iBudget Florida Stakeholders’ Meeting

1. iBudget FloridaStakeholders’ Meeting December 4, 2009

2. 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 Overview of Proposed System

3. Consumer and family training and tools for managing budgets Policies for limiting risk of overspending and options for corrective action plans Behind-the-scenes reviews for health & safety, provider manipulation, and fraud Process for determining budgets for consumers with exceptional needs Overview of Proposed System

4. 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 Overview of Proposed System

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

6. 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

7. Feedback so far: System now does provide for adequate consumer control System now does not provide for adequate consumer control Some individuals don’t have natural supports to help exercise self-direction Consumer and Family Control

8. Feedback so far: Some families will be unable to manage a budget Concern that individuals’ natural supports might not let them make desired choices Concern that some providers may not cooperate or may be manipulative Consumer and Family Control

9. Feedback so far: Consumers may make poor choices that put them at risk Consumers need opportunities to make choices and learn from the poor ones Consumer and Family Control

10. Decisions needed: Limits on spending to ensure that funds last through the year Option A: Monthly allocation Option B: 10% up front; 85%, spread over 12 months; 5% emergency reserve Option C: 20% up front; 80% spread over 4 quarters Consumer and Family Control

11. Decisions needed: Other methods to discourage overspending Monthly statements Waiver support coordinator issues service authorizations (consumer and family may do so in Option C) Swipe card system Consumer and Family Control

12. Decisions needed: What to do if a person overspends but still needs services Require to adjust services to fit budget Limit flexibility to make future changes Require a representative to help Temporary increase in funding to meet critical health and safety needs Require training or a mentor paid from budget Consumer and Family Control

13. Decisions needed: How to provide training on making good choices Web Through Waiver Support Coordinator In-person group trainings hosted by FCC or Area Office Paid service through person’s budget Consumer and Family Control

14. Decisions needed : Caps on service amounts: Option A: Similar to current handbook Option B: Only on limited services which are related to health & safety Option C: No Consumer and Family Control

15. Decisions needed : Whether funds for certain critical health and safety-related services must be reserved and may not be spent on other services: Option A: Residential habilitation, nursing, therapies Option B: Residential habilitation only Option C: None Consumer and Family Control

16. Decisions needed : Who may issue service authorizations to begin or end services: Option A: Waiver support coordinator, along with area staff for certain services Option B: Waiver support coordinator Option C: Consumer, family, and waiver support coordinator Consumer and Family Control

17. Decisions needed : What information consumers need to make good decisions Their own goals and needs Traditional and innovative strategies for achieving goals/meeting needs Outcomes/performance data Consumer and Family Control

18. Decisions needed : How to help consumers track spending Waiver support coordinator Web-based budget tool Service logs Monthly statement Consumer and Family Control

19. Decisions needed : How to find out if any providers are uncooperative or manipulative Analysis of service usage/spending patterns Reports from consumers/families Quality assurance contractor reporting Consumer and Family Control

20. Decisions needed : What support to give to consumers who don’t have unpaid help in decision-making Waiver support coordinators continue in that role Waiver support coordinators help find supports to help Quality assurance review Behind-the-scenes audits Consumer and Family Control

21. Decisions needed : If funds can be carried over to a future year like in CDC+ Option A: No Option B: 50% carry over for up to 1 year Option C: 100% carry over, no time limit Consumer and Family Control

22. Main question: How do we best ensure that individuals receive the services that they need within allowable waiver coverage? Service Review

23. 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 Service Review

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

25. Decisions needed: What are situations requiring a review? Who will conduct reviews? Service Review

26. Decisions needed: Situations requiring review Under all options: Newly-enrolled in waiver If overspent budget within last 12 months First time in a licensed home Service Review

27. Decisions needed: Situations requiring a review Under all options: Temporary significant change in needs requiring additional funds Permanent significant change in needs requiring additional funds Extraordinary need request Service Review

28. Decisions needed: Situations requiring a review The first iBudget Florida plan: Option A: Yes Option B: Yes Option C: Only if using different services than previous plan Service Review

29. Decisions needed: Situations requiring a review Every 3 years: Option A: Yes Option B: No Option C: No Service Review

30. Decisions needed: Situations requiring a review If adding new service family: Option A: Yes Option B: Yes Option C: No Service Review

31. Decisions needed: Situations requiring a review If increasing amounts of certain services within budget amount: Option A: Yes--behavioral services, nursing services, therapies Option B: Yes—intensive behavioral services, nursing services, therapies Option C: No Service Review

32. Decisions needed: Situations requiring a review If decreasing amounts of certain services within budget amount: Option A: Yes--behavioral services, nursing services, therapies Option B: No Option C: No Service Review

33. Decisions needed: Situations requiring more frequent review: If meets certain criteria: Current or previous forensic involvement Extraordinary medical needs Extraordinary behavioral needs Community based care child Only paid supports in person’s life Service Review

34. Decisions needed: The process for requesting reviews Computer-based Who will perform reviews Option A: Contracted provider, Central Office, and Area Offices Option B: Central Office and Area Offices Option C: Area Offices Service Review

35. Main question: How do we ensure health, safety, and good outcomes? Quality Assurance and Quality Improvement

36. APD Plans: New quality assurance contract uses different measures Increasing percentage of support coordination records reviewed to 50% Will review about 25% of consumers individually Florida is joining National Core Indicators initiative Quality Assurance and Quality Improvement

37. Feedback so far: Support revision of the quality assurance system to be more understandable, less bureaucratic, and more person-centered Concern that individuals may make poor choices that put their health and safety at risk Concern that individuals may be at risk of exploitation by providers and natural supports Quality Assurance and Quality Improvement

38. Key Areas: Health & safety Budget management Outcomes Compliance Quality Assurance and Quality Improvement

39. Participants in QA/QI System: Consumers & families Waiver Support Coordinators Providers Family Care Councils Advocacy & provider organizations APD Central Office staff Quality Assurance and Quality Improvement

40. Participants in QA/QI System: APD Area staff Certified Behavior Analysts Nursing staff Questionnaire for Situational Information Administrators Licensing Group home monthly monitoring Provider enrollment Supported living coordinator Quality Assurance and Quality Improvement

41. Examples of key activities: Assessment Planning Training Standard setting/process determination Monitoring/data analysis Information sharing Problem identification Corrective action Quality Assurance and Quality Improvement

42. Decisions needed: Options: Health & safety: Requirement for use of full or enhanced waiver support coordination by certain individuals (e.g., those with forensic involvement) Competency-based training Utilization reviews to identify service patterns of concern Quality Assurance and Quality Improvement

43. Decisions needed: Options: Health & safety: Review by area certified behavior analysts and nursing staff based on QSI scores Limits on certain flexibility in selecting and changing services Quality Assurance and Quality Improvement

44. Decisions needed: Options: Budget management: Training for all levels of skill Timely information through web-based tools Consumer & family Support coordinator Area office Contracted Quality Assurance reviewers Quality Assurance and Quality Improvement

45. Decisions needed: Options: Budget management: Policies to deter overspending Corrective action plans to address overspending Data analysis of spending patterns Quality Assurance and Quality Improvement

46. Decisions needed: Options: Outcomes: Training on outcomes under a more self-directed system Training for support coordinators on handling issues of poor choice-making Central Office review of support plans to assess consumer goals under new system Quality Assurance and Quality Improvement

47. Decisions needed: Options: Outcomes: Procedures for waiver support coordinators to access area office support and direction in addressing problematic consumer choice-making Quality Assurance and Quality Improvement

48. Decisions needed: Options: Compliance: Training for consumers/families on provider responsibilities Revise relevant assurances and the handbook to clarify expectations and responsibilities under self-directed system Quality Assurance and Quality Improvement

49. Decisions needed: Options: Compliance: Review service patterns to identify provider non-compliance Review service delivery against budget/support plan Publicly share information about non-compliant providers Quality Assurance and Quality Improvement

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