1. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 1 6/21/11 iBudget Florida Stakeholders’ Meeting June 21, 2011

2. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 2 6/21/11 Needs met through waiver AND state plan, natural supports and community resources Waiver Support Coordinators freed to help get other resources Consumers have lots of flexibility for spending up to individual iBudget maximum amount Requests for additional funding require thorough review iBudget Paradigm

3. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 3 6/21/11 Waiver Support Coordination Current situation: –Levels/funding for support coordination: Limited—all children; adults who choose (can’t use funds for another service; children can’t increase level by choice) Full—all adults, unless they choose limited Transitional—consumers who are transitioning from an ICF/DD

4. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 4 6/21/11 Waiver Support Coordination Levels of support coordination available: –Limited –Full –Enhanced Funding in consumer’s iBudget: –Adults funded at full –Children funded at limited

5. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 5 6/21/11 Waiver Support Coordination Consumers have more flexibility to choose among waiver support coordination levels –Some consumers may choose to decrease level and use funds for another service –Some may choose to increase level using funds in their budget

6. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 6 6/21/11 Waiver Support Coordination Some consumers will not be allowed to choose a lower waiver support coordination level For those using limited waiver support coordination, an orientation to iBudget Florida is required

7. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 7 6/21/11 Waiver Support Coordination Requirements for use of waiver support coordination level: See handout

8. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 8 6/21/11 Funding Assumptions

9. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 9 6/21/11 Funding Determination Supplemental Funding –Basic question: What is process/standard for determining an individual’s funding?

10. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 10 6/21/11 Funding Process—Before Fiscal Year Begins Algorithm is run for everyone APD pre-approves services Notice sent with algorithm-based allocation and pre-approved service information

11. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 11 6/21/11 Funding Process—Before Fiscal Year Begins Individuals create plan to meet needs with all resources, including budget allocations

12. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 12 6/21/11 Funding Process—Before Fiscal Year Begins If individuals believe they, caregivers, or public are in immediate, serious jeopardy without funding increase AND They meet other statutory eligibility criteria: They can apply for extraordinary need funding

13. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 13 6/21/11 Funding Determination Supplemental Funding –Plan--extraordinary need supplemental funding: For individuals whose situation is so unique that the algorithm is not able to determine their budget amount. Small number of consumers would qualify

14. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 14 6/21/11 Funding Determination Supplemental Funding –Requirements to receive funding Eligible under law/rule for supplemental funding. Has sought non-waiver supports to meet needs within budget but they are not sufficient.

15. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 15 6/21/11 Funding Determination Supplemental Funding –Requirements to receive funding Cannot adjust budget to meet needs. Qualify for specific waiver services requested to meet needs

16. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 16 6/21/11 Funding Determination Supplemental Funding –Statutory eligibility criteria for receiving extraordinary need funding: The health and safety of the client, the client's caregiver, or the public [would be] in immediate, serious jeopardy unless the increase is approved.

17. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 17 6/21/11 Funding Determination Supplemental Funding –Statutory eligibility criteria for receiving extraordinary need supplemental funding: Documented history of significant, potentially life-threatening behaviors Complex medical condition that requires active intervention by a licensed nurse on an ongoing basis

18. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 18 6/21/11 Funding Determination Supplemental Funding –Statutory eligibility criteria for receiving extraordinary need supplemental funding: A chronic co-morbid condition A need for total physical assistance with activities such as eating, bathing, toileting, grooming, and personal hygiene

19. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 19 6/21/11 Supplemental Funding Request & Review Additional funding available during year to address, if all criteria met: Temporary change in need Permanent change in need One-time purchase need

20. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 20 6/21/11 Funding Determination Supplemental Funding –Statutory eligibility criteria for receiving permanent change in need funding: A significant increase in the need for services after the beginning of the service plan year that would place the health and safety of the client, the client’s caregiver, or the public in serious jeopardy because of substantial changes in the client’s circumstances...

21. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 21 6/21/11 Funding Determination Supplemental Funding –Statutory eligibility criteria for receiving permanent change in need funding: Loss of services authorized under the state Medicaid plan due to a change in age Permanent or long-term loss or incapacity of a caregiver

22. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 22 6/21/11 Funding Determination Supplemental Funding –Statutory eligibility criteria for receiving permanent change in need funding: A significant change in medical or functional status which requires the provision of additional services on a permanent or long-term basis

23. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 23 6/21/11 Funding Determination Supplemental Funding –Statutory eligibility criteria for receiving temporary change in need: The health and safety of the client, the client’s caregiver, or the public [would be] in serious jeopardy unless the increase is approved

24. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 24 6/21/11 Funding Determination Supplemental Funding –Statutory eligibility criteria for receiving temporary change in need funding: Special services or treatment for a serious temporary condition when the service or treatment is expected to ameliorate the underlying condition.

25. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 25 6/21/11 Funding Determination Supplemental Funding –Statutory eligibility criteria for receiving temporary change in need funding: The provision of services to address the temporary loss of support from a caregiver

26. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 26 6/21/11 Funding Determination Supplemental Funding Determination Process –Must meet all requirements –Similar to APD’s current system under cost plan freeze

27. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 27 6/21/11 Funding Phase-In To mitigate impacts of funding reductions: Grant no increases Cap decreases Law requires cap of 50% on reductions due to iBudget Florida implementation during 1 st year Re-evaluate after iBudget Florida has proven its effectiveness

28. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 28 6/21/11 Geographic Phase-In General approach: Limited implementation to test and refine processes and enhance algorithm, then— Phased rollout across the state Target completion by July 1, 2012

29. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 29 6/21/11 Geographic Phase-In General approach: Given accelerated timeframe, delay consumer portal rollout until after statewide implementation Allows time to enhance it, dedicate sufficient resources to training

30. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 30 6/21/11 Next Steps Begin rulemaking process Develop and implement training for consumers, families, waiver support coordinators, and providers Set up new procedures and train area staff

31. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 31 6/21/11 Next Steps Help transition providers Promulgate new iBudget Florida waiver handbook Work with waiver support coordinators and consumers and families to begin developing new cost plans

32. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 32 6/21/11 Rule Development Workshop Today— 2:00 P.M. – 4:00 P.M.

33. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 33 6/21/11 Thank you!