July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 1 iBudget Florida Stakeholders’ Group Meeting July 1, 2010 Workgroup on Services, Providers, Waiver Support Coordinators & Administrative Issues

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 2 Introductions Workgroup members Staff Guests

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 3 Review of Minutes from Previous Meeting

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 4 Meeting Objectives Share information Receive input on preferred options, potential improvements, implementation considerations, and other relevant issues

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 5 Overall Goals Simplify the system Enhance: –Self-direction –Sustainability –Equity

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 6 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 iBudget Paradigm

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 7 This is a starting point –We’ll be testing the system through an initial phase-in. –Intend to refine system over time Are seeking the best solution among the alternatives –All have pro’s and con’s Keep in mind...

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 8 Waiver submitted by early August Draft rules by mid-July Draft operating procedures by late July Training developed by late August; begin training in early September Target Implementation Plan

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 9 Collect baseline data for evaluation by late September IT system implemented by early October Start communicating w/ phase in area consumers, WSC’s, providers, and staff as soon as phase-in site announced Target Implementation Plan

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 10 Completed initial review of rules and operating procedures that need revising and development. Phase-in area not final. –Will have a coordinated system of publicizing to ensure accurate information. IT system design progressing; coding beginning soon. Updates

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 11 Waiver drafting in progress Hired iBudget Florida Operations Project Manager. Will release RFQ for evaluation soon. Initial flowcharting/system design completed Updates

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 12 Overview of Proposed System 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

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 13 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 Behind-the-scenes reviews for health & safety, provider manipulation, and fraud Process for determining budgets for consumers with exceptional needs

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 14 Overview of Proposed System 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

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 15 Topics for Today Policy on Waiver Support Coordination services Rate/service negotiation guidelines Service family groupings Provider use of technology Obtaining timely service information

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 16 Service Families Groupings: –Issues: Facilitating functioning of online system to streamline approval of requested services

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 17 Service Families Groupings: –Plan: Listed 8 service families –Law: Did not mention service families

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 18 Service Families Groupings: –See handout for suggested revised groupings

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 19 Waiver Support Coordination Issues: –Match rate to work required –Match work and responsibility to needs of consumer, and allow to change as needs change –Ensure health and safety

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 20 Waiver Support Coordination Levels of support coordination available: –Current situation: Limited—all children and adults who choose Full—all adults, unless they choose limited Transitional—consumers who are transitioning from an ICF/DD

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 21 Waiver Support Coordination –Plan: Levels of support coordination available: –Limited –Full –Enhanced Funding in consumer’s iBudget: –Adults funded at full –Children funded at limited

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 22 Waiver Support Coordination –Plan: Consumer or caregiver must receive orientation: –For adult to move to limited –For child to stay at limited

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 23 Waiver Support Coordination –Plan: Adults: –Required to use full during 1st 6 months on iBudgets –May choose limited thereafter and shift funds to other services if individual or caregiver gets iBudget Orientation

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 24 Waiver Support Coordination –Plan: Children: –Receive limited support coordination during first six months –Required to use full support coordination thereafter if caregiver does not get iBudget Orientation

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 25 Waiver Support Coordination Service elements: –Contacts with consumer –Contacts with providers –Consumer/family training –Coordination of community and natural supports

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 26 Waiver Support Coordination Service elements: –Support planning –Service review/approval responsibilities –Assess service quality –Budget management

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 27 Waiver Support Coordination Service elements: –24/7 on call –Ongoing eligibility determination –Advocacy on consumer’s behalf

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 28 Waiver Support Coordination Defining levels of support coordination: –See handout A: Define by tasks B: Define by hours

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 29 Waiver Support Coordination Limitations on Choice of WSC level: –Plan: consumers required to use full WSC: Are newly-enrolled in the waiver. Have had forensic involvement. Have complex medical needs. Have complex behavioral needs.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 30 Waiver Support Coordination Limitations on Choice of WSC level: –Plan: consumers required to use full WSC: Will soon be or are transitioning from school. Are changing their residential setting to group home or supported living from a different setting.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 31 Waiver Support Coordination Limitations on Choice of WSC level: –Plan: consumers required to use full WSC: Have a recent alcohol or drug abuse history. Are having difficulty managing their care or funding.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 32 Waiver Support Coordination Limitations on Choice of WSC level: –Discussion: consumers required to use full WSC: Living in licensed homes In supported living

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 33 Waiver Support Coordination Orientation requirement for receiving limited WSC : –Current situation: No orientation/training required

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 34 Waiver Support Coordination Orientation requirement for receiving limited WSC : –How administered? A: Online. B: By waiver support coordinator. C: By area staff.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 35 Waiver Support Coordination Orientation requirement for receiving limited WSC : –Topics covered: Types of waiver services offered Use of iBudget system Emergency backup planning and procedures Community and natural supports

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 36 Waiver Support Coordination Orientation requirement for receiving limited WSC: –What if caregiver refuses to take orientation/training, but funding is insufficient to receive full WSC?

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 37 Waiver Services Rate/service negotiation: –How might consumers and providers be able to tailor services to consumers’ needs?

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 38 Waiver Services Rate/service negotiation: eligible services –Plan: Review on a case-by-case basis. –Law: APD may allow negotiation for “any or all” services except for residential habilitation.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 39 Waiver Services Rate/service negotiation: –Current situation: Most consumers do not negotiate rates; however, CDC+ consumers can. Nearly all rates are set by rule. WSC’s may negotiate rates for consumable medical supplies or adaptive equipment.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 40 Waiver Services Rate/service negotiation: –Issues: Want to provide flexibility to tailor services better to consumers’ needs and budgets Want to ensure quality services, particularly for residential services and professional services

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 41 Waiver Services Rate/service negotiation: –Services for which consumers should be able to negotiate rates A: Higher-cost non-facility-based, non- licensed services (supported employment, supported living) B: Any 1:1 non-facility based, non-licensed service except waiver support coordination. C: Any service except residential habilitation and waiver support coordination.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 42 Waiver Services Rate/service negotiation: –Service elements that are negotiable A: None. B: Documentation requirements C: Availability of service (may fill in if cancellation, or may not be on call) D: Specific content of service

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 43 Waiver Services Rate/service negotiation: –Documentation required A: “Job description”/contract; area approval required. B: “Job description”/contract, in file. C: None.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 44 Waiver Services Billing units: –Should we maintain quarter-hour billing for all services in which it’s currently used?

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 45 Waiver Services Billing units: –Should we maintain quarter-hour billing for all services in which it’s currently used? Issues: –Simplicity of billing and documentation –Flexibility for families

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 46 Waiver Services Billing units: –Should we maintain quarter-hour billing for all services in which it’s currently used? Current situation: see chart.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 47 Waiver Services Billing units: –Should we maintain quarter-hour billing for all services in which it’s currently used? Plan and law: did not discuss

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 48 Waiver Services Billing units: –Should we maintain quarter-hour billing for all services in which it’s currently used? Options: –A: Keep all quarter-hour billing. –B: Use only for therapies/nursing; discontinue use for non-professional services. –C: No quarter hour billing.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 49 Providers Communication –Short and long-term, what are reasonable expectations for providers’ technology infrastructure ( , fax, use of computers, etc.)

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 50 Providers Communication –What are reasonable expectations for providers’ technology infrastructure ( , fax, use of computers, etc.) Current situation: –Varies among providers (online billing access?) –APD does not require use

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 51 Providers Communication –What are reasonable expectations for providers’ technology infrastructure ( , fax, use of computers, etc.) Plan: –Highlights use of technology to speed work and facilitate tracking and analysis

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 52 Providers Communication –What are reasonable expectations for providers’ technology infrastructure ? –Issues: –Maintaining providers to facilitate consumer choice –Efficient functioning and simplicity of system –Security of data

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 53 Providers Communication –What are reasonable expectations for providers’ technology infrastructure? –Issues: –Timeliness and accuracy of records –New quality assurance system may require provider data entry

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 54 Providers Communication –What are reasonable expectations for providers’ technology infrastructure ( , fax, use of computers, etc.) Options: –A: Require address –B: Require fax –C: Require online submission of forms

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 55 Providers Communication –Short-term, how do we get accurate information on expenditures within current system?

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 56 Consumer & Family Control Budget Management –Short-term, how do we get timely, accurate information on expenditures within current system? Issues: –System sustainability requires accurate budget tracking –Providers are at varying levels of sophistication

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 57 Consumer & Family Control Budget Management –Short-term, how do we get timely, accurate information on expenditures within current system? Issues: –APD technology still in development –Will have to rely at minimum on combination of encumbrances through service authorizations and billing data

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 58 Consumer & Family Control Budget Management –Short-term, how do we get timely, accurate information on expenditures within current system? Current situation: use a combination of billing information, service logs, and personal contacts with providers.

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 59 Consumer & Family Control Budget Management –Short-term, how do we get timely, accurate information on expenditures within current system? Plan: described need for such information but acknowledged technical challenges

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 60 Consumer & Family Control Budget Management –Short-term, how do we get timely, accurate information on expenditures within current system? A: Rely solely on encumbrances and billing data (up to a year lag), along w/ telephone contacts

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 61 Consumer & Family Control Budget Management –Short-term, how do we get timely, accurate information on expenditures within current system? B: Require basic service information to be submitted within 15 days of quarters’ end (by telephone/IVR, fax of paper to WSC’s, online form, ???)

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 62 Consumer & Family Control Budget Management –Short-term, how do we get timely, accurate information on expenditures within current system? C: Encourage submission of bills close to date of service

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 63 Questions? Suggestions? Comments?

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 64 Thank you for your time!