WSC service)

Consumer and Family Control

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

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

• Could negotiate some rates up to maximum

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

Area Staff View

Area Staff View

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

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

How will this affect Area staff?

• PSA process changes

– Area staff will have greater role in service review and approval (though online system will automatically process many requests)

• Help answer questions from consumers, families, WSCs, and providers

• Support QA process

• Encourage and support self-direction while ensuring health and safety within budget

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 (say, by

geography) and budget amounts

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

iBudget Florida Public Meetings

• Monday, August 30, 2010 – Tallahassee

– Tallahassee Community College

• Tuesday, August 31, 2010 – Madison

– Madison Public Library

• Wednesday, September 1, 2010 – Carrabelle

– Carrabelle City Commission Chambers

Budget Florida

…has arrived! Get the latest info and provide input via APD’s Web site

apdcares.org

Questions?Jim DeBeaugrine

Director

Charlie CristGovernor