Something new is on the horizon… …for individuals receiving waiver services.

The Waive(r) of the Future Budget Florida Describe comment card process The Waive(r) of the Future

What’s wrong with the present? You said: “There’s waaaay too much paperwork” “I have to wait for decisions” “Services my son needs are denied” “We can do things better ourselves” “Give us access to a wider set of services” “I’m tired of so much change”

How we got to this point Managing APD funding is difficult . . . Which has led to deficits Since APD must stay within the budget the Legislature sets . . . It leads to cost control measures like tiers, rebasing, and prior service authorization . . . Which increases bureaucracy and limits consumer control . . . and . . . Keeps us from serving the waiting list.

What does the waiver of the future look like? The Answer: iBudget Florida More self-direction More simplicity – less “red tape” Greater equity More stable, sustainable system

Why iBudgets? 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.

The Waive(r) of the future is almost here Initial implementation of iBudgets is in late Fall 2010 in one area of the state Need federal government approval first Wider phase-in begins late 2011 or 2012

How did APD make the iBudget 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

What’s different about iBudget? Current System Services decided first Complex system: WSC writes plan PSA review Rebasing affects Tiers affect Change in services often requires new PSA review iBudget Florida Funding decided first using formula Simpler, flexible system: Can spend up to individual iBudget limit Limited service review process More choice in services Pro: Very individualized “High touch”—personal discussions w/ WSC Cons: Not equitable (was a rationality, but not fully equitable; now some have had drastic cuts from tiers) Lots of bureaucracy—means far away people make decisions, not as responsive to changes in need Administratively complex—uses lots of resources (staff time, funding, delays in services) Not controlling costs well, and involves problems for people Can’t predict cost of serving wait list

Features of iBudget You have more control over your services—can get your priority services faster and make changes easier You’ll know your budget for services up front to help you plan Wider array of services available to all Prior service authorization ended as we know it Greater support for you WSCs will have less paperwork to do You’ll have training and tools to self-direct if you want

Features of iBudget Stronger quality assurance and quality improvement APD and QA contractor will review for health and safety, provider manipulation, and fraud More stable system Would phase-in gradually

Sounds great, but how does all this work? 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 exceptional/ changed/one-time needs = total APD waiver funding Still tweaking the algorithm & analyzing its impact but these are elements. QSI subsections are Behavioral & Functional QSI questions are Q18 (Transfer) Q20 (Hygiene) Q23 (self-protection) Living setting explains about 46% of the variance; Age about 11%; QSI subscale scores about 13% QSI individual questions about 6% Together (because there is some interaction; for instance, children primarily live in family homes, so those correlate stronger) explain about 62% of variance—very good!

What else should I know? Initially, some budgets would increase, others decrease, and some stay about the same Will phase-in gradually—over a few years Exceptional 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

What if my iBudget isn’t enough? Exceptional need funding available if critical health and safety risk Temporary and permanent increase for significantly changed needs that current iBudget can’t accommodate One-time funding available—durable medical, environmental modifications, nonroutine dental Thorough review of requests for more funding

Service Review The process as we know it would go away—minimized or eliminated as much as possible while meeting federal requirements Streamlined paperwork More flexibility Review spread among areas, Central Office, and contracted experts More review for unusual situations, less (or no) review for routine decisions

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 . .

Waiver Support Coordination • Waiver Support Coordinator’s role will shift to more of a facilitator and guide • Will be seeking to reduce paperwork Allow more customized level of service Most will have more flexibility to choose support coordination level (limited, full, or enhanced) More meaningful distinction between levels (for example: more limited support in limited WSC service)

Consumer and Family Control Training would be provided to consumers and families on iBudget policies and choice-making Unless in CDC+, must use Medicaid-enrolled providers Could negotiate some rates up to maximum

What the Future Holds Greater control over your lives Less delay in getting services Services better tailored to meet your needs WSC freed up to help you more Greater equity in funding Reduced bureaucracy and “red tape” More stable system

Budget Florida apdcares.org Get the latest info and provide Describe comment card process Get the latest info and provide additional input via APD’s Web site apdcares.org