iBudget Florida Stakeholders’ Meeting

1. iBudget FloridaStakeholders’ Meeting October 23, 2009

2. Main question: How should we get information about people to know their needs? Assessment Instrument

3. Current system: Previously used the Florida Status Tracking Survey (FSTS) and the Individual Cost Guide (ICG) Now uses the Questionnaire for Situational Information (QSI) Covers physical, functional, and behavioral areas Assessment Instrument

4. APD Recommendations: QSI be used as assessment instrument QSI improvements be ongoing Assessment Instrument

5. Decisions needed: How and when to request reassessment How and when to appeal results Assessment Instrument

6. Feedback so far: Want information on the QSI’s validity and reliability Concern that it does not identify certain needs of individuals Assessment Instrument

7. Your thoughts: What are your concerns about the QSI? How can we make people more comfortable with the QSI? Assessment Instrument

8. Main question: What services and flexibility should be available to consumers? Services

9. Current system: 27 services in Tiers 1, 2, and 3 13 services in Tier 4 Providers must be Medicaid enrolled (except for CDC+ program) Statewide rates with some geographic differentials Need for a service is determined through prior service authorization Services

10. APD Recommendations: Must use Medicaid enrolled providers Services allow more flexibility Rates be neutral Same set of services available to all individuals Services

11. Decisions needed: • Potentially combining services for greater simplicity and flexibility • Limits, if any, for each service – Dollar amount – Hours – Need proven (prescription or assessment) • Provider qualifications Services

12. Feedback so far: • Make additional services available in Tier 4 • Want flexibility to use greater amounts of services Services

13. Your thoughts: • How could service options meet consumers’ needs better? • What limits on control or other safeguards might be important for health and safety? Services

14. Main question: What should the waiver support coordinator’s role be? Waiver Support Coordination

15. Current system: • Waiver support coordination is a required service • Children have limited waiver support coordination; adults have limited or full coordination • Waiver support coordinators have lots of required paperwork – Very little is processed electronically—heavily paper based Waiver Support Coordination

16. APD Recommendations: • Waiver support coordinator’s role will shift to more of a facilitator and guide • Will be seeking to reduce paperwork Waiver Support Coordination

17. Decisions needed: Waiver support coordinators’ specific tasks What waiver support coordinator service options will be available How we will streamline forms and processes What additional training, if any, to require Waiver Support Coordination

18. Feedback so far: Questions about what the role should be Waiver Support Coordination

19. Your thoughts: What should the waiver support coordinator’s role be? What should the split of individual, family, and waiver support coordinator responsibilities be? What concerns are there about the waiver support coordinator’s role in a more self-directed system? What options would a waiver support coordinator have if he or she felt an individual was making bad choices? Waiver Support Coordination

20. Main question: How do we best ensure that individuals receive the services that they need within allowable waiver coverage? Prior Service Authorization (PSA)

21. Current system: • All services must be approved through prior service authorization • Reviews are performed by area staff and a contracted provider – It’s time-intensive – It’s complex – It’s paperwork-intensive Prior Service Authorization

22. APD Recommendations: The process as we know it go away—be minimized or eliminated as much as possible while meeting federal requirements Streamlined paperwork More flexibility Personalized approach Prior Service Authorization

23. Decisions needed: Situations requiring a review The process for requesting reviews Who will perform reviews Prior Service Authorization

24. Feedback so far: Scaling back is great but we need something to meet federal requirements for assessing medical necessity of services Prior Service Authorization

25. Your thoughts: What service approval process is appropriate for: Prior Service Authorization • Medical services • Therapies • Behavioral services • Extraordinary needs • Meaningful day activities • Residential habilitation • Supports in the home

26. Main question: What would be reasonable limits on individual control? Consumer and Family Control

27. Current system: Waiver support coordinators work with individuals and families to support choice Individuals and families have little insight into spending of funds for supports Prior service authorization is required before service amounts are increased Consumer and Family Control

28. APD Recommendations: Training be provided to consumers and families on choice-making Consumers and families have greater control over the amounts and types of services they get Consumer and Family Control

29. Decisions needed: Limits on spending to ensure that funds last through the year What to do if a person overspends but still needs services How to provide training on making good choices Consumer and Family Control

30. Decisions needed : What information consumers need to make good decisions How to help consumers track spending What support to give to consumers who don’t have unpaid help in decision-making If funds can be carried over to a future year like in CDC+ Consumer and Family Control

31. Feedback so far: Some individuals don’t have sufficient support to exercise self-direction Concern that some providers may not cooperate or may be manipulative Consumer and Family Control

32. Your thoughts: What information and training do consumers and families need to make good decisions? How could they get that information? How can we help those who don’t have families or friends to help them make choices? Consumer and Family Control

33. Your thoughts: How might we limit spending to ensure that funds remain through the year? Should we do this? How are pro’s and con’s of allowing carryover of unused funds to another year? How can we find out if any providers are uncooperative or manipulative, and what penalties might be assessed? Consumer and Family Control

34. Main question: How do we ensure that people with extraordinary or changed needs get enough funding? Extraordinary and Changed Needs

35. Current System: Individuals are assigned to tiers, which cap spending If needs are believed to have changed, the waiver support coordinator requests a prior service authorization review for additional services and/or a tier change Extraordinary and Changed Needs

36. Decisions needed: Process to identify people with extraordinary needs and set their budgets Process to handle requests for funding due to changed needs and determine the funds required Extraordinary and Changed Needs

37. Decisions needed: • How to identify people with extraordinary or changed needs – Statistician will help when the model is more developed • How to set their budgets • How to decide if needs have changed • How to calculate funds needed for changed needs Extraordinary and Changed Needs

38. Feedback so far: Want to ensure that funds are available for people with changed needs or extraordinary needs Extraordinary and Changed Needs

39. Main question: How do we monitor to ensure health, safety, and good outcomes? Quality Assurance

40. Current system: Contracted provider (Delmarva) performs quality assurance activities in conjunction with APD staff Contracted provider uses desk reviews, on-site visits, and consumer interviews to assess provider performance and consumer outcomes Medical Case Management Team and/or WSCs determine if additional review is required for health and safety Support planning, annual reports, and quality assurance contractor determine if individuals are progressing toward goals Quality Assurance

41. APD Plans: New quality assurance contract uses different measures Florida is joining National Core Indicators initiative Quality Assurance

42. Decisions needed: What might change under a new contract in a more self-directed system What might trigger any special health and safety reviews Quality Assurance

43. Feedback so far: Support revision of the quality assurance system to be more understandable, less bureaucratic, and more person-centered Quality Assurance

44. Your thoughts: What are your concerns regarding quality assurance in a more self-directed system? How should consumer outcomes be assessed in a more self-directed system? What should be done if the consumer is making poor choices and their health and safety are at risk? Quality Assurance

45. Main question: How do we make budgets predictable and sustainable for consumers and the agency? Overall System Financing

46. Current system: • Legislature appropriates funding • Complex rules control individual cost plans and spending to seek to stay within the appropriation – Individuals are assigned to one of four tiers – Rebasing for those with changed cost plans – PSA determines medical necessity Overall System Financing

47. Current system: Legislature cuts services and imposes other requirements to control spending About 25% of APD customers had cost plan reductions under the tiers Overall System Financing

48. APD Recommendations: System be fairer to consumers and be sensitive to individual needs Important to Remember: State constitution requires balanced budget—APD must stay within its appropriation Legislature makes decisions on how to fund the wait list Overall System Financing

49. Decisions needed: How much funding to reserve for extraordinary and changed needs How tiers will mesh with this system Will be designing it without tiers Overall System Financing

50. Main question: Who may provide services? Service Providers