june 30, 2010 ibudget florida stakeholders’ group workgroup meeting—for discussion purposes only...

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


Introductions

• Workgroup members

• Staff

• Guests


Review of Minutes from Previous Meeting


Meeting Objectives

• Share information

• Receive input on preferred options, potential improvements, implementation considerations, and other relevant issues


Overall Goals

Simplify the system

Enhance:

– Self-direction

– Sustainability

– Equity


• 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


• 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 . . .


• 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


• 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


• 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


• Waiver drafting in progress

• Hired iBudget Florida Operations Project Manager.

• Will release RFQ for evaluation soon.

• Initial flowcharting/system design completed

Updates


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



• 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



• 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


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


Topics for Today

• Initial Phase-In Evaluation

• Consumer/family budget tracking


Consumer & Family Control

• Monthly budgeting requirements:– Plan:

• 10% flexible spending (available at beginning of year)

• 5% emergency savings• 85% for monthly allotment



• Monthly budgeting requirements:– Issues:

• Ensure funds last the entire fiscal year• Provide flexibility as needs vary through

year• Maintain appropriate level of review



• 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



• Monthly budgeting requirements:– Should consumers see emergency reserve

line?• A: No.• B: Only when released (10th month).• C: Yes, always.


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.



• Monthly budgeting requirements:– When is 5% reserve released if not used?

• A: Never• B: Beginning of May



• Provider notice:– What notice to providers should be required

or encouraged?



• Provider notice: What notice to providers should be required or encouraged?– Plan: Did not discuss. Implies full ability to

change providers as desired.



• Provider notice: What notice to providers should be required or encouraged?– Issues:

• Maximize flexibility for consumers• Allow providers to plan



• 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



• 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.



• Requests for Additional Funds: – Plan allows requests due to:

• Extraordinary need• One-time change• Temporary change• Permanent change

– Law includes guidelines



• Requests for Additional Funds: – Current situation:

• Requests reviewed through PSA process



• 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



• 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



• 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.



• 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



• 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



• Consumers receiving greater review and with limitations on flexibility:– Plan: this applies to:

• Consumers with forensic involvement

• Consumers unable to manage own budgets


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



• 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




• Foster children• Consumers transitioning from school—6

months pre- and post-transition




• Consumers transitioning between types of living settings (ICF/DD to waiver; group home to supported living; etc)—for 6 months




• Newly-enrolled in the waiver—for 6 months

• Recent alcohol or drug abuse history—for 6 months



• Service Family Approval:– On what basis should service families be

approved? • When transitioning to iBudget from tier

waivers• When brand-new to waiver



• Service Family Approval:– Current situation:

• Services approved one-by-one through PSA process



• 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



• Service Family Approval: Basis for Approving Service Families– Recommendations--automatic approval:

• Transportation• Adult dental (requires revising service

families)



• 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



• 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


Initial Phase-In Evaluation

Proposed general elements (primarily based on HB 7225 provisions):• Cost savings or cost avoidance

• Cost containment• Predictability of expenditures



Proposed general elements (primarily based on HB 7225 provisions):• Opportunities for self-direction • Quality of care• Access to service



General elements (primarily based on HB 7225 provisions):• Satisfaction of consumers, as well as families/guardians of consumers • Simplicity and efficiency of the system



• Budget Management– What will be consumers & families’

mindsets toward their budgets?– How do we get accurate information on

expenditures within current system?


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



• 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




on expenditures within current system? • Current situation: use a combination of

billing information, service logs, and personal contacts with providers.




on expenditures within current system? • Plan: described need for such

information but acknowledged technical challenges


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.




on expenditures within current system? • A: Rely solely on encumbrances and billing

data (up to a year lag), along w/ telephone contacts




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, ???)



• Budget Management– What will be consumers & families’

mindsets toward their budgets?• How do we encourage a mindset of

ownership and cost-effectiveness?


Questions?Suggestions?Comments?


Thank you for your time!

june 30, 2010 ibudget florida stakeholders’ group workgroup meeting—for discussion purposes only...

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