june 30, 2010 ibudget florida stakeholders’ group workgroup meeting—for discussion purposes only...
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June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 1
iBudget FloridaStakeholders’ Group Meeting
June 30, 2010
Workgroups on Service Review, Consumer and Family Control, &
Quality Assurance and Algorithm, Assessment, Overall System Funding & Extraordinary and
Changed Needs
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 2
Introductions
• Workgroup members
• Staff
• Guests
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 3
Review of Minutes from Previous Meeting
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 4
Meeting Objectives
• Share information
• Receive input on preferred options, potential improvements, implementation considerations, and other relevant issues
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 5
Overall Goals
Simplify the system
Enhance:
– Self-direction
– Sustainability
– Equity
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 6
• 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
iBudget Paradigm
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 7
• This is a starting point
– We’ll be testing the system through an initial phase-in.
– Intend to refine system over time
• Are seeking the best solution among the alternatives
– All have pro’s and con’s
Keep in mind . . .
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 8
• Waiver submitted by early August
• Draft rules by late July
• Draft operating procedures by late July
• Training developed by late August; begin training in early September
Target Implementation Plan
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 9
• Collect baseline data for evaluation by late September
• IT system implemented by early October• Start communicating with phase in area
consumers, WSC’s, providers, and staff upon announcement
Target Implementation Plan
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 10
• Completed initial review of rules and operating procedures that need revising and development.
• Phase-in area not final. – Will have a coordinated system of publicizing to
ensure accurate information.
• IT system design progressing; coding beginning soon.
Updates
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 11
• Waiver drafting in progress
• Hired iBudget Florida Operations Project Manager.
• Will release RFQ for evaluation soon.
• Initial flowcharting/system design completed
Updates
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 12
Overview of Proposed System
• Budgets determined through algorithm • 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
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 13
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 indicators of health & safety, provider manipulation, and fraud• Process for determining budgets for consumers with extraordinary needs
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 14
Overview of Proposed System
• Electronic/automated as much as possible—virtually paperless• Phase-in over a reasonable time period—e.g., number of consumers (say by geography) and budget amounts
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 15
Topics for Today• Guidelines for budgeting• Notice to providers• Requests for and use of additional
funds• Consumers receiving higher level of
review/limits on flexibility• Service family approval
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 16
Topics for Today
• Initial Phase-In Evaluation
• Consumer/family budget tracking
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 17
Consumer & Family Control
• Monthly budgeting requirements:– Plan:
• 10% flexible spending (available at beginning of year)
• 5% emergency savings• 85% for monthly allotment
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 18
Consumer & Family Control
• Monthly budgeting requirements:– Issues:
• Ensure funds last the entire fiscal year• Provide flexibility as needs vary through
year• Maintain appropriate level of review
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 19
Consumer & Family Control
• Monthly budgeting requirements:– How much can consumers deviate from
monthly allotment without area review?• A: Not at all• B: May do so within a range (ex: up to
5% over) but beyond that requires area approval
• C: No restrictions, but area alerted if beyond a range and may review
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 20
Consumer & Family Control
• Monthly budgeting requirements:– Should consumers see emergency reserve
line?• A: No.• B: Only when released (10th month).• C: Yes, always.
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 21
Consumer & Family Control• Monthly budgeting requirements:
– How do consumers use the 5% emergency reserve?• A: Must specifically request use & get area
approval.• B: Must specifically request use in online
system, but area approval not needed• C: WSC/consumer gets alert that it’s being
used.
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 22
Consumer & Family Control
• Monthly budgeting requirements:– When is 5% reserve released if not used?
• A: Never• B: Beginning of May
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 23
Consumer & Family Control
• Provider notice:– What notice to providers should be required
or encouraged?
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 24
Consumer & Family Control
• Provider notice: What notice to providers should be required or encouraged?– Plan: Did not discuss. Implies full ability to
change providers as desired.
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 25
Consumer & Family Control
• Provider notice: What notice to providers should be required or encouraged?– Issues:
• Maximize flexibility for consumers• Allow providers to plan
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 26
Consumer & Family Control
• Provider notice: What notice to providers should be required or encouraged?– Current situation:
• Consumers have complete flexibility to change providers
• APD strives to provide notice for system-required changes
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 27
Consumer & Family Control
• Provider notice: What notice to providers should be required or encouraged?– A: Require 15 days’ notice unless
health/safety concerns.– B: Encourage 15-30 days’ notice.– C: No guidelines or requirements.
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 28
Consumer & Family Control
• Requests for Additional Funds: – Plan allows requests due to:
• Extraordinary need• One-time change• Temporary change• Permanent change
– Law includes guidelines
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 29
Consumer & Family Control
• Requests for Additional Funds: – Current situation:
• Requests reviewed through PSA process
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 30
Consumer & Family Control
• Requests for Additional Funds: – Required to demonstrate how meet
statutory/rule requirements for receiving additional funds (meet criteria, are unable to accommodate within budget)
– Documentation required; will be able to be submitted via iBudget online system
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 31
Consumer & Family Control
• Requests for Additional Funds: – Review every 3-6 months to assess
whether additional funds are still needed– Will be timeframes for area review and
response
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 32
Consumer & Family Control
• Handling unused additional funds: – A: Funds unused within 3 months are
“returned” to APD– B: Funds unused within 3 months require
justification for lack of use, demonstration they are still needed, or are “returned”
– C: No review/return of unused funds.
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 33
Consumer & Family Control
• Consumers receiving greater review and with limitations on flexibility:– Issues:
• Ensure health and safety of consumers who are more vulnerable
• Promote wise use of funds• Still provide for self-direction• Simplify processes
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 34
Consumer & Family Control
• Consumers receiving greater review and with limitations on flexibility:– Current situation:
• Nearly all changes that any consumer makes are reviewed through PSA unless it’s a reduction
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 35
Consumer & Family Control
• Consumers receiving greater review and with limitations on flexibility:– Plan: this applies to:
• Consumers with forensic involvement
• Consumers unable to manage own budgets
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 36
Consumer & Family Control• Consumers receiving greater review/limited
changes--what flexibility would be available to make changes without review?– A: Require area review/approval of all
changes – B: Require area review/approval of certain
changes with conference/every 6 months– C: Area review/approval of certain changes
(tailor to situation) with optional conference as needed
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 37
Consumer & Family Control
• Consumers receiving greater review and with limitations on flexibility:– Who, and how defined--recommendations:
• Consumers with complex medical needs--based on certain QSI responses or service use
• Consumers with complex behavioral needs--based on certain QSI responses or service use
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 38
Consumer & Family Control
• Consumers receiving greater review and with limitations on flexibility:– Who, and how defined--recommendations:
• Foster children• Consumers transitioning from school—6
months pre- and post-transition
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 39
Consumer & Family Control
• Consumers receiving greater review and with limitations on flexibility:– Who, and how defined--recommendations:
• Consumers transitioning between types of living settings (ICF/DD to waiver; group home to supported living; etc)—for 6 months
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 40
Consumer & Family Control
• Consumers receiving greater review and with limitations on flexibility:– Who, and how defined--recommendations:
• Newly-enrolled in the waiver—for 6 months
• Recent alcohol or drug abuse history—for 6 months
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 41
Consumer & Family Control
• Service Family Approval:– On what basis should service families be
approved? • When transitioning to iBudget from tier
waivers• When brand-new to waiver
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 42
Consumer & Family Control
• Service Family Approval:– Current situation:
• Services approved one-by-one through PSA process
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 43
Consumer & Family Control
• Service Family Approval: Basis for Approving Service Families– Recommendations--automatic approval:
• Support Coordination• Life Skills Development• Personal Supports for adults in family
home or supported living
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 44
Consumer & Family Control
• Service Family Approval: Basis for Approving Service Families– Recommendations--automatic approval:
• Transportation• Adult dental (requires revising service
families)
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 45
Consumer & Family Control
• Service Family Approval: Basis for Approving Service Families– Consider service use for past 2 years—
receive approval for services that consumers had been approved for unless situation has changed
– QSI responses
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 46
Consumer & Family Control
• Service Family Approval: Basis for Approving Service Families– After initial transition, area staff will review
requests for service families– Requests (including documentation)
submitted via online system
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 47
Initial Phase-In Evaluation
Proposed general elements (primarily based on HB 7225 provisions):• Cost savings or cost avoidance
• Cost containment• Predictability of expenditures
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 48
Initial Phase-In Evaluation
Proposed general elements (primarily based on HB 7225 provisions):• Opportunities for self-direction • Quality of care• Access to service
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 49
Initial Phase-In Evaluation
General elements (primarily based on HB 7225 provisions):• Satisfaction of consumers, as well as families/guardians of consumers • Simplicity and efficiency of the system
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 50
Consumer & Family Control
• Budget Management– What will be consumers & families’
mindsets toward their budgets?– How do we get accurate information on
expenditures within current system?
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 51
Consumer & Family Control• Budget Management
– How do we get timely, accurate information on expenditures within current system? • Issues:
–System sustainability requires accurate budget tracking
–Providers are at varying levels of sophistication
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 52
Consumer & Family Control
• Budget Management– How do we get timely, accurate information
on expenditures within current system?
• Issues:–APD technology still in development–Will have to rely at minimum on
combination of encumbrances through service authorizations and billing data
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 53
Consumer & Family Control
• Budget Management– How do we get timely, accurate information
on expenditures within current system? • Current situation: use a combination of
billing information, service logs, and personal contacts with providers.
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 54
Consumer & Family Control
• Budget Management– How do we get timely, accurate information
on expenditures within current system? • Plan: described need for such
information but acknowledged technical challenges
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 55
Consumer & Family Control• Budget Management
– How do we get timely, accurate information on expenditures within current system?
• A: Budget on monthly basis; do quarterly service authorizations to balance flexibility with budget control
• B: Do yearly service authorizations; rely on frequency in service authorization to control spending.
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 56
Consumer & Family Control
• Budget Management– How do we get timely, accurate information
on expenditures within current system? • A: Rely solely on encumbrances and billing
data (up to a year lag), along w/ telephone contacts
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 57
Consumer & Family Control
• Budget Management– How do we get timely, accurate information
on expenditures within current system? • B: Require basic service information to be
submitted within 15 days of quarters’ end (by telephone/IVR, fax of paper to WSC’s, online form, ???)
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 58
Consumer & Family Control
• Budget Management– What will be consumers & families’
mindsets toward their budgets?• How do we encourage a mindset of
ownership and cost-effectiveness?
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 59
Questions?Suggestions?Comments?
June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 60
Thank you for your time!
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