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Budget Florida

Budget Florida

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Budget Florida

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Presentation Transcript

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

  2. 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 2010—then passed a law requiring APD to implement it (s. 393.0663, F.S.) Why iBudgets?

  3. Managed Care Bill transitioning DD HCBS services to managed care passed House in 2010 Speaker’s suggested principles for approval in tomorrow’s organizational session: Phase in the implementation of the statewide managed care program, allowing adequate time for development of managed long-term care and reserving the final phase of the implementation of managed care for persons with developmental disabilities. iBudget Florida is the law now (s. 393.0663, F.S.) Why iBudgets?

  4. Simplify the system Enhance: Self-direction Sustainability Equity Overall Goalsof iBudget Florida

  5. 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 How did APD make the iBudget Florida plan?

  6. iBudget Florida Paradigm • 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

  7. Overview of Proposed System • Budgets determined through algorithm and provided at beginning of plan year • 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

  8. 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

  9. 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 (by geography) and budget amounts

  10. AHCA has submitted waiver application—1st 90 day clock ends 12/12/10 Online iBudget Florida system well into development—1st phase completed today Communication materials developed Rules and processes being designed When iBudget Florida is fully implemented, tiers will go away Status Update

  11. First phase-in location: Area 2B--Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla counties Area 2A will follow in about six months Bay, Calhoun, Gulf, Holmes, Jackson, and Washington counties Wider phase-in begins late 2011 or 2012 Phase 1 Implementation of IBudget Florida

  12. 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 extraordinary needs/ changed/one-time needs = total APD waiver funding

  13. What else is important? Initially, some budgets will increase, others decrease, and some stay about the same Will phase-in gradually—over a few years Extraordinary 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

  14. iBudget Funding

  15. 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

  16. Services

  17. Services

  18. Services

  19. Waiver Support Coordination • Waiver Support Coordinator’s role will shift from paper pusher to social worker Reduced paperwork load frees up time More customized level of service--most may choose support coordination level (limited, full, or enhanced) Children can choose full support coordination Adults can choose limited and use funding for other services

  20. Waiver Support Coordination • More meaningful distinction between levels Limited Full Enhanced (renaming of Transitional)

  21. Consumer and Family Control Training will be provided to consumers and families on iBudget Florida policies and choice-making Unless in CDC+, must use Medicaid-enrolled providers

  22. Consumer and Family Control Could negotiate some rates up to maximum Family & Guardian Training Person-Centered Planning Personal Supports

  23. 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

  24. WSC Screen Shots – Cost Plan Task listed Dorothy Dexter’s Cost Plan Review

  25. WSC Screen Shots – Cost Plan Review the Activity

  26. WSC Screen Shots – Review

  27. WSC Screen Shots – Review Review the Monthly Cost Plan

  28. WSC Screen Shots – Review Review the Service Plan Submit for Area Review

  29. WSC Screen Shots – Submit

  30. Cost Plan Building Process System automatically either: Approves cost plan OR Routes for area review All 1st plans on iBudget require area review Afterwards, plans are automatically approved if within basic guidelines Will significantly reduce time for service approval in many cases

  31. System Cost Plan Review System will approve plans if: Within budget guidelines No new services requested No reductions in critical services (res hab, behavior, nursing) Routed for area review if (examples): Outside budget guidelines Requesting non-approved services Reductions in critical services Fund request will have own process

  32. What if a personal iBudget can’t meet an individual’s needs? Extraordinary need funding is available if critical health and safety risk Temporary or permanent increase for significantly changed needs that current iBudget can’t accommodate One-time funding is available—durable medical, environmental modifications, nonroutine dental Thorough review of requests for more funding

  33. 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 don’t

  34. Consumer/Family Uses of Online System Draft Cost Plans Submit Cost Plans to their Waiver Support Coordinator Review their iBudget Florida Account Information E-mail their Waiver Support Coordinator

  35. Questions?