iBudget and the Road

Ahead for You

You Talked . . . We Listened

• “Give us access to a wider set of services”

• “I’m tired of so much change”

• “Services my son needs are denied”

• “We can do things better ourselves”

• “I have to wait for decisions”

• “There’s waaaay too much paperwork”

How We Got to this Point • Managing APD funding is difficult . . .

• Which has led to deficits

• Since APD MUST stay within the budget the Legislature sets . . .

• It leads to cost control measures like tiers, rebasing, and prior service authorization . . .

• Which increases bureaucracy and limits consumer control . . . AND . . .

• Keeps us from serving the wait list.

Are iBudgets an Answer?

• More self-direction

• Less “red tape”

• Greater equity

• More stable, sustainable system

Why iBudgets?

• Other options raise concerns

– Managed care

– Greater institutionalization

– Continued deficits, growing wait list, awkward legislative cost-control measures

• Legislature told us to develop a plan by February 2010

How Did APD Make the iBudget 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 through our Web site

What’s Different About iBudget?

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:• Budget up to

individual limit• Limited service

review process• More choice in

services

Features of iBudget• You have more control over your services—can

get your priority services faster and make changes easier– You’ll know budget for services up front to help you plan

– Wider array of services available to all

– Prior service authorization ended as we know it

• Greater support for you– WSCs will have less paperwork to do

– You’ll have training and tools to self-direct if you want

Features of iBudget

• 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

Sounds Great, But How Does All This Work?

• 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

Sounds Great, But How Does All This Work?

• Can scale back PSA process—gives you more control

• PSA process reduction and electronic records reduce WSC workload

• Computer systems help you and APD monitor budgets, services, and quality

• A chance for more self-direction

Algorithm??

• What is an algorithm?

– Mathematical formula that considers data (consumer characteristics) and determines a budget amount

– Imitates patterns of spending for similar consumers from previous years

– Used in many other contexts:

• Amazon.com recommendations—data on product views

• Credit scores—data on accounts, payment history

More on the Algorithm

• Distributes appropriations fairly and equitably

– Statistically proven to fit Florida’s data and experience pretty closely

– Model considers funding patterns prior to tier implementation (FY 07-08 and 06-07)—these years had the highest levels of expenditures

– Is a starting point! APD will work with stakeholders and you to refine and enhance over time

– APD is analyzing for impacts

What Else Should I Know?

• Initially, some budgets would increase, others decrease, and some stay about the same– Will phase-in gradually—over two or three years

– Exceptional need process if critical health and safety needs are unmet with budget

– Expect more system stability after initial phase-in

– Actuaries will help us determine reserve funding needed

• 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 Should I Know?

• This is a plan—Legislature, federal government need to OK it

• Plan shows our initial direction

– APD is still studying these ideas

– Would refine as we work on implementing

– Would get more stakeholder input

Service ReviewThe 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

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

Waiver Support Coordination

• 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 (ex: more limited support in limited WSC service)

Consumer and Family Control

• Training would be provided to consumers and families on iBudget policies and choice-making

• Unless in CDC+, must use Medicaid-enrolled providers

• Could negotiate some rates up to maximum

$

iBudget

iBudget – Service Delivery System

Consumer Support Plan and Cost Plan Development

Service 1

Service 2

Service 4

Service 3

I’m in CDC+What About Me?

• CDC+ option will continue

• CDC+ participants will have funding determined through iBudget

• CDC+ participants will “spend” iBudget according to CDC+ policies

• Pending feedback from Legislature:

– Draft to Legislature: February 1, 2010

– CMS approval sought as soon as possible

– If approved, phase-in begins Fall/Winter 2010

– QSI improvements/algorithm refinement: Spring/Summer 2011

– Wider phase in begins late 2011 or 2012

Suggested High-Level Implementation Plan

Phase-In

General approach:

• Limited implementation to test and refine processes and enhance algorithm, then . . .

• Gradual phase-in:

- By area

- By consumer characteristics (living setting, age, etc.)

- Of budget amounts

What if My iBudget Isn’t Enough?

• Exceptional need funding available if critical health and safety risk

• Temporary and permanent increase for significantly changed needs that current iBudget can’t accommodate

• One-time funding available—durable medical, environmental modifications, nonroutine dental

• Thorough review of requests for more funding

Stakeholders Told Us . . .

• Enhance the QSI

• Test more variables for the algorithm

• Want same services available to all

• Test and measure the impact of iBudgets

• Consider policy options carefully

iBudget Florida• A draft plan

• We welcome comments!

• Legislature will review plan and give APD direction

• Federal government must approve, too

• A starting point—We will be enhancing algorithm, QSI, and policies as we go along—much more work to be done

The End of our Journey • Greater control over your lives

• Less delay in getting services

• Services better tailored to meet your needs

• WSC freed up to help you more

• Greater equity in funding

• Reduced bureaucracy and “red tape”

• More stable system

iBudget Florida• Provide additional input through

APD Web site:

www.apdcares.org

• Please read plan to be posted later in January and give us comments