Something new is on the horizon…

1. Something new is on the horizon… …for individuals receiving waiver services.

2. Budget Florida The Waive(r) of the Future

3. Initial locations: Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla counties Phase 1 Implementation of IBudget Florida Area 2B

4. Area 2A will follow in about six months Bay, Calhoun, Gulf, Holmes, Jackson, and Washington counties Wider phase-in begins late 2011 or 2012 Phase 1 Implementation of IBudget Florida

5. 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 Why iBudgets?

6. 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 How did APD make the iBudget Florida plan?

7. 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 What’s different about iBudget Florida?

8. 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

9. 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 Features of iBudget Florida

10. 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 Algorithm Used to Determine Individual Budgets

11. 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 This Means to Consumers and Area Staff

12. 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 What else is important?

13. 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 Service Review

14. 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 Services

15. • 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) Waiver Support Coordination

16. 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 Consumer and Family Control

17. 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 Online Budgeting Tool

18. Area Staff View

19. Area Staff View

20. CDC+ option will continue CDC+ participants will have funding determined through their iBudgets CDC+ participants will “spend” iBudgets according to CDC+ policies CDC+ and iBudget Florida

21. 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 What if a personal iBudget can’t meet an individual’s needs?

22. 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 How will this affect Area staff?

23. 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

24. 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

25. 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 iBudget Florida Public Meetings

26. Budget Florida …has arrived! Get the latest info and provide input via APD’s Web site apdcares.org

27. Questions? Jim DeBeaugrine Director Charlie Crist Governor