draft for purposes of discussion with ibudget florida stakeholders’ group 1 9/14/10 ibudget...

Draft for purposes of discussion with iBudget Florida Stakeholders’ Group 1

9/14/10

iBudget FloridaStakeholders’ Meeting

September 14, 2010


9/14/10

Public Comment

Email: [email protected]


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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

• Consumers have lots of flexibility for spending up to individual iBudget maximum amount

• Requests for additional funding require thorough review

iBudget Paradigm


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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.


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• 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


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• 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


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Funding DeterminationDifferent 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


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Funding DeterminationDuring 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


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Funding Assumptions

Standard iBudgets

Exceptional Need

Temporary/PermanentIncreasesOne-time Expenditures


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Funding Scenarios

Basic ScenarioLarger number qualifying for

supplemental funding

Funds available for

general waiver

population


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Funding Determination• Supplemental Funding

– Basic question: Do we seek to maximize funding for consumers’ basic budgets, or have more generous supplemental funding policies?• Discussion?


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– 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


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–3. Cannot adjust budget to meet needs

–4. Qualify for specific waiver services requested to meet needs


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–5. Need for funds is not due to budget mismanagement


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–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


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– 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.


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– 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)


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– 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


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– 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


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– 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


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– 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


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– 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


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– Eligibility criteria for receiving extraordinary need supplemental funding:• How to specifically define these?• Additional criteria?


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– Eligibility criteria for receiving permanent change in need funding IN iBUDGET FLORIDA PLAN• Change in algorithm during the fiscal

year


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– 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 . . .


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– 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


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– 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


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– 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


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– 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?


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– 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


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– 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


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– 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.


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– 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


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– Eligibility criteria for receiving temporary change in need funding:• Discussion:

–How to specifically define criteria in law?

–Additional criteria and how to define them?


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– 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.


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– 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


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– Eligibility criteria for receiving one-time purchase need funding:• How to specifically define these?• Additional criteria?


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– 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?


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• 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. :


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• 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.)


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– 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?


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– 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?


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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?:


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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?:


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– 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


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– 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?


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Phase-InGeneral approach:

• Limited implementation to test and refine processes and enhance algorithm, then--• Gradual phase-in:

--By area--Of budget amounts


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Phase-InOptions for phase-in of iBudget

amounts:– A: Base on most recent cost plan– B: Base on expenditures


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Phase-InOptions 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


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Phase-InOptions 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


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Phase-InTimeframe:

– See handout


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Public Comment

Email: [email protected]


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Thank you!

draft for purposes of discussion with ibudget florida stakeholders’ group 1 9/14/10 ibudget...

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