june 30, 2010 ibudget florida stakeholders’ group workgroup meeting—for discussion purposes only...
TRANSCRIPT
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June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 1
iBudget FloridaStakeholders’ 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
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Introductions
• Workgroup members
• Staff
• Guests
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June 30, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 3
Review of Minutes from Previous Meeting
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Meeting Objectives
• Share information
• Receive input on preferred options, potential improvements, implementation considerations, and other relevant issues
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Overall Goals
Simplify the system
Enhance:
– Self-direction
– Sustainability
– Equity
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• 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
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• 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 . . .
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• 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
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• 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
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• 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
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• Waiver drafting in progress
• Hired iBudget Florida Operations Project Manager.
• Will release RFQ for evaluation soon.
• Initial flowcharting/system design completed
Updates
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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
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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
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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
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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
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Topics for Today
• Initial Phase-In Evaluation
• Consumer/family budget tracking
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Consumer & Family Control
• Monthly budgeting requirements:– Plan:
• 10% flexible spending (available at beginning of year)
• 5% emergency savings• 85% for monthly allotment
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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
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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
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Consumer & Family Control
• Monthly budgeting requirements:– Should consumers see emergency reserve
line?• A: No.• B: Only when released (10th month).• C: Yes, always.
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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.
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Consumer & Family Control
• Monthly budgeting requirements:– When is 5% reserve released if not used?
• A: Never• B: Beginning of May
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Consumer & Family Control
• Provider notice:– What notice to providers should be required
or encouraged?
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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.
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Consumer & Family Control
• Provider notice: What notice to providers should be required or encouraged?– Issues:
• Maximize flexibility for consumers• Allow providers to plan
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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
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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 15-30 days’ notice.– C: No guidelines or requirements.
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Consumer & Family Control
• Requests for Additional Funds: – Plan allows requests due to:
• Extraordinary need• One-time change• Temporary change• Permanent change
– Law includes guidelines
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Consumer & Family Control
• Requests for Additional Funds: – Current situation:
• Requests reviewed through PSA process
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Consumer & Family Control
• Service Family Approval:– Current situation:
• Services approved one-by-one through PSA process
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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
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Consumer & Family Control
• Service Family Approval: Basis for Approving Service Families– Recommendations--automatic approval:
• Transportation• Adult dental (requires revising service
families)
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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
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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
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Initial Phase-In Evaluation
Proposed general elements (primarily based on HB 7225 provisions):• Cost savings or cost avoidance
• Cost containment• Predictability of expenditures
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Initial Phase-In Evaluation
Proposed general elements (primarily based on HB 7225 provisions):• Opportunities for self-direction • Quality of care• Access to service
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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
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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?
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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
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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
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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.
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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
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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.
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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
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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, ???)
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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?
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Questions?Suggestions?Comments?
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Thank you for your time!