iBudget Florida Stakeholders’ Meeting

1. iBudget FloridaStakeholders’ Meeting June 21, 2011

2. Needs met through waiver AND state plan, natural supports and community resources Waiver Support Coordinators freed to help get other resources Consumers have lots of flexibility for spending up to individual iBudget maximum amount Requests for additional funding require thorough review iBudget Paradigm

3. Current situation: Levels/funding for support coordination: Limited—all children; adults who choose (can’t use funds for another service; children can’t increase level by choice) Full—all adults, unless they choose limited Transitional—consumers who are transitioning from an ICF/DD Waiver Support Coordination

4. Levels of support coordination available: Limited Full Enhanced Funding in consumer’s iBudget: Adults funded at full Children funded at limited Waiver Support Coordination

5. Consumers have more flexibility to choose among waiver support coordination levels Some consumers may choose to decrease level and use funds for another service Some may choose to increase level using funds in their budget Waiver Support Coordination

6. Some consumers will not be allowed to choose a lower waiver support coordination level For those using limited waiver support coordination, an orientation to iBudget Florida is required Waiver Support Coordination

7. Requirements for use of waiver support coordination level: See handout Waiver Support Coordination

8. Funding Assumptions

9. Supplemental Funding Basic question: What is process/standard for determining an individual’s funding? Funding Determination

10. Funding Process—Before Fiscal Year Begins • Algorithm is run for everyone • APD pre-approves services • Notice sent with algorithm-based allocation and pre-approved service information

11. Funding Process—Before Fiscal Year Begins • Individuals create plan to meet needs with all resources, including budget allocations

12. Funding Process—Before Fiscal Year Begins • If individuals believe they, caregivers, or public are in immediate, serious jeopardy without funding increase AND • They meet other statutory eligibility criteria: • They can apply for extraordinary need funding

13. Supplemental Funding Plan--extraordinary need supplemental funding: For individuals whose situation is so unique that the algorithm is not able to determine their budget amount. Small number of consumers would qualify Funding Determination

14. Supplemental Funding Requirements to receive funding Eligible under law/rule for supplemental funding. Has sought non-waiver supports to meet needs within budget but they are not sufficient. Funding Determination

15. Supplemental Funding Requirements to receive funding Cannot adjust budget to meet needs. Qualify for specific waiver services requested to meet needs Funding Determination

16. Supplemental Funding Statutory eligibility criteria for receiving extraordinary need funding: The health and safety of the client, the client's caregiver, or the public [would be] in immediate, serious jeopardy unless the increase is approved. Funding Determination

17. Supplemental Funding Statutory eligibility criteria for receiving extraordinary need supplemental funding: Documented history of significant, potentially life-threatening behaviors Complex medical condition that requires active intervention by a licensed nurse on an ongoing basis Funding Determination

18. Supplemental Funding Statutory eligibility criteria for receiving extraordinary need supplemental funding: A chronic co-morbid condition A need for total physical assistance with activities such as eating, bathing, toileting, grooming, and personal hygiene Funding Determination

19. Supplemental Funding Request & Review • Additional funding available during year to address, if all criteria met: • Temporary change in need • Permanent change in need • One-time purchase need

20. Supplemental Funding Statutory eligibility criteria for receiving permanent change in need funding: A significant increase in the need for services after the beginning of the service plan year that would place the health and safety of the client, the client’s caregiver, or the public in serious jeopardy because of substantial changes in the client’s circumstances . . . Funding Determination

21. Supplemental Funding Statutory eligibility criteria for receiving permanent change in need funding: Loss of services authorized under the state Medicaid plan due to a change in age Permanent or long-term loss or incapacity of a caregiver Funding Determination

22. Supplemental Funding Statutory eligibility criteria for receiving permanent change in need funding: A significant change in medical or functional status which requires the provision of additional services on a permanent or long-term basis Funding Determination

23. Supplemental Funding Statutory eligibility criteria for receiving temporary change in need: The health and safety of the client, the client’s caregiver, or the public [would be] in serious jeopardy unless the increase is approved Funding Determination

24. Supplemental Funding Statutory eligibility criteria for receiving temporary change in need funding: Special services or treatment for a serious temporary condition when the service or treatment is expected to ameliorate the underlying condition. Funding Determination

25. Supplemental Funding Statutory eligibility criteria for receiving temporary change in need funding: The provision of services to address the temporary loss of support from a caregiver Funding Determination

26. Supplemental Funding Determination Process Must meet all requirements Similar to APD’s current system under cost plan freeze Funding Determination

27. Funding Phase-In • To mitigate impacts of funding reductions: • Grant no increases • Cap decreases • Law requires cap of 50% on reductions due to iBudget Florida implementation during 1st year • Re-evaluate after iBudget Florida has proven its effectiveness

28. Geographic Phase-In • General approach: • Limited implementation to test and refine processes and enhance algorithm, then— • Phased rollout across the state • Target completion by July 1, 2012

29. Geographic Phase-In • General approach: • Given accelerated timeframe, delayconsumer portal rollout until after statewide implementation • Allows time to enhance it, dedicate sufficient resources to training

30. Begin rulemaking process Develop and implement training for consumers, families, waiver support coordinators, and providers Set up new procedures and train area staff Next Steps

31. Help transition providers Promulgate new iBudget Florida waiver handbook Work with waiver support coordinators and consumers and families to begin developing new cost plans Next Steps

32. Rule Development Workshop Today—2:00 P.M. – 4:00 P.M.

33. Thank you!