Transcript The Road Ahead for You and APD

Budget
Florida
The Waive(r) of the Future
11/15/10 APD Public Meeting with Advocacy Community
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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 2010—then passed a law
requiring APD to implement it (s.
393.0663, F.S.)
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APD Home and Community Based
Waiver Funding
900.0
850.0
800.0
750.0
700.0
650.0
2005-06
2006-07
2007-08
2008-09
2009-10
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2010-11
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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.
393.0663, F.S.)
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Overall Goals
of 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 application—
1st 90 day clock ends 12/12/10
• Online iBudget Florida system well into
development—1st 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 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
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iBudget Funding
Standard iBudgets
Extraordinary Need
Temporary/Permanent
Increases
One-time Expenditures
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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
Group
1
Service Family
Life Skills
Development
Service
Life Skills Development (New service
encompassing ADT, Supported Employment,
Residential Habilitation Qrt Hr., Companion)
New Service - Person Centered Planning
New Services - Family & Guardian Training
Consumable Medical Supplies
2
Supplies and
Equipment
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
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Services
Residential Habilitation (Standard)
Residential Habilitation (Behavior Focused)
4
Residential
Services*
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
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Services
Private Duty Nursing
Residential Nursing
Skilled Nursing
Dietician Services
6
Wellness and
Therapeutic
Supports*
Respiratory Therapy
Speech Therapy
Occupational Therapy
Physical Therapy
Specialized Mental Health Counseling
Behavior Analysis Services
Behavior Assistant Services
7
Transportation
Transportation
8
Dental Services
Adult Dental Services
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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
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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 Dexter’s 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 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
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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 don’t
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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?
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