1. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 1 9/14/10 iBudget Florida Stakeholders’ Meeting September 14, 2010

2. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 2 9/14/10 Public Comment Email: APDiBudget@apd.state.fl.us

3. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 3 9/14/10 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

4. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 4 9/14/10 Funding Process—Before Fiscal Year Begins APD runs an algorithm for everyone For the vast majority of people, the algorithm determines initial budget A very small number of people will not fit the algorithm, and their budgets are determined through an “extraordinary need” process.

5. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 5 9/14/10 Funding Process—Before Fiscal Year Begins After the algorithm is run for everyone: APD reviews and determines whether individual qualifies for extraordinary need funding If so, APD grants additional supplemental funding for extraordinary needs for the individual

6. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 6 9/14/10 Funding Process—Before Fiscal Year Begins After algorithm is run for everyone, continued: APD pre-approves services Notice sent with budget & pre-approved service information to the individual Individuals can apply to receive extraordinary need funding if they were not initially granted any in their original budget

7. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 7 9/14/10 Funding Determination Different funding situations the process must accommodate: At beginning of plan year—people whom the algorithm doesn’t fit During plan year—people who have changes in their situations

8. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 8 9/14/10 Funding Determination During plan year—people who have changes in their situation: --Temporary change in need—ex: short term injury --Permanent change in need—ex: moved to new living setting or turned 21 --One-time purchase need—ex: major durable medical equipment need

9. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 9 9/14/10 Funding Assumptions

10. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 10 9/14/10 Funding Scenarios Basic Scenario Larger number qualifying for supplemental funding Funds available for general waiver population

11. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 11 9/14/10 Funding Determination Supplemental Funding –Basic question: Do we seek to maximize funding for consumers’ basic budgets, or have more generous supplemental funding policies? Discussion?

12. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 12 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? 5 requirements to receive funding –1. Eligible under law/rule for supplemental funding –2. Has sought non-waiver supports to meet needs within budget but they are not sufficient

13. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 13 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? 5 requirements to receive funding –3. Cannot adjust budget to meet needs –4. Qualify for specific waiver services requested to meet needs

14. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 14 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? 5 requirements to receive funding –5. Need for funds is not due to budget mismanagement

15. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 15 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? 5 requirements to receive funding –Look at all needs in aggregate » If new need arises, may have to shift budget to meet that need and use new non-waiver supports to meet ongoing needs

16. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 16 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Current situation: Complex system of laws and rules involving tiers, prior service authorization review, limits on ability to request changes, etc.

17. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 17 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Plan: Supplemental funding would be available, but the bar would be high and review of requests thorough (in contrast to flexibility within “standard” amount)

18. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 18 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Requirement 1: Eligible for: –Extraordinary need –Temporary change –One-time need –Permanent change

19. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 19 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Requirement 1: Law provided some eligibility criteria for receiving supplemental funding but allowed APD to add more criteria

20. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 20 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving extraordinary need supplemental funding—IN PLAN: For individuals whose situation is so unique that the algorithm is not able to determine their budget amount. Small number of consumers would qualify

21. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 21 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving extraordinary need supplemental funding IN LAW— includes but is not limited to: Documented history of significant, potentially life-threatening behaviors Complex medical condition that requires active intervention by a licensed nurse on an ongoing basis

22. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 22 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving extraordinary need supplemental funding IN LAW— includes but is not limited to: A chronic co-morbid condition A need for total physical assistance with activities such as eating, bathing, toileting, grooming, and personal hygiene

23. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 23 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving extraordinary need supplemental funding: How to specifically define these? Additional criteria?

24. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 24 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving permanent change in need funding IN iBUDGET FLORIDA PLAN Change in algorithm during the fiscal year

25. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 25 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving permanent change in need funding IN LAW: 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...

26. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 26 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving permanent change in need funding—LAW and PROPOSED CRITERIA: Loss of services authorized under the state Medicaid plan due to a change in age: change in age

27. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 27 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving permanent change in need funding—LAW and PROPOSED CRITERIA: Permanent or long-term loss or incapacity of a caregiver: change in living setting

28. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 28 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving permanent change in need funding--LAW and PROPOSED CRITERIA: A significant change in medical or functional status which requires the provision of additional services on a permanent or long-term basis: change in QSI score in algorithm

29. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 29 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving permanent change in need funding: Discussion: –Responses to proposal on permanent change in need funding? –Should there be a minimum change in QSI score to trigger granting more funds?

30. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 30 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving temporary change in need funding in iBUDGET FLORIDA PLAN: Limit funding to those situations where health and safety is under serious threat

31. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 31 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving temporary change in need funding in LAW: If funding were not provided, changes that would place the health and safety of the client, the client’s caregiver, or the public in serious jeopardy, unless the increase is approved

32. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 32 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving temporary change in need funding in LAW—includes but is not limited to: Special services or treatment for a serious temporary condition when the service or treatment is expected to ameliorate the underlying condition.

33. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 33 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving temporary change in need funding in LAW—includes but is not limited to: The provision of services to address the temporary loss of support from a caregiver

34. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 34 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving temporary change in need funding: Discussion: –How to specifically define criteria in law? –Additional criteria and how to define them?

35. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 35 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving one-time purchase need funding—IN iBUDGET FLORIDA PLAN: Consumers would be required to demonstrate that these purchases were needed, were not available through the state plan or another source, and could not be made using their iBudget without placing health and safety at critical risk.

36. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 36 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving one-time purchase need funding—IN LAW: If funding were not provided, changes that would place the health and safety of the client, the client’s caregiver, or the public in serious jeopardy, unless the increase is approved

37. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 37 9/14/10 Funding Determination Supplemental Funding –Eligibility criteria for receiving one-time purchase need funding: How to specifically define these? Additional criteria?

38. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 38 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Requirement 2: Other sources cannot meet needs –How is this documented and determined? –What tools are available to help locate/develop other supports?

39. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 39 9/14/10 Funding Determination Supplemental Funding Requirement 2: Has sought non-waiver supports to meet needs but they are not sufficient. Documentation--discussion: –A: Complete APD form--specific checklist of options that must be explored. –B: Submit log of options tried & responses. :

40. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 40 9/14/10 Funding Determination Supplemental Funding Requirement 2: Has sought non-waiver supports to meet needs but they are not sufficient. Possible tools for helping find non-waiver supports--discussion: –A: List of potential resources online –B: Training for waiver support coordinator and family (LENS, etc.)

41. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 41 9/14/10 Funding Determination Supplemental Funding –Requirement 2: Has sought non-waiver supports to meet needs but they are not sufficient. Discussion, continued: C: Area staff consultation D: Listservs/email groups E: FCC meetings Other ideas?

42. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 42 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Requirement 3: Cannot adjust budget to meet needs. –How is this documented and determined?

43. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 43 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Requirement 3: Cannot adjust budget to meet needs. Discussion: 1.How do we determine a want versus need? 2.Should some needs be prioritized over others for funding? If so, which ones? :

44. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 44 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Requirement 3: Cannot adjust budget to meet needs, discussion, continued:. 3.Should there be categories of needs that are not eligible for supplemental funding? (less critical needs) If so, which ones? :

45. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 45 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Requirement 4: Qualify for specific waiver services requested to meet needs –Handbook will be addressed later

46. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 46 9/14/10 Funding Determination Supplemental Funding –How do we provide supplemental funding only to those who truly need it? Requirement 5: Lack of funds is not due to budget mismanagement. –How do we determine if this has occurred?

47. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 47 9/14/10 Phase-In General approach: Limited implementation to test and refine processes and enhance algorithm, then-- Gradual phase-in: --By area --Of budget amounts

48. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 48 9/14/10 Phase-In Options for phase-in of iBudget amounts: –A: Base on most recent cost plan –B: Base on expenditures

49. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 49 9/14/10 Phase-In Options for phase-in of iBudget amounts: –3 year plan: Year 1: 90% of current/10% of iBudget Year 2: 60% of current/40% of iBudget Year 3: 20% of current/80% of iBudget

50. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 50 9/14/10 Phase-In Options for phase-in of iBudget amounts: –4 year plan: Year 1: 90% of current/10% of iBudget Year 2: 80% of current/20% of iBudget Year 3: 60% of current/40% of iBudget Year 4: 20% of current/80% of iBudget

51. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 51 9/14/10 Phase-In Timeframe: –See handout

52. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 52 9/14/10 Public Comment Email: APDiBudget@apd.state.fl.us

53. Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 53 9/14/10 Thank you!