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Budget Florida. The Waive(r) of the Future. Other options raise concerns Managed care Greater institutionalization Continued deficits, growing waiting list, awkward legislative cost-control measures

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budget florida

Budget Florida

The Waive(r) of the Future

Other options raise concerns

Managed care

Greater institutionalization

Continued deficits, growing waiting list, awkward legislative cost-control measures

Legislature told us to develop a plan by February 2010—then passed a law requiring APD to implement it (s. 393.0663, F.S.)

Why iBudgets?

Managed Care

Bill transitioning DD HCBS services to managed care passed House in 2010

Speaker’s suggested principles for approval in tomorrow’s organizational session:

Phase in the implementation of the statewide managed care program, allowing adequate time for development of managed long-term care and reserving the final phase of the implementation of managed care for persons with developmental disabilities.

iBudget Florida is the law now (s. 393.0663, F.S.)

Why iBudgets?

overall goals of ibudget florida
Simplify the system





Overall Goalsof iBudget Florida
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 via our Web site

How did APD make

the iBudget Florida plan?


iBudget Florida Paradigm

  • 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

Overview of Proposed System

  • Budgets determined through algorithm and provided at beginning of plan year
  • 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

  • Consumer and family training and tools for managing budgets
  • Policies for limiting risk of overspending and options for corrective action plans
  • Reviews for health and safety, provider manipulation, and fraud
  • Process for determining budgets for consumers with extraordinary needs

Overview of Proposed System

  • Electronic/automated as much as possible
    • New online tool for creating budgets and tracking funding
  • Phase-in over a reasonable time period
    • e.g., number of consumers (by geography) and budget amounts
AHCA has submitted waiver application—1st 90 day clock ends 12/12/10

Online iBudget Florida system well into development—1st phase completed today

Communication materials developed

Rules and processes being designed

When iBudget Florida is fully implemented, tiers will go away

Status Update

First phase-in location: Area 2B--Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla counties

Area 2A will follow in about six months

Bay, Calhoun, Gulf, Holmes, Jackson, and Washington counties

Wider phase-in begins late 2011 or 2012

Phase 1 Implementation of IBudget Florida

algorithm used to determine individual budgets
Algorithm Used to Determine Individual Budgets

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 extraordinary needs/ changed/one-time needs = total APD waiver funding

what else is important
What else is important?

Initially, some budgets will increase, others decrease, and some stay about the same

Will phase-in gradually—over a few years

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

Expect more system stability after initial phase-in

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


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 Coordination

• Waiver Support Coordinator’s role will shift from paper pusher to social worker

Reduced paperwork load frees up time

More customized level of service--most may choose support coordination level (limited, full, or enhanced)

Children can choose full support coordination

Adults can choose limited and use funding for other services

waiver support coordination22
Waiver Support Coordination

• More meaningful distinction between levels



Enhanced (renaming of Transitional)

consumer and family control
Consumer and Family Control

Training will be provided to consumers and families on iBudget Florida policies and choice-making

Unless in CDC+, must use Medicaid-enrolled providers

consumer and family control24
Consumer and Family Control

Could negotiate some rates up to maximum

Family & Guardian Training

Person-Centered Planning

Personal Supports

cdc and ibudget florida
CDC+ and iBudget Florida

CDC+ option will continue

CDC+ participants will have funding determined through their iBudgets

CDC+ participants will “spend” iBudgets according to CDC+ policies


WSC Screen Shots – Cost Plan

Task listed Dorothy Dexter’s Cost Plan Review


WSC Screen Shots – Review

Review the Monthly Cost Plan


WSC Screen Shots – Review

Review the Service Plan

Submit for Area Review

cost plan building process
Cost Plan Building Process

System automatically either:

Approves cost plan OR

Routes for area review

All 1st plans on iBudget require area review

Afterwards, plans are automatically approved if within basic guidelines

Will significantly reduce time for service approval in many cases

system cost plan review
System Cost Plan Review

System will approve plans if:

Within budget guidelines

No new services requested

No reductions in critical services (res hab, behavior, nursing)

Routed for area review if (examples):

Outside budget guidelines

Requesting non-approved services

Reductions in critical services

Fund request will have own process

what if a personal ibudget can t meet an individual s needs
What if a personal iBudget can’t meet an individual’s needs?

Extraordinary need funding is available if critical health and safety risk

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

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

Thorough review of requests for more funding

online budgeting tool
Online Budgeting Tool

Online budget tool to create budgets and track spending if consumers and families want to do so

- Waiver Support Coordinator will handle

if they don’t

consumer family uses of online system
Consumer/Family Uses of Online System

Draft Cost Plans

Submit Cost Plans to their Waiver Support Coordinator

Review their iBudget Florida Account Information

E-mail their Waiver Support Coordinator