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

2. The Waive(r) of the Future Budget Florida

3. Phase 1 Implementation of IBudget Florida Initial locations: Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla counties Area 2B

4. Phase 1 Implementation of IBudget Florida Area 2A will follow in about six months –Bay, Calhoun, Gulf, Holmes, Jackson, and Washington counties Wider phase-in begins late 2011 or 2012

5. 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 2010then passed a law requiring APD to implement it

6. How did APD make the iBudget 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

7. Whats different about iBudget Florida? 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

8. Features of iBudget Florida More control over servicescan get priority services faster and make changes easier –Budgets for services are determined up front to allow for planning –Wider array of services available to all –Prior service authorization ended as we know it Greater support –WSCs will have less paperwork to do –Training and tools to self-direct are available if requested

9. Features of iBudget Florida 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

10. 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 iBudgets + funds for exceptional/ changed/one-time needs = total APD waiver funding

11. What This Means to Consumers and Area Staff Can scale back PSA processgives more control PSA process reduction and electronic records reduce WSC workload Computer systems help monitor budgets, services, and quality A chance for more consumer self- direction

12. What else is important? Initially, some budgets would increase, others decrease, and some stay about the same –Will phase-in graduallyover 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

13. 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

14. 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

15. Waiver Support Coordination Waiver Support Coordinators 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)

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

17. 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 dont

18. Area Staff View

20. CDC+ and iBudget Florida CDC+ option will continue CDC+ participants will have funding determined through their iBudgets CDC+ participants will spend iBudgets according to CDC+ policies

21. What if a personal iBudget cant meet an individuals needs? Extraordinary need funding is available if critical health and safety risk Temporary or permanent increase for significantly changed needs that current iBudget cant accommodate One-time funding is available durable medical, environmental modifications, nonroutine dental Thorough review of requests for more funding

22. How will this affect Area staff? PSA process changes –Area staff will have greater role in service review and approval (though online system will automatically process many requests) Help answer questions from consumers, families, WSCs, and providers Support QA process Encourage and support self-direction while ensuring health and safety within budget

23. 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 (say, by geography) and budget amounts

24. 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

25. iBudget Florida Public Meetings Monday, August 30, 2010 – Tallahassee –Tallahassee Community College Tuesday, August 31, 2010 – Madison –Madison Public Library Wednesday, September 1, 2010 – Carrabelle –Carrabelle City Commission Chambers

26. Budget Florida …has arrived! Get the latest info and provide input via APDs Web site apdcares.org

27. Questions? Jim DeBeaugrine Director Charlie Crist Governor