Individual Budgeting: Control of the Budget

1. 5 Individual Budgeting: Control of the Budget

2. Why is control over an Individual Budget important? • It is an important way that individuals using arrangements that support self-determination exercise meaningful control over their mental health specialty services and supports. 2 Self-Determination Peer Project

3. Use of public mental health funds is to achieve the individual plan of services A Self-determination Agreement between the agency and the person must be made A copy of the individual budget must be provided to the person Why is control of Individual Budget important? 3 Self-Determination Peer Project

4. If the budget needs to change, Person Centered Planning is used Funds can never “belong” to the person as if they were their own money Why is control of Individual Budget important? 4 Self-Determination Peer Project

5. Control of an Individual Budget:What does it mean? • These arrangements are partnerships between the PIHP/CMHSP and the individual in which PIHP/CMHSP delegates authority for the funding in the individual budget to the individual 5 Self-Determination Peer Project

6. Control of an Individual Budget:What does it mean? The individual’s responsibility: to use the funding for the services and supports in the plan of service consistent with Medicaid & other requirements The PIHP/CMHSP responsibility: monitoring and ensuring that the individual obtains the services and supports in his or her plan of service 6 Self-Determination Peer Project

7. Individual Budgeting: Definition, What it Includes and Does Not Include

8. Individual Budget: What is it? Definition from the Michigan Self-Determination Policy & Practice Guideline: A fixed allocation of public mental health resources Denoted in dollar terms Agreed upon as the necessary cost of specialty mental health services and supports needed to accomplish a individual’s plan of services 8 Self-Determination Peer Project

9. Individual Budget: What is it? An Individual budget is the expected or estimated costs of a concrete approach to obtaining the mental health specialty services and supports in the individual plan of service (IPOS) for which an individual is choosing to use arrangements that support self-determination 9 Self-Determination Peer Project

10. Individual Budget: What it is not? An individual budget does not include services and supports obtained through the traditional service delivery system or from other funding sources 10 Self-Determination Peer Project

11. Individual Budget: What it is not? An individual budget also must be differentiated from the estimated costs of providing mental health specialty services and supports that must be provided to all individuals who receive services and supports in the public mental health system. Source: MDCH/PIHP Contract § 6.3.3. Information Requirements, B.2.f. 11 Self-Determination Peer Project

12. Individual Budget: What it is not? An Individual Budget does not include: • Services and supports and from other funding sources (e.g. Home Help, Michigan Rehabilitation Services) • The individual’s own income 12 Self-Determination Peer Project

13. Individual Budgeting: Process to Develop a Budget

14. How is an Individual Budget developed? Each PIHP/CMHSP must have: A process to cost out services and supports A purchasing process for services and supports Help individuals to find qualified and capable providers 14 Self-Determination Peer Project

15. How is an Individual Budget developed? Person Centered Planning process Plan of Service Individual Budget Involving individual, his/her allies, and the PIHP/CMH Amount determined with information from previous steps Individual’s needs and goals developed 15 Self-Determination Peer Project

16. How is an Individual Budget developed? 1. The PIHP/CMHSP must cost out the services and supports identified in the plan of service example: a reasonable number of hours at a reasonable rate 2. The individual and the PIHP/CMHSP agree to both the drafted plan of service and the individual budget 16 Self-Determination Peer Project

17. How is an Individual Budget developed: Retrospective budgeting? Retrospective Step 2: Assessment completed using Person Centered Planning principles Step 1: Individual enters CMH System Step 3: Person Centered Plan facilitated Step 6: Individual receives services & support outlined in Plan of Service & Person Centered Plan Step 5: Amount of Budget that is self-directed Step 4: Plan of Service & Total dollar amount of benefit determined 17 Self-Determination Peer Project 17

18. Individual Budgeting: Using the Budget

19. What can the Individual Budget be used for? • The individual uses the funding in the individual budget to buy and pay for the services and supports in his/her plan of service. • The fiscal intermediary fee if the individual is directly employing workers and/or using the fiscal intermediary to process payments to other providers. 19 Self-Determination Peer Project

20. Individual Budget Use: The Plan of Service • Estimate of what the person needs • Considers all resources available to the person • Changes to meet the needs of the person 20 Self-Determination Peer Project

21. Individual Budget Use: The Plan of Service • Amount: How much? • Scope: What services and supports? • Duration: How long? 21 Self-Determination Peer Project

22. What are the limits on how the budget is used? • The individual budget cannot be used for mental health specialty services and supports: • not authorized in the plan of service • services and supports not available through the public mental health system 22 Self-Determination Peer Project

23. Individual Budgeting: Accessible, Portable, and Flexible Budgets

24. Yes, BUT…IS THE BUDGET FAP? Flexible Accessible Portable 24 Self-Determination Peer Project

25. F L E X I B L E F ree Loose & Limber Elastic X tra stretchy 25 Self-Determination Peer Project

26. Budget FLEXIBLE means you may adjust the use of CMHSP-authorized funds within the budget between budgetary line items and/or categories in order to adjust his/her specialty mental health services and supports arrangements as he or she deems necessary to accomplish his/her plan. (SD Guideline II.E.4.a.) 26 Self-Determination Peer Project

27. A C C E S S I B L E A vailable C lose C onvenient E asy to Get & Reach S imple Sensible & Sound 27 Self-Determination Peer Project

28. Know the amount for the entire individual budget Understand purpose (to purchase) of the budget Know the options and limitations for this specific application of CMHSP-authorized funds Are to obtain the services in individual budget and supports spelled in the IPOS Know where the resources are banked Budget ACCESSIBLE means you: 28 Self-Determination Peer Project

29. Have people (allies) you want to help - actually help you- with your budget Can locate in your Self-Determination Agreement where the use and limitations of the of CMHSP-authorized funds in the budget are written and you know about them Have knowledge of amount, scope and duration for each service and support Budget ACCESSIBLE means you: 29 Self-Determination Peer Project

30. P O R T A B L E Practical O rganizable R eachable & Ready T ransfer 30 Self-Determination Peer Project

31. Budget PORTABLE means you are able to • Make changes to the budget without approval from the PIHP/CMHSP • Move those specific CMHSP-authorized funds 31 Self-Determination Peer Project

32. Budget PORTABLE means you are able to • Easily switch specific CMHSP- authorized funds from one LINE ITEM to another • Change the budget resources specific application of CMHSP-authorized funds from one service provider to another (as long as the provider meets provider qualifications for the service or support) 32 Self-Determination Peer Project

33. Yes, BUT…IS THE BUDGET FAP? Flexible Accessible Portable 33 Self-Determination Peer Project

34. Adjustments that Require a Modification to the Individual Budget • substituting one service for another service that is not similar • forgoing services and supports, or using services and supports not authorized in the Self-Determination Agreement 34 Self-Determination Peer Project

35. To make an adjustment that fundamentally alters the IPOS • CALL the supports coordinator or case manager • Do it through the person-centered planning process 35 Self-Determination Peer Project

36. Informed Options Individuals must be informed of the options for flexibility and portability Individuals must be provided with guidance about the types of variations they may initiate and the types that will require prior approval Including expectations that these must be communicated to the PIHP/CMHSP Informed in writing 36 Self-Determination Peer Project

37. Individual Budgeting: The Role of Fiscal Intermediary

38. How does the Fiscal Intermediary (FI) help with the budget? A Fiscal Intermediary is an independent legal entity that acts as assures financial accountability for the funds in a person’s Individual Budget and performs essential tasks that support person using arrangements that support self-determination 38 Self-Determination Peer Project

39. How does the Fiscal Intermediary (FI) help with the budget? It is a fiscal agent for the PIHP/CMHSP who monitors the budget and ensures that the individual budget is not overspent. It gives the individual Monthly Budget Reports to know if he/she is over or under spending. 39 Self-Determination Peer Project

40. Serves as the employer agent Employs workers to assure compliance with payroll tax and insurance requirements Ensures compliance with requirements of funding agency Provides monthly budget reports Offers help to direct supports using arrangements How does the Fiscal Intermediary (FI) help with the budget? 40 Self-Determination Peer Project