6/4/11 iBudget Florida – Family Cafe 2011 11

6/4/11 iBudget Florida - Family Cafe 2011 11

Why Try Something New? Managing APD funding is difficult . . . Which has led to deficits . . . Since APD must stay within the budget the Legislature sets . . . It leads to cost control measures like tiers, rebasing, and prior service authorization . . . Which increases bureaucracy and limits consumer control. 6/4/11 iBudget Florida - Family Cafe 2011 2

Self-Direction Equity Simplicity Sustainability 3

iBudget Florida is the law! 2009 Legislature required a plan for individual budgeting by Feb. 1, 2010 Developed with stakeholder group involving consumers, families, solo providers, agency providers, WSC’s, and advocates Authorized by 2010 Legislature 6/4/11 iBudget Florida - Family Cafe 2011 4

iBudget Florida is the law! Approved by the federal government effective March 15, 2011 2011 Legislature allowed iBudget Florida to continue rather than including APD in managed care —we have 2 years to show it works. 6/4/11 iBudget Florida - Family Cafe 2011 55

2011 Legislative Update CS/HB 7109, section 1: s. 393.0661 (10): “Implementation of Medicaid waiver programs and services authorized under this chapter is limited by the funds appropriated for the individual budgets pursuant to s. 393.0662 and the four-tiered waiver system pursuant to subsection (3).” 6/4/11 iBudget Florida - Family Cafe 2011 6

2011 Legislative Update CS/HB 7109, section 1: s. 393.0661 (10): “ . . . When necessary based on projected deficits, the agency must establish specific corrective action plans that incorporate corrective actions of contracted providers that are sufficient to align program expenditures with annual appropriations . . . 6/4/11 iBudget Florida - Family Cafe 2011 7

2011 Legislative Update CS/HB 7109, section 1: s. 393.0661 (10), cont’d: “If deficits continue during the 2012-2013 fiscal year, the agency in conjunction with the Agency for Health Care Administration shall develop a plan to redesign the waiver program and submit the plan to the President of the Senate and the Speaker of the House of Representatives by September 30, 2013. 6/4/11 iBudget Florida - Family Cafe 2011 8

2011 Legislative Update CS/HB 7109, section 1: s. 393.0661 (10), cont’d: At a minimum, the plan must include the following elements: (a) Budget predictability. Agency budget recommendations must include specific steps to restrict spending to budgeted amounts based on alternatives to the iBudget and four-tiered Medicaid waiver models. . .” 6/4/11 iBudget Florida - Family Cafe 2011 9

2011 Legislative Update FY 2011-12 General Appropriations Act, Specific Appropriation 231: APD “shall provide to the Governor, the President of the Senate, and the Speaker of the House of Representatives monthly surplus-deficit reports projecting the total Medicaid Waiver program expenditures for the fiscal year along with any corrective action plans necessary to align program expenditures with annual appropriations in accordance with sections 393.0661 (7) and (8), Florida Statutes.” 6/4/11 iBudget Florida - Family Cafe 2011 10

2011 Legislative Update FY 2011-12 General Appropriations Act: “Funds in Specific Appropriation 231 reflect a reduction . . . as a result of continuing the Tier Waiver individual cost plan freeze in effect on April 1, 2011, pursuant to s.339.0661(8), F.S., from July 1, 2011, through June 30, 2012; until the agency implements an approved plan that contains expanding costs within the waiver; or until all clients are transferred into the iBudget, whichever comes first.” 6/4/11 iBudget Florida - Family Cafe 2011 11

2011 Legislative Update FY 2011-12 General Appropriations Act: “From the funds in Specific Appropriation 231, the Agency for Persons with Disabilities shall work with the Agency for Health Care Administration and other stakeholders to develop a plan that will result in sufficient fiscal and operational controls to allow the Agency for Persons with Disabilities to manage Medicaid waiver spending within the legislative appropriation . . . The Agency for Persons with Disabilities shall submit the plan to the Governor, the President of the Senate, and the Speaker of the House of Representatives no later than September 1, 2011.” 6/4/11 iBudget Florida - Family Cafe 2011 12

2011 Legislative Update APD must remain within its waiver services appropriation APD will need to use a variety of means—cost plan freezes, rate cuts, etc. The Legislature will be watching how we do 6/4/11 iBudget Florida - Family Cafe 2011 13 13

2011 Legislative Update Everyone will need to work together: APD, Customers, Support Coordinators, and Providers to ensure SUCCESS! 6/4/11 iBudget Florida - Family Cafe 2011 14

2011 Legislative Update The Good News—during a tough budget year: Over 160 Million in NEW funding to address projected deficit About 5 million in NEW funding over last year’s level iBudget Florida is the plan for the future 6/4/11 iBudget Florida - Family Cafe 2011 15

2011 Legislative Update iBudget Florida is one approach to sustainability— Not a “silver bullet”, but a better way to manage the waiver system with: –Flexibility –Choice –Control –Responsiveness 6/4/11 iBudget Florida - Family Cafe 2011 16

iBudget Florida has begun! To begin testing iBudget Florida— Four individuals in the Tallahassee area started May 1, 2011 Next steps: Evaluating and enhancing iBudget Working with stakeholders to plan rollout 6/4/11 iBudget Florida - Family Cafe 2011 17 17

Much Will Stay the Same Day-to-Day. . . Providers Majority of services and rates Waiver Support Coordinators’ important role Area offices Residential options 6/4/11 iBudget Florida - Family Cafe 2011 18

So What’s New? How you plan what services you get What your funding for those services will be 6/4/11 iBudget Florida - Family Cafe 2011 19 19

So What’s New? You will have more choice over what services you get and how much of each you get! Individuals will be preapproved for 6/4/11 types of services (but not quantity, frequency, etc.) Must ensure health & safety iBudget Florida - Family Cafe 2011 20

So What’s New? YOU decide how much to spend on which services within your overall budget You can move funds around to meet changing needs—even funds unspent in previous months 6/4/11 iBudget Florida - Family Cafe 2011 21

So What’s New? Streamlines, or eliminates “PSA” process You can change services quickly in many cases Online system can often review and approve automatically If online system can’t approve, APD staff will review 6/4/11 iBudget Florida - Family Cafe 2011 22 22

So What’s New? New websites to help consumers & WSC’s plan and manage services (optional for consumers) Build cost plans Change cost plans Approve cost plans Track service use 6/4/11 iBudget Florida - Family Cafe 2011 23 23

So What’s New? Equitable budgets while staying within our funding as required by the Legislature Uses new method to decide budget amounts Funding assigned at the beginning of the year Ensures that the total of all budgets isn’t more than agency funding 6/4/11 iBudget Florida - Family Cafe 2011 24

So What’s New? Grouped services into service families Renamed some services Created new services 6/4/11 iBudget Florida - Family Cafe 2011 25

What Services Have Changed? Day Activities renamed: Life Skills Development Services Companion Life Skills Development 6/4/11 Level I Supported Employment Life Skills Development Level II Adult Day Training Life Skills Development iBudget Florida - Family Cafe 2011 26

What Services Have Changed? New Services- for the Future * Person Centered Planning * Family & Legal Representative Training 6/4/11 iBudget Florida - Family Cafe 2011 27

What Services Have Changed? New service—Personal Supports – For adults in family or own home only – Encompasses: In-Home Supports Respite Personal Care, and Companion – 6/4/11 One worker can do a variety of things for you iBudget Florida - Family Cafe 2011 28

What Services Have Changed? Respite remains a distinct services-children in family home only Adults in residential facilities can receive companion through Life Skills Development—Level II (Companion) service 6/4/11 iBudget Florida - Family Cafe 2011 29

What Services Have Changed? Support Coordination has three levels: –Limited –Full –Enhanced (similar to current transitional) You can choose your level in many cases! 6/4/11 iBudget Florida - Family Cafe 2011 30

What Else is Good to Know? Individual funding may be different than now – We must stay within total amount allocated by the Legislature 6/4/11 iBudget Florida - Family Cafe 2011 31 31

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 6/4/11 iBudget Florida - Family Cafe 2011 32

What About the Tier System? Upon implementation of the iBudget Florida waiver, the Tier System will be phased out There is no more rebasing Each person will have their own individual budget 6/4/11 iBudget Florida - Family Cafe 2011 33 33

An Example 6/4/11 iBudget Florida - Family Cafe 2011 34

Mariella’s Story Age: 27 Lives with Family at Home Assigned to Tier 3 Current Services: ADT, Companion, Behavior analysis, Transportation and Respite Full Support Coordination 6/4/11 iBudget Florida - Family Cafe 2011 35

Meeting with WSC and Mariella Waiver Support Coordinator reviews preapproved services and budget amount Pre-approved services: Life Skills Development Personal Supports Waiver Support Coord. Transportation Person Centered Planning Adult Dental Family & Legal Rep Training Behavior Analysis 6/4/11 iBudget Florida - Family Cafe 2011 36

Making Decisions Will Mariella and her representative use the iBudget Florida consumer website? Apply for Other Services? üYes – Behavior Assistant Services How Should Mariella Use her Funds? üSame services Behavior Assistant WSC Inputs Cost Plan into iBudget Florida Online System 6/4/11 iBudget Florida - Family Cafe 2011 37

First iBudget Plan First plan must be Reviewed and Approved by “Live” Person Proposed Cost Plan: Mariella meets handbook requirements for Behavior Assistant Services Has enough funding in her budget Plan addresses her health and safety It is Approved! 6/4/11 iBudget Florida - Family Cafe 2011 38

Service Authorizations & Service Tracking § Service authorizations are automatically generated § Mariella’s providers are notified by email § Her providers proceed with services § Her providers submit service logs Service Logs and Paid Claims Information are viewed by WSC & Mariella to help manage budget 6/4/11 iBudget Florida - Family Cafe 2011 39

Mariella Receives Services 6/4/11 iBudget Florida - Family Cafe 2011 40

Managing Services & Needs 6/4/11 iBudget Florida - Family Cafe 2011 41

Questions? 6/4/11 iBudget Florida - Family Cafe 2011 42 42

Thank you! For more information go to: www.ibudgetflorida.org 6/4/11 iBudget Florida - Family Cafe 2011 43 43