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Budget Florida The Waive(r) of the Future 11/15/10 APD Public Meeting with Advocacy Community Budget Florida The Waive(r) of the Future 11/15/10 APD Public Meeting with Advocacy Community 1

Why i. Budgets? • Other options raise concerns – Managed care – Greater institutionalization Why i. Budgets? • 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. ) 11/15/10 APD Public Meeting with Advocacy Community 2

11/15/10 APD Public Meeting with Advocacy Community 3 11/15/10 APD Public Meeting with Advocacy Community 3

APD Home and Community Based Waiver Funding 900. 0 2005 -06 880. 0 2006 APD Home and Community Based Waiver Funding 900. 0 2005 -06 880. 0 2006 -07 2007 -08 860. 0 840. 0 820. 0 800. 0 2008 -09 2009 -10 2010 -11 780. 0 760. 0 740. 0 720. 0 700. 0 11/15/10 APD Public Meeting with Advocacy Community 4

Why i. Budgets? • Managed Care – Bill transitioning DD HCBS services to managed Why i. Budgets? • 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. • i. Budget Florida is the law now (s. 393. 0663, F. S. ) 11/15/10 APD Public Meeting with Advocacy Community 5

Overall Goals of i. Budget Florida Simplify the system Enhance: – Self-direction – Sustainability Overall Goals of i. Budget Florida Simplify the system Enhance: – Self-direction – Sustainability – Equity 11/15/10 APD Public Meeting with Advocacy Community 6

How did APD make the i. Budget Florida plan? • Did a lot of How did APD make the i. Budget Florida 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 via our Web site 11/15/10 APD Public Meeting with Advocacy Community 7

i. Budget Florida Paradigm • Needs met through waiver AND state plan, natural supports i. Budget 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 i. Budget maximum amount • Requests for additional funding require thorough review 11/15/10 APD Public Meeting with Advocacy Community 8

Overview of Proposed System • Budgets determined through algorithm and provided at beginning of 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 11/15/10 APD Public Meeting with Advocacy Community 9

Overview of Proposed System • Consumer and family training and tools for managing budgets 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 11/15/10 APD Public Meeting with Advocacy Community 10

Overview of Proposed System • Electronic/automated as much as possible – New online tool 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 11/15/10 APD Public Meeting with Advocacy Community 11

Status Update • AHCA has submitted waiver application— 1 st 90 day clock ends Status Update • AHCA has submitted waiver application— 1 st 90 day clock ends 12/12/10 • Online i. Budget Florida system well into development— 1 st phase completed today • Communication materials developed • Rules and processes being designed – When i. Budget Florida is fully implemented, tiers will go away 11/15/10 APD Public Meeting with Advocacy Community 12

Phase 1 Implementation of IBudget Florida • First phase-in location: Area 2 B--Franklin, Gadsden, Phase 1 Implementation of IBudget Florida • First phase-in location: Area 2 B--Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla counties • Area 2 A will follow in about six months – Bay, Calhoun, Gulf, Holmes, Jackson, and Washington counties • Wider phase-in begins late 2011 or 2012 11/15/10 APD Public Meeting with Advocacy Community 13

Algorithm Used to Determine Individual Budgets • Uses a statistically validated formula or algorithm 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 i. Budgets + funds for extraordinary needs/ changed/one-time needs = total APD waiver funding 11/15/10 APD Public Meeting with Advocacy Community 14

What else is important? • Initially, some budgets will increase, others decrease, and some 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 11/15/10 APD Public Meeting with Advocacy Community 15

i. Budget Funding 11/15/10 APD Public Meeting with Advocacy Community 16 i. Budget Funding 11/15/10 APD Public Meeting with Advocacy Community 16

Services Design of service array • Services grouped in 8 service families - Can 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 11/15/10 APD Public Meeting with Advocacy Community 17

Services Group 1 Service Family Life Skills Development Service Life Skills Development (New service Services Group 1 Service Family Life Skills Development Service Life Skills Development (New service encompassing ADT, Supported Employment, Residential Habilitation Qrt Hr. , Companion) New Service - Person Centered Planning New Services - Family & Guardian Training Consumable Medical Supplies 2 Supplies and Equipment Durable Medical Equipment and Supplies Environmental Accessibility Adaptations Personal Emergency Response Systems (Unit and Services) 3 Personal Supports (New service encompassing In -Home Supports, Respite, Personal Care & Companion)--Adults in family or own home only Respite--children in family home only 11/15/10 APD Public Meeting with Advocacy Community 18

Services Residential Habilitation (Standard) 4 Residential Services* Residential Habilitation (Behavior Focused) Residential Habilitation (Intensive Services Residential Habilitation (Standard) 4 Residential Services* Residential Habilitation (Behavior Focused) Residential Habilitation (Intensive Behavior) Specialized Medical Home Care Supported Living Coaching 5 Support Coordination--Limited Coordination (Some Support Coordination--Full individuals will have limitations on their ability to choose a Support Coordination--Enhanced different level of Support Coordination). 11/15/10 APD Public Meeting with Advocacy Community 19

Services Private Duty Nursing Residential Nursing Skilled Nursing Dietician Services 6 Wellness and Therapeutic Services Private Duty Nursing Residential Nursing Skilled Nursing Dietician Services 6 Wellness and Therapeutic Supports* Respiratory Therapy Speech Therapy Occupational Therapy Physical Therapy Specialized Mental Health Counseling Behavior Analysis Services Behavior Assistant Services 7 Transportation 8 Dental Services Adult Dental Services 11/15/10 APD Public Meeting with Advocacy Community 20

Waiver Support Coordination • Waiver Support Coordinator’s role will shift from paper pusher to 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 11/15/10 APD Public Meeting with Advocacy Community 21

Waiver Support Coordination • More meaningful distinction between levels – Limited – Full – Waiver Support Coordination • More meaningful distinction between levels – Limited – Full – Enhanced (renaming of Transitional) 11/15/10 APD Public Meeting with Advocacy Community 22

Consumer and Family Control • Training will be provided to consumers and families on Consumer and Family Control • Training will be provided to consumers and families on i. Budget Florida policies and choice-making • Unless in CDC+, must use Medicaid-enrolled providers 11/15/10 APD Public Meeting with Advocacy Community 23

Consumer and Family Control • Could negotiate some rates up to maximum – Family Consumer and Family Control • Could negotiate some rates up to maximum – Family & Guardian Training – Person-Centered Planning – Personal Supports 11/15/10 APD Public Meeting with Advocacy Community 24

CDC+ and i. Budget Florida • CDC+ option will continue • CDC+ participants will CDC+ and i. Budget Florida • CDC+ option will continue • CDC+ participants will have funding determined through their i. Budgets • CDC+ participants will “spend” i. Budgets according to CDC+ policies 11/15/10 APD Public Meeting with Advocacy Community 25

WSC Screen Shots – Cost Plan Task listed Dorothy Dexter’s Cost Plan Review 11/15/10 WSC Screen Shots – Cost Plan Task listed Dorothy Dexter’s Cost Plan Review 11/15/10 APD Public Meeting with Advocacy Community 26

WSC Screen Shots – Cost Plan Review the Activity 11/15/10 APD Public Meeting with WSC Screen Shots – Cost Plan Review the Activity 11/15/10 APD Public Meeting with Advocacy Community 27

WSC Screen Shots – Review 11/15/10 APD Public Meeting with Advocacy Community 28 WSC Screen Shots – Review 11/15/10 APD Public Meeting with Advocacy Community 28

WSC Screen Shots – Review the Monthly Cost Plan 11/15/10 APD Public Meeting with WSC Screen Shots – Review the Monthly Cost Plan 11/15/10 APD Public Meeting with Advocacy Community 29

WSC Screen Shots – Review the Service Plan Submit for Area Review 11/15/10 APD WSC Screen Shots – Review the Service Plan Submit for Area Review 11/15/10 APD Public Meeting with Advocacy Community 30

WSC Screen Shots – Submit 11/15/10 APD Public Meeting with Advocacy Community 31 WSC Screen Shots – Submit 11/15/10 APD Public Meeting with Advocacy Community 31

Cost Plan Building Process • System automatically either: – Approves cost plan OR – Cost Plan Building Process • System automatically either: – Approves cost plan OR – Routes for area review • All 1 st plans on i. Budget require area review • Afterwards, plans are automatically approved if within basic guidelines • Will significantly reduce time for service approval in many cases 11/15/10 APD Public Meeting with Advocacy Community 32

System Cost Plan Review • System will approve plans if: – Within budget guidelines 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 11/15/10 APD Public Meeting with Advocacy Community 33

What if a personal i. Budget can’t meet an individual’s needs? • Extraordinary need What if a personal i. Budget 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 i. Budget can’t accommodate • One-time funding is available—durable medical, environmental modifications, nonroutine dental • Thorough review of requests for more funding 11/15/10 APD Public Meeting with Advocacy Community 34

Online Budgeting Tool • Online budget tool to create budgets and track spending if 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 11/15/10 APD Public Meeting with Advocacy Community 35

Consumer/Family Uses of Online System • Draft Cost Plans • Submit Cost Plans to Consumer/Family Uses of Online System • Draft Cost Plans • Submit Cost Plans to their Waiver Support Coordinator • Review their i. Budget Florida Account Information • E-mail their Waiver Support Coordinator 11/15/10 APD Public Meeting with Advocacy Community 36

Questions? 11/15/10 APD Public Meeting with Advocacy Community 37 Questions? 11/15/10 APD Public Meeting with Advocacy Community 37