11/15/10 APD Public Meeting with Advocacy Community 1 The Waive(r) of the Future Budget Florida

11/15/10 APD Public Meeting with Advocacy Community 2 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 , F.S.)

11/15/10 APD Public Meeting with Advocacy Community 3

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5 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 , F.S.)

11/15/10 APD Public Meeting with Advocacy Community 6 Overall Goals of iBudget Florida Simplify the system Enhance: –Self-direction –Sustainability –Equity

11/15/10 APD Public Meeting with Advocacy Community 7 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

11/15/10 APD Public Meeting with Advocacy Community 8 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

11/15/10 APD Public Meeting with Advocacy Community 9 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

11/15/10 APD Public Meeting with Advocacy Community 10 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

11/15/10 APD Public Meeting with Advocacy Community 11 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

11/15/10 APD Public Meeting with Advocacy Community 12 Status Update AHCA has submitted waiver application— 1 st 90 day clock ends 12/12/10 Online iBudget Florida system well into development—1 st phase completed today Communication materials developed Rules and processes being designed –When iBudget Florida is fully implemented, tiers will go away

11/15/10 APD Public Meeting with Advocacy Community 13 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

11/15/10 APD Public Meeting with Advocacy Community 14 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

11/15/10 APD Public Meeting with Advocacy Community 15 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

11/15/10 APD Public Meeting with Advocacy Community 16 iBudget Funding

11/15/10 APD Public Meeting with Advocacy Community 17 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

11/15/10 APD Public Meeting with Advocacy Community 18 Services GroupService FamilyService 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 2 Supplies 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

11/15/10 APD Public Meeting with Advocacy Community 19 Services 4 Residential 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

11/15/10 APD Public Meeting with Advocacy Community 20 Services 6 Wellness 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 7Transportation 8Dental ServicesAdult Dental Services

11/15/10 APD Public Meeting with Advocacy Community 21 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

11/15/10 APD Public Meeting with Advocacy Community 22 Waiver Support Coordination More meaningful distinction between levels –Limited –Full –Enhanced (renaming of Transitional)

11/15/10 APD Public Meeting with Advocacy Community 23 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

11/15/10 APD Public Meeting with Advocacy Community 24 Consumer and Family Control Could negotiate some rates up to maximum –Family & Guardian Training –Person-Centered Planning –Personal Supports

11/15/10 APD Public Meeting with Advocacy Community 25 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

11/15/10 APD Public Meeting with Advocacy Community 26 WSC Screen Shots – Cost Plan Task listed Dorothy Dexter’s Cost Plan Review

11/15/10 APD Public Meeting with Advocacy Community 27 WSC Screen Shots – Cost Plan Review the Activity

11/15/10 APD Public Meeting with Advocacy Community 28 WSC Screen Shots – Review

11/15/10 APD Public Meeting with Advocacy Community 29 WSC Screen Shots – Review Review the Monthly Cost Plan

11/15/10 APD Public Meeting with Advocacy Community 30 WSC Screen Shots – Review Review the Service Plan Submit for Area Review

11/15/10 APD Public Meeting with Advocacy Community 31 WSC Screen Shots – Submit

11/15/10 APD Public Meeting with Advocacy Community 32 Cost Plan Building Process System automatically either: –Approves cost plan OR –Routes for area review All 1 st 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

11/15/10 APD Public Meeting with Advocacy Community 33 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

11/15/10 APD Public Meeting with Advocacy Community 34 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

11/15/10 APD Public Meeting with Advocacy Community 35 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

11/15/10 APD Public Meeting with Advocacy Community 36 Consumer/Family Uses of Online System Draft Cost Plans Submit Cost Plans to their Waiver Support Coordinator Review their iBudget Florida Account Information their Waiver Support Coordinator

11/15/10 APD Public Meeting with Advocacy Community 37 Questions?