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Individual Budgeting: Control of the Budget 1

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
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3. Why is control of Individual Budget important?
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 3
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4. Why is control of Individual Budget important?
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 4
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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
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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
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7. Individual Budgeting: Definition, What it Includes and Does Not Include7

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
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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
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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
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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 § Information Requirements, B.2.f. 11
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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
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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
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15. Person Centered Planning process
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
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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
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17. How is an Individual Budget developed: Retrospective budgeting?
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
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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
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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
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21. Individual Budget Use: The Plan of Service
Amount: How much?
Scope: What services and supports?
Duration: How long? 21
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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
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23. Individual Budgeting: Accessible, Portable, and Flexible Budgets

24. Yes, BUT…IS THE BUDGET FAP?
Flexible
Accessible
Portable 24
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25. F ree L oose & Limber E lastic X tra stretchy
F L E X I B L E
F ree L oose & Limber E lastic X tra stretchy 25
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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
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27. A C C E S S I B L E
A vailable C lose C onvenient E asy to Get & Reach S imple S ensible & Sound 27
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28. Budget ACCESSIBLE means you:
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 28
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29. Budget ACCESSIBLE means you:
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 29
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30. P O R T A B L E P ractical O rganizable R eachable & Ready T ransfer30
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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
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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
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33. Yes, BUT…IS THE BUDGET FAP?
Flexible
Accessible
Portable 33
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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
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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
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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
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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
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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
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40. How does the Fiscal Intermediary (FI) help with the budget?
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 40
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