1. Independence Plus means that … Planning Budgeting Spending …Are individualized and directed by the person and those closest to him or her CMSO/DEHPG

2. CMS Requirements for Independence Plus Programs 1. Person Centered Planning 2. Individual Budgeting 3. Self-Directed Supports 4. Quality Management CMSO/DEHPG

3. Person-Centered Planning A process directed by the participant Develops strengths, capacities, preferences, needs & outcomes Enables & assists participant to meet personal goals & access services & supports

4. Person-Centered Plan… More than the Budget Addresses person’s life goals –work, recreation, relationships –where to live, & with whom –supports & services needed & desired to reach life goals May include a mix of paid & non-paid services & supports

5. CMS ADDRESSES THESE ISSUES REGARDING PCP Includes individualized contingency planning for situations that would jeopardize person’s health or welfare Provides system-wide back-up info Process for risk management Specifies how plan will be reviewed, managed & monitored

6. CMS ADDRESSES THESE ISSUES REGARDING PCP Planning process is detailed with regard to person’s role, & identification of strengths, capacities, desired outcomes, etc. Assurances that individual preferences, choices & control are honored; Extent to which PCP process addresses or does not address plan of care requirements

7. QUESTIONS FOR DISCUSSION: PERSON CENTERED PLANNING How is person centered planning operationalized? Person centered vs. person directed What does the person self-direct? …the planning process? the staff? the budget? How will PCP be monitored?

8. The Individual Budget Value ($) of services & supports under the control & direction of the participant May include Medicaid & Non-Medicaid services/supports but must have clear audit trail of Medicaid $

9. CMS ADDRESSES THESE ISSUES REGARDING IB Describes the method for calculating based on reliable costs or services utilization; Developed using a consistent methodology for all involved participants; Reviewed & monitored according to a specified method & frequency; Provides participant ability to move money around; Methodology is open to public inspection; Informs participant of amount that is authorized to be self- directed; Defines a process for making adjustments & informs participant; Provides procedures to evaluate over & under expenditures; Provides prompt mechanisms to adjust funding in response to individual situations;

10. Two Different Approaches for Determining Individual Benefit Prospective Method –Benefit amount is determined in advance of PCP –Objective assessment of need determines IB; –Participant determines spending plan, services, supports & implementation strategy Retrospective Method –Benefit amount is determined in response to PCP –Participant Identifies needs within PCP –Agency (alone or in concert with participant) determines benefit amount, services & supports –Participant determines spending plan, & implementation strategy

11. Prospective/Retrospective Budgeting Participant Enters System Assessment completed using PCP principles PCP Completed Total dollar amount of benefit determined PCP completed Total dollar amount of benefit determined Services & support goals in PCP Retrospective Budgeting Prospective Budgeting Amount of Budget that is self-directed

12. QUESTIONS FOR DISCUSSION: INDIVIDUAL BUDGETS What methods do states use to develop individual budgets? What are options? Is an individual budget the same as a cost cap? What portion of the participant’s total benefit may be self-directed? Is the benefit portable (I.e., can the money move with the person)? How does person centered planning interface with individual budget development?

13. Web Resources CMS web sites: www.cms.hhs.gov/independenceplus (information about Independence Plus including 1915 (c) & 1115 templates & the mailboxes to send questions electronically)www.cms.hhs.gov/independenceplus www.cms.hhs.gov/medicaid/waivers (information about individual states’ Independence Plus applications/programs)www.cms.hhs.gov/medicaid/waivers

14. Web Resources www.cms.hhs.gov/medicaid/waivers/qu ality.asp (information about Quality Framework)www.cms.hhs.gov/medicaid/waivers/qu ality.asp www.cms.hhs.gov/promisingpractices (resource information and states’ promising practices)www.cms.hhs.gov/promisingpractices Related Information: www.hcbs.org (resources, articles & reports on self-determination & self- direction & states’ promising practices)www.hcbs.org