June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 1 iBudget Florida Stakeholders’ Group Meeting June 30, 2010 Workgroups on Service Review, Consumer and Family Control, & Quality Assurance and Algorithm, Assessment, Overall System Funding & Extraordinary and Changed Needs

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 2 Introductions Workgroup members Staff Guests

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 3 Review of Minutes from Previous Meeting

June 30, 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

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 5 Overall Goals Simplify the system Enhance: –Self-direction –Sustainability –Equity

June 30, 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

June 30, 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...

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 8 Waiver submitted by early August Draft rules by late July Draft operating procedures by late July Training developed by late August; begin training in early September Target Implementation Plan

June 30, 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 with phase in area consumers, WSC’s, providers, and staff upon announcement Target Implementation Plan

June 30, 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

June 30, 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

June 30, 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

June 30, 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 Reviews for indicators of health & safety, provider manipulation, and fraud Process for determining budgets for consumers with extraordinary needs

June 30, 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

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 15 Topics for Today Guidelines for budgeting Notice to providers Requests for and use of additional funds Consumers receiving higher level of review/limits on flexibility Service family approval

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 16 Topics for Today Initial Phase-In Evaluation Consumer/family budget tracking

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 17 Consumer & Family Control Monthly budgeting requirements: –Plan: 10% flexible spending (available at beginning of year) 5% emergency savings 85% for monthly allotment

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 18 Consumer & Family Control Monthly budgeting requirements: –Issues: Ensure funds last the entire fiscal year Provide flexibility as needs vary through year Maintain appropriate level of review

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 19 Consumer & Family Control Monthly budgeting requirements: –How much can consumers deviate from monthly allotment without area review? A: Not at all B: May do so within a range (ex: up to 5% over) but beyond that requires area approval C: No restrictions, but area alerted if beyond a range and may review

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 20 Consumer & Family Control Monthly budgeting requirements: –Should consumers see emergency reserve line? A: No. B: Only when released (10 th month). C: Yes, always.

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 21 Consumer & Family Control Monthly budgeting requirements: –How do consumers use the 5% emergency reserve? A: Must specifically request use & get area approval. B: Must specifically request use in online system, but area approval not needed C: WSC/consumer gets alert that it’s being used.

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 22 Consumer & Family Control Monthly budgeting requirements: –When is 5% reserve released if not used? A: Never B: Beginning of May

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 23 Consumer & Family Control Provider notice: –What notice to providers should be required or encouraged?

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 24 Consumer & Family Control Provider notice: What notice to providers should be required or encouraged? –Plan: Did not discuss. Implies full ability to change providers as desired.

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 25 Consumer & Family Control Provider notice: What notice to providers should be required or encouraged? –Issues: Maximize flexibility for consumers Allow providers to plan

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 26 Consumer & Family Control Provider notice: What notice to providers should be required or encouraged? –Current situation: Consumers have complete flexibility to change providers APD strives to provide notice for system- required changes

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 27 Consumer & Family Control Provider notice: What notice to providers should be required or encouraged? –A: Require 15 days’ notice unless health/safety concerns. –B: Encourage days’ notice. –C: No guidelines or requirements.

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 28 Consumer & Family Control Requests for Additional Funds: –Plan allows requests due to: Extraordinary need One-time change Temporary change Permanent change –Law includes guidelines

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 29 Consumer & Family Control Requests for Additional Funds: –Current situation: Requests reviewed through PSA process

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 30 Consumer & Family Control Requests for Additional Funds: –Required to demonstrate how meet statutory/rule requirements for receiving additional funds (meet criteria, are unable to accommodate within budget) –Documentation required; will be able to be submitted via iBudget online system

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 31 Consumer & Family Control Requests for Additional Funds: –Review every 3-6 months to assess whether additional funds are still needed –Will be timeframes for area review and response

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 32 Consumer & Family Control Handling unused additional funds: –A: Funds unused within 3 months are “returned” to APD –B: Funds unused within 3 months require justification for lack of use, demonstration they are still needed, or are “returned” –C: No review/return of unused funds.

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 33 Consumer & Family Control Consumers receiving greater review and with limitations on flexibility: –Issues: Ensure health and safety of consumers who are more vulnerable Promote wise use of funds Still provide for self-direction Simplify processes

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 34 Consumer & Family Control Consumers receiving greater review and with limitations on flexibility: –Current situation: Nearly all changes that any consumer makes are reviewed through PSA unless it’s a reduction

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 35 Consumer & Family Control Consumers receiving greater review and with limitations on flexibility: –Plan: this applies to: Consumers with forensic involvement Consumers unable to manage own budgets

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 36 Consumer & Family Control Consumers receiving greater review/limited changes--what flexibility would be available to make changes without review? –A: Require area review/approval of all changes –B: Require area review/approval of certain changes with conference/every 6 months –C: Area review/approval of certain changes (tailor to situation) with optional conference as needed

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 37 Consumer & Family Control Consumers receiving greater review and with limitations on flexibility: –Who, and how defined--recommendations: Consumers with complex medical needs- -based on certain QSI responses or service use Consumers with complex behavioral needs--based on certain QSI responses or service use

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 38 Consumer & Family Control Consumers receiving greater review and with limitations on flexibility: –Who, and how defined--recommendations: Foster children Consumers transitioning from school—6 months pre- and post-transition

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 39 Consumer & Family Control Consumers receiving greater review and with limitations on flexibility: –Who, and how defined--recommendations: Consumers transitioning between types of living settings (ICF/DD to waiver; group home to supported living; etc)—for 6 months

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 40 Consumer & Family Control Consumers receiving greater review and with limitations on flexibility: –Who, and how defined--recommendations: Newly-enrolled in the waiver—for 6 months Recent alcohol or drug abuse history— for 6 months

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 41 Consumer & Family Control Service Family Approval: –On what basis should service families be approved? When transitioning to iBudget from tier waivers When brand-new to waiver

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 42 Consumer & Family Control Service Family Approval: –Current situation: Services approved one-by-one through PSA process

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 43 Consumer & Family Control Service Family Approval: Basis for Approving Service Families –Recommendations--automatic approval: Support Coordination Life Skills Development Personal Supports for adults in family home or supported living

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 44 Consumer & Family Control Service Family Approval: Basis for Approving Service Families –Recommendations--automatic approval: Transportation Adult dental (requires revising service families)

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 45 Consumer & Family Control Service Family Approval: Basis for Approving Service Families –Consider service use for past 2 years— receive approval for services that consumers had been approved for unless situation has changed –QSI responses

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 46 Consumer & Family Control Service Family Approval: Basis for Approving Service Families –After initial transition, area staff will review requests for service families –Requests (including documentation) submitted via online system

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 47 Initial Phase-In Evaluation Proposed general elements (primarily based on HB 7225 provisions): Cost savings or cost avoidance Cost containment Predictability of expenditures

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 48 Initial Phase-In Evaluation Proposed general elements (primarily based on HB 7225 provisions): Opportunities for self-direction Quality of care Access to service

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 49 Initial Phase-In Evaluation General elements (primarily based on HB 7225 provisions): Satisfaction of consumers, as well as families/guardians of consumers Simplicity and efficiency of the system

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 50 Consumer & Family Control Budget Management –What will be consumers & families’ mindsets toward their budgets? –How do we get accurate information on expenditures within current system?

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 51 Consumer & Family Control Budget Management –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

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 52 Consumer & Family Control Budget Management –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

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 53 Consumer & Family Control Budget Management –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.

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 54 Consumer & Family Control Budget Management –How do we get timely, accurate information on expenditures within current system? Plan: described need for such information but acknowledged technical challenges

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 55 Consumer & Family Control Budget Management –How do we get timely, accurate information on expenditures within current system? A: Budget on monthly basis; do quarterly service authorizations to balance flexibility with budget control B: Do yearly service authorizations; rely on frequency in service authorization to control spending.

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 56 Consumer & Family Control Budget Management –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

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 57 Consumer & Family Control Budget Management –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, ???)

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 58 Consumer & Family Control Budget Management –What will be consumers & families’ mindsets toward their budgets? How do we encourage a mindset of ownership and cost-effectiveness?

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 59 Questions? Suggestions? Comments?

June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 60 Thank you for your time!